Fertility preservation in women with central nervous system tumors

Fertility preservation is an increasingly important component of survivorship care for adolescent and young adult (AYA) women with central nervous system (CNS) tumors. As survival improves, attention to long-term reproductive health is increasingly needed.

This narrative review examines how CNS tumors and their treatments may impair fertility, including hypothalamic-pituitary dysfunction, spinal irradiation, and chemotherapy-induced ovarian toxicity, particularly from alkylating agents. Established fertility preservation strategies, including oocyte and embryo cryopreservation, and emerging approaches are discussed, together with the limited evidence on the reproductive effects of newer neuro-oncology therapies and the management of pregnancy after CNS tumor diagnosis. A PubMed search of literature published up to March 2026 was performed, including prospective and retrospective studies, systematic reviews, meta-analyses, clinical guidelines, and relevant case reports addressing fertility preservation and pregnancy in women with CNS tumors.

Early oncofertility counseling and individualized fertility risk assessment should be integrated into routine neuro-oncology care before potentially gonadotoxic treatments. Multidisciplinary management and long-term reproductive follow-up are essential to support informed reproductive decisions, while prospective studies are needed to clarify the reproductive effects of newer therapies and the impact of pregnancy on CNS tumor behavior.