Fertility in breast cancer survivorship: a scoping review

To summarize current evidence on fertility issues in breast cancer survivors, including gonadotoxic potential of cancer-directed therapies, available fertility preservation options, counseling practices, post-treatment pregnancy outcomes, and future research needs. This review aims to guide clinical practice and to highlight current gaps in oncofertility care.

A critical review of recent literature was conducted, consolidating data from clinical trials, cohort studies, guidelines, and expert consensus. Key themes in oncofertility care for breast cancer survivors were mapped through the breadth of literature, including therapy-associated gonadotoxicity, fertility preservation strategies, multidisciplinary care models, and post-treatment reproductive outcomes.

Breast cancer-directed therapies (chemotherapy, long-term endocrine therapy, targeted therapies) can adversely impact fertility via delaying reproductive timelines and direct gonadotoxicity. Oocyte and embryo cryopreservation are first-line methods for fertility preservation; other options include ovarian tissue cryopreservation and ovarian suppression with gonadotropin-releasing hormone (GnRH) agonist administration. Pregnancy after stage 0-3 breast cancer is considered safe, with no evidence of increased recurrence or mortality risk even among those with hormonally sensitive cancers. Fertility counseling and ovarian toxicity assessment remain inconsistently implemented in clinical trials. In addition, barriers to fertility care disproportionately affect historically excluded populations.

Oncofertility is a crucial element of survivorship care for reproductive-aged patients with breast cancer. Cancer-directed therapies can significantly impair the likelihood of future fertility. Early, structured fertility counseling, multidisciplinary care team collaboration including reproductive endocrinology, and incorporation of timely fertility preservation interventions are vital to maintain fertility potential without harming oncologic outcomes. Major gaps remain in counseling practices and equitable access to fertility preservation.

Enhanced access to fertility preservation, individualized reproductive planning, and multidisciplinary care teams can improve quality of life and support informed decision-making regarding future childbearing in breast cancer survivors.