The American Society of Clinical Oncology (ASCO) has released updated guidelines to guide fertility preservation for people with cancer, with the previous update published in 2018.
The 2025 update reflects substantial growth in the evidence base, with 166 studies incorporated compared with just 61 studies in the 2018 guidelines. According to the authors, this expanded evidence has allowed for more detailed recommendations and has broadened the scope to address the needs of diverse patient populations.
What Are the Most Significant Changes?
The 2025 guidelines maintain the recommendation of the 2018 guidelines that healthcare providers should discuss fertility preservation with all reproductive-age patients as early as possible before cancer treatment begins. However, the updated recommendations also include posttreatment fertility discussions. The guidelines now recommend yearly fertility discussions after treatment, when cancer treatments change, or when pregnancy is being considered.
“This is because cancer survivors’ family-building decisions change over time, and they do not always remember the initial counseling; posttreatment counseling can reduce distress and improve quality of life, even if the patient does not undergo fertility preservation per se,” Su reasoned.
She added that now, there are more data to inform infertility risk stratification, and patients at high risk can seriously consider fertility preservation to expand their family-building options, whereas patients at low risk do not need to undergo additional procedures before cancer treatments.
In addition to posttreatment fertility discussions, the updated guidelines also recommend offering oocyte and embryo freezing for fertility preservation posttreatment to individuals who are at risk for primary ovarian insufficiency but still have a viable ovarian reserve. Recommendations for posttreatment fertility preservation were not included in the 2018 guidelines. Su acknowledged, however, that the timing of attempting posttreatment fertility preservation is still unclear, “with some data suggesting an optimal number of oocytes 2-3 years after the end of treatment.”
What About Ovarian Suppression?
The 2025 ASCO guidelines provide detailed recommendations regarding the use of gonadotropin-releasing hormone agonists (GnRHa).
Although the 2018 guideline noted “conflicting evidence” for the use of GnRHa and other means of ovarian suppression for fertility preservation, the 2025 update maintains that GnRHa should not be used in place of established fertility preservation methods, such as oocyte, embryo, or ovarian tissue cryopreservation but may be offered as an adjunct to patients with breast cancer.
Additionally, the 2025 guidelines introduced a new recommendation that GnRHa may be offered for menstrual suppression in patients with oncologic emergencies requiring urgent chemotherapy, something that was not addressed in the 2018 guidelines.
Ref: www.medscape.com
