Fertility Preservation in People With Cancer: ASCO Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO Fertility Preservation 2025
- Design
- Clinical practice guideline update based on a systematic review, by a multidisciplinary expert panel
- Sample size
- 166 studies (evidence base)
- Source
- JCO · 2025
In plain words
Cancer treatments can affect your ability to have children. It is best to talk with your care team about protecting fertility before treatment starts and, if you are interested or unsure, to be referred to a fertility specialist. Methods such as freezing sperm, eggs, embryos or ovarian tissue are available for different people, and the choice depends on age, sex and the circumstances of the illness.
Key points
Key guideline recommendations
People with cancer should be evaluated and counselled about fertility risks at diagnosis and during survivorship.
Patients interested in, or uncertain about, fertility preservation should be referred to reproductive specialists. Fertility preservation methods should be discussed before gonadotoxic cancer treatments.
Sperm cryopreservation should be offered to men before cancer treatment; if they are unable to provide a semen sample, testicular sperm extraction should be used.
Testicular tissue cryopreservation in prepubertal boys is experimental and should be offered only within a clinical trial.
Men should be advised of a potentially higher risk of genetic damage in sperm collected shortly after starting and after completing cancer treatment.
Women should be offered established fertility preservation methods, including embryo, oocyte and ovarian tissue cryopreservation (OTC), ovarian transposition and conservative gynaecological surgery.
In vitro maturation of oocytes may be offered as an emerging method.
Post-treatment fertility preservation may be offered to people who did not undergo fertility preservation before treatment or who did not cryopreserve enough oocytes or embryos.
GnRHa should not be used in place of established fertility preservation methods but may be offered as an adjunct to women with breast cancer.
For patients with oncological emergencies requiring urgent cancer treatment, GnRHa may be offered for menstrual suppression.
Established fertility preservation methods in children who have entered puberty should be offered with patient assent and parent/legal guardian consent. The only established method for prepubertal girls is OTC.
Oncology teams should ensure timely access to a multidisciplinary fertility preservation team. Clinicians should advocate for comprehensive coverage of fertility preservation services and help patients obtain insurance benefits.
Study population
People with cancer (including men, women, prepubertal children and children who have entered puberty) at risk of impaired fertility due to the disease or its treatment.
Endpoints
This document is a clinical practice guideline and has no trial endpoint. Its aim is to give updated recommendations on fertility preservation (FP) in people with cancer.
Safety and side effects
The abstract gives no information on adverse events. The only safety point mentioned is that men should be advised of a potentially higher risk of genetic damage in sperm collected shortly after starting and after completing cancer treatment.
Clinical significance and place in guidelines
This guideline recommends assessment and counselling on fertility risks at diagnosis and during survivorship, with fertility preservation options raised before cancer treatment. It also stresses that GnRHa does not replace established fertility preservation methods and may be offered only as an adjunct in women with breast cancer. Oncology teams should provide timely access to a multidisciplinary fertility preservation team. Adoption of this guideline in other guidelines should be checked separately.
Limitations
The abstract does not report the level of evidence or strength of the recommendations; see the full guideline for these details. Two errata have been published for this paper (J Clin Oncol 2025;43(15):1847 and 2025;43(22):2553) and should be checked when using the text.
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.