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Should Fertility Preservation Be Offered to Young Women with Melanoma Receiving Immune Checkpoint Inhibitors? A SWOT

Diego Raimondo1, Michele Miscia1,2, Antonio Raffone2,3

  • 1Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy.

Current Oncology (Toronto, Ont.)
|December 24, 2025
PubMed

Insights

Fertility preservation counseling is recommended before immune checkpoint inhibitor (ICI) therapy for melanoma. While ICIs improve survival, their impact on ovarian function requires further study, necessitating proactive fertility discussions.

Area of Science:

  • Oncology
  • Reproductive Immunology
  • Melanoma Therapeutics

Background:

  • Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in melanoma treatment.
  • Improved survival rates raise concerns about long-term survivorship, including fertility in young women.
  • The reproductive safety of ICIs is not well-characterized.

Purpose of the Study:

  • To evaluate the rationale for fertility preservation (FP) before ICI therapy using a SWOT analysis.
  • To synthesize preclinical and clinical evidence regarding ICI effects on reproductive health.
  • To inform clinical practice regarding fertility concerns in premenopausal women undergoing ICI treatment.

Main Methods:

  • Conducted a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.
  • Synthesized preclinical data from animal models of PD-1/CTLA-4 blockade.
  • Reviewed limited human correlative studies on ovarian reserve markers.

Main Results:

  • Preclinical models show ovarian immune activation, cytokine release (e.g., TNF-α), and follicular loss with PD-1/CTLA-4 blockade.
  • Human data are limited, with some analyses suggesting potential declines in ovarian reserve.
  • Evidence suggests a potential risk to ovarian function, though not definitively quantified.

Conclusions:

  • Prospective studies are needed to precisely determine the risks of ICIs to fertility.
  • Proactive fertility preservation counseling should be standard before initiating ICI therapy.
  • Balancing oncologic safety with reproductive autonomy is crucial for young women with melanoma.
Keywords:
adolescents and young adults (AYA)controlled ovarian stimulation (COS)fertility preservationimmune checkpoint inhibitorsimmunotherapymelanomaoncofertilityovarian reserveovarian tissue cryopreservation (OTC)pregnancy

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