Expanding Horizons in Fertility Preservation: Diverse Populations, Emerging Indications, and Ethical Considerations

Fertility preservation has traditionally centered on intervention before gonadotoxic cancer treatment, yet many patients do not fit this conventional pathway. Reproductive risk may arise before puberty, result from a genetic predisposition to primary ovarian insufficiency, intersect with gender-affirming care, or be recognized only after gonadotoxic exposure. This Views and Reviews series examines fertility preservation in transgender and gender-diverse patients, girls before and during puberty, patients with genetic conditions associated with primary ovarian insufficiency, and individuals seeking preservation after chemotherapy or radiation. Across these settings, evidence is frequently limited, the optimal timing of intervention may be uncertain, and technical feasibility does not necessarily predict future reproductive benefit. The series considers clinical strategies and outcomes alongside access, procedural burden, autonomy, psychosocial effects, and long-term safety, providing a framework for individualized counseling as fertility-preservation indications continue to evolve.