The advances in cancer therapy over the past two decades have led to remarkable improvements in survival rates, but treatments such as chemotherapy, radiotherapy and/or surgery may induce premature ovarian insufficiency (POI). Fertility preservation (FP) is therefore a key challenge for these women.

At diagnosis, all women affected by cancer should benefit from an informed consultation on the threat of compromising their fertility with planned cancer treatment. In case of total body irradiation, pelvic irradiation, bone marrow transplantation and aggressive chemotherapy with high dose of alkylating agents, the risk is considered to be very high. However, only a small fraction of patients are actually referred to specialists to discuss FP prior to cancer treatments. The decision-making process is especially problematic since the long-term effects of cancer treatment have not been fully elucidated. The prevalence of subfertility is nevertheless known to be increased, even when ovarian function is maintained. The main issue is that health care workers are unfamiliar with the rapid advances taking place in FP research and their implementation in clinical practice. Selection criteria need to be available not only to endocrinologists and gynecologists in reproductive medicine, but also pediatricians and oncologists.