Infertility evaluation and treatment in cancer survivors

As survival rates for cancer continue to rise, growing attention is being directed toward the reproductive health of female cancer survivors. This review outlines the unique considerations in evaluating and treating infertility in this population. Cancer survivors face an elevated risk of infertility relating to treatment-induced hypothalamic-pituitary dysfunction, loss of ovarian function, or non-functional or surgically absent reproductive anatomy. A comprehensive, individualized infertility evaluation is essential and should incorporate a multidisciplinary approach involving infertility specialists, oncologists, high-risk obstetricians, genetic specialists, and mental health care providers. Risk-based assessment tools may offer insight into ovarian function and may help guide fertility treatment timing. Fertility treatment options for survivors include both standard and modified ovarian stimulation protocols. The use of preimplantation genetic testing for monogenic disease, donor gametes or embryos, and gestational carriers may also be necessary. Although outcomes data remain limited, early evidence suggests that clinical pregnancy and live birth rates in this population can be favorable, particularly with personalized treatment strategies. Increased prospective research is critical to optimizing fertility care and informing evidence-based counseling for this growing population.