FERTILITY PRESERVATION AFTER GONADOTOXIC TREATMENT: CURRENT EVIDENCE, FEASIBILITY, AND OUTCOMES

Improved cancer survival has made reproductive health an essential component of survivorship care. Although fertility preservation has traditionally focused on interventions before gonadotoxic therapy, many survivors received no pretreatment intervention, stored insufficient reproductive material, or later require additional gonadotoxic therapy. Evidence guiding fertility preservation after exposure remains limited and heterogeneous. This review examines treatment-induced ovarian injury, assessment of residual reproductive potential, candidate selection and timing, available fertility-preservation strategies, reproductive outcomes, safety, and emerging restorative technologies. Previous gonadotoxic therapy should not be considered an absolute barrier to intervention. Management should instead integrate age, pretreatment and current ovarian reserve, treatment type and cumulative exposure, disease status, anticipated further therapy, and reproductive goals. Oocyte or embryo cryopreservation is generally preferred for postpubertal survivors with recruitable follicles, whereas ovarian tissue cryopreservation may be considered selectively. As the fertility preservation field continues to evolve, individualized prediction of residual reproductive potential and the development of safe fertility-restoring strategies are expected to redefine reproductive care for cancer survivors who present after gonadotoxic treatment.