[Fertility preservation in hematopoietic cell transplantation: focusing on female patients]

Advancements in hematopoietic cell transplantation (HCT) have enabled long-term survival for young patients with hematologic disorders. However, addressing infertility caused by gonadal dysfunction remains a significant challenge. Since myeloablative conditioning regimens often destroy gonadal function completely, collaborating with reproductive medicine specialists from the pre-treatment stage is essential to determine the appropriate timing for fertility preservation. Domestic and international guidelines on fertility preservation have recently been updated, and measures for fertility preservation in patients undergoing high-risk treatments, including HCT, are currently being developed. However, cases of successful pregnancy and childbirth using assisted reproductive technology after HCT remain rare. This article offers an overview of gonadal toxicity related to HCT, the indications and limitations of fertility preservation methods, the effectiveness of ovarian shielding, and the safety and risks of pregnancy and childbirth following HCT. It also outlines practical approaches for achieving pregnancy and childbirth in HCT patients in clinical practice.