Annals of translational medicine · 2026
Fertility preservation in young women with breast cancer: a narrative review of effectiveness, oncologic safety, and clinical practice implications.
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Arruda Cerqueira Renata, Steffens Daniel, Rosa Maria Eduarda Alves Pimenta, Vieira Carvalho Ariane, Drummond-Lage Ana Paula
Аннотация
BACKGROUND AND OBJECTIVE: Breast cancer is the most frequently diagnosed malignancy among women of reproductive age, and advances in cancer survival have increased the relevance of fertility preservation (FP) as a component of comprehensive oncologic care. Concerns regarding treatment-related gonadotoxicity, potential delays in chemotherapy initiation, and long-term oncologic safety continue to influence clinical decision-making. This narrative review of systematic reviews aimed to synthesize contemporary evidence on FP methods in young women with breast cancer, focusing on effectiveness, timing, and oncologic safety.
METHODS: A structured narrative review of systematic reviews and meta-analyses was conducted using PubMed/MEDLINE and Web of Science from database inception through December 2025. Eligible articles were English-language systematic reviews evaluating FP strategies in premenopausal or perimenopausal women with breast cancer and reporting reproductive and/or oncologic outcomes. Data were extracted using a predefined framework, and findings were integrated through qualitative synthesis.
KEY CONTENT AND FINDINGS: Sixteen systematic reviews were included. FP strategies evaluated included temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy, controlled ovarian stimulation (COS) with oocyte or embryo cryopreservation, and alternative approaches such as ovarian tissue cryopreservation (OTC) and in vitro maturation (IVM). COS followed by embryo cryopreservation demonstrated the highest rates of clinical pregnancy and live birth. GnRHa use was consistently associated with improved ovarian function recovery, reduced premature ovarian insufficiency, and increased post-treatment pregnancy rates. Across studies, FP interventions were not associated with increased risks of disease recurrence or compromised survival outcomes.
CONCLUSIONS: Current evidence supports the effectiveness and oncologic safety of established FP preservation strategies in young women with breast cancer. Importantly, the integration of structured oncofertility pathways into routine oncology practice requires early referral systems, multidisciplinary coordination, and individualized risk assessment. Translating these findings into practice is essential to ensure equitable access to FP within comprehensive cancer care.
METHODS: A structured narrative review of systematic reviews and meta-analyses was conducted using PubMed/MEDLINE and Web of Science from database inception through December 2025. Eligible articles were English-language systematic reviews evaluating FP strategies in premenopausal or perimenopausal women with breast cancer and reporting reproductive and/or oncologic outcomes. Data were extracted using a predefined framework, and findings were integrated through qualitative synthesis.
KEY CONTENT AND FINDINGS: Sixteen systematic reviews were included. FP strategies evaluated included temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy, controlled ovarian stimulation (COS) with oocyte or embryo cryopreservation, and alternative approaches such as ovarian tissue cryopreservation (OTC) and in vitro maturation (IVM). COS followed by embryo cryopreservation demonstrated the highest rates of clinical pregnancy and live birth. GnRHa use was consistently associated with improved ovarian function recovery, reduced premature ovarian insufficiency, and increased post-treatment pregnancy rates. Across studies, FP interventions were not associated with increased risks of disease recurrence or compromised survival outcomes.
CONCLUSIONS: Current evidence supports the effectiveness and oncologic safety of established FP preservation strategies in young women with breast cancer. Importantly, the integration of structured oncofertility pathways into routine oncology practice requires early referral systems, multidisciplinary coordination, and individualized risk assessment. Translating these findings into practice is essential to ensure equitable access to FP within comprehensive cancer care.