Beyond Fertility: Ethical and Psychosocial Dimensions of Fertility Preservation in Children and Adolescents.

This narrative review examines fertility preservation in children and adolescents receiving gonadotoxic treatment for cancer and serious non-malignant conditions, including chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. It considers the impact of these therapies on future reproductive potential and summarizes current fertility preservation strategies according to sex and pubertal status. Established options for postpubertal adolescents are discussed alongside gonadal tissue cryopreservation approaches for prepubertal children and emerging experimental strategies, including insights from animal studies and the uncertainties surrounding the future clinical use of preserved tissue. Particular attention is given to the ethical complexities of fertility preservation in childhood, including informed consent, assent, parental decision-making, evolving autonomy, and procedures with uncertain future benefit. The psychological impact on children, adolescents, and their families is also considered, together with the role of multidisciplinary teams in providing timely, equitable, developmentally appropriate counseling and ongoing psychosocial support. The review concludes that fertility preservation should be regarded not as a single decision made before gonadotoxic treatment, but as a longitudinal process extending from diagnosis through survivorship and into adulthood.