Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update
A newer version of this guideline has been published: Fertility Preservation in People With Cancer: ASCO Guideline Update (2025)
- Study type
- Clinical guideline
- Study name
- ASCO Fertility Preservation 2018
- Design
- Clinical practice guideline update based on a systematic review of the literature (PubMed and the Cochrane Library, January 2013 to March 2017) and review by the update panel
- Sample size
- 61 publications identified and reviewed
- Source
- JCO · 2018
In plain words
If you are of an age to have children, or your child has cancer, it is best for the doctor to talk with you at the very start of treatment about the risk of infertility and the ways to protect fertility. Freezing sperm, eggs and embryos are standard methods and widely available. In young women with breast cancer, when proven methods are not possible, medicines called GnRHa may be offered, but these medicines do not replace the proven methods.
Key points
Key guideline recommendations
- Not stated in the abstract
Health care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years, or with parents/guardians of children, as early as possible.
- Not stated in the abstract
Providers should be prepared to discuss fertility preservation options and/or refer all potential patients to appropriate reproductive specialists.
- Not stated in the abstract
Potential threats to fertility should be communicated to the patient as early as possible in the treatment process to allow the widest array of fertility preservation options. This discussion should be documented.
- Not stated in the abstract
Sperm, oocyte and embryo cryopreservation are considered standard practice and are widely available.
- Not stated in the abstract
There is conflicting evidence to recommend GnRHa and other means of ovarian suppression for fertility preservation. When proven fertility preservation methods are not feasible, and in young women with breast cancer, GnRHa may be offered in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. GnRHa should not be used in place of proven fertility preservation methods.
- Not stated in the abstract
The field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future.
Study population
Adults and children with cancer; patients treated during their reproductive years, or parents/guardians of affected children.
Endpoints
This document is a guideline and has no trial endpoint. Its aim is to give updated recommendations on fertility preservation in adults and children with cancer.
Safety and side effects
No safety data are given in the abstract.
Clinical significance and place in guidelines
This update found that new evidence published between 2013 and 2017 did not substantially change the 2013 recommendations. Its practical emphasis is on early discussion and documentation of the fertility conversation, referral to a fertility specialist, and the standard status of sperm, oocyte and embryo cryopreservation. The current status of this guideline and newer versions should be checked.
Limitations
According to the abstract, evidence on GnRHa and other methods of ovarian suppression for fertility preservation is conflicting. The level of evidence and strength of the recommendations are not given in the abstract and should be checked in the full guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.