ESHRE guideline: female fertility preservation

Area of Science:

• Reproductive Medicine and Endocrinology
• Oncology Supportive Care
• Gender-Affirming Care

Background:

• The field of fertility preservation (FP) has expanded significantly due to increased recognition of fertility loss as a side effect of cancer treatments and advancements in oocyte vitrification and ovarian tissue cryopreservation (OTC).
• Provision of FP services for young women has become more widespread, though access remains uneven.

Purpose of the Study:

• To provide recommended management for fertility preservation in women and transgender men based on the best available scientific literature.
• To offer clear advice on best practices in female FP, addressing a growing demand from diverse patient populations.

Main Methods:

• Development of the guideline followed a structured methodology by the European Society of Human Reproduction and Embryology (ESHRE).
• Key questions were formulated by experts, followed by comprehensive literature searches and assessments of papers published up to November 1, 2019.
• Recommendations were formulated through expert consensus and underwent a stakeholder review before final approval.

Main Results:

• The guideline presents 78 recommendations covering organization of care, information provision, pre-FP assessment, FP interventions, and after-treatment care.
• Includes 50 evidence-based recommendations (31 strong, 19 weak), 25 good practice points, and 3 research-only recommendations.
• Addresses FP needs for patients undergoing gonadotoxic treatments (cancer, benign diseases), those with genetic conditions, transgender men, and women seeking oocyte cryopreservation for age-related loss.

Conclusions:

• The guideline offers clinicians evidence-based advice on female FP, acknowledging that many interventions require further study, particularly regarding pregnancy outcomes.
• Highlights the need for more research in FP, especially for techniques like OTC and in vitro maturation (IVM), to refine current recommendations.
• Provides a list of research recommendations to stimulate further investigation in the field of female fertility preservation.