Fertility preservation and subsequent reproductive outcomes in female pediatric patients with hematologic malignancies.

Improved survival of pediatric and adolescent patients with hematologic malignancies has shifted attention toward long-term quality-of-life outcomes, including fertility. Female survivors of leukemia and lymphoma are at high risk of gonadal and uterine damage due to exposure to alkylating agents, radiotherapy, and hematopoietic stem cell transplantation, resulting in premature ovarian insufficiency, diminished ovarian reserve, and adverse pregnancy outcomes. Concurrently, fertility preservation strategies have evolved, expanding options for both prepubertal and postpubertal patients. This narrative review summarizes the impact of contemporary hematologic treatments on female reproductive function and critically appraises current fertility preservation approaches, including oocyte cryopreservation, ovarian tissue cryopreservation, ovarian transposition, and pharmacologic ovarian suppression. We also review evidence on spontaneous fertility and pregnancy outcomes in survivors and discuss the specific challenges associated with hematologic malignancies, such as treatment urgency and the risk of malignant cell reintroduction following ovarian tissue transplantation. Finally, emerging strategies, including artificial ovary construction and in vitro follicle growth, are briefly addressed. Integrating early, multidisciplinary oncofertility counseling into standard care is essential to optimize reproductive outcomes and ensure equitable access to fertility preservation for young cancer survivors.