Sept. 26, 2026
Fertility preservation has become an essential component of comprehensive cancer care, particularly as more patients are diagnosed and successfully treated during their reproductive years. Early discussions and timely referrals are critical to ensuring patients understand and take advantage of the options available.
"Any patient of reproductive age facing a diagnosis or treatment that could impair fertility should have a discussion with their physician about fertility preservation," says Carrie L. Langstraat, M.D., a gynecologic oncologist at Mayo Clinic in Rochester, Minnesota. "The emerging field of oncofertility enables our multidisciplinary team to cohesively manage fertility options for patients with cancer."
To preserve reproductive potential without compromising the outcomes of cancer treatments, Mayo Clinic's oncofertility efforts are managed by a multidisciplinary team including experts in areas such as reproductive endocrinology and infertility (REI), oncology, surgery, and genetics.
When a patient receives a cancer diagnosis, the urgency of treatment and survival has the potential to overshadow future fertility considerations. The American Society of Clinical Oncology released updated clinical practice guidelines in 2025 recognizing the advances in cancer survivorship and fertility preservation options. The society formally recommended fertility preservation as an integral piece of a comprehensive treatment plan. As with many aspects of cancer care, timing can be crucial.
"Oncofertility often operates under specific timelines," says Ali J. Ainsworth, M.D., a reproductive endocrinologist and infertility specialist at Mayo Clinic in Rochester, Minnesota. "Patients might need fertility preservation services within days of diagnosis while also preparing to begin chemotherapy, radiation or surgery. Our team can help provide subspecialty guidance, comprehensive coordination and reassurance that every viable option is being considered."
This coordinated approach is particularly important because fertility-preserving strategies are highly individualized and can vary significantly based on diagnosis, age, treatment plans, and timing of therapeutic or surgical needs. Mayo Clinic's Fertility Preservation Program works in close collaboration with oncology colleagues to provide timely and coordinated care. This allows for completion of fertility preservation without significant delays in cancer treatment.
The most commonly used fertility preservation techniques include oocyte cryopreservation and embryo cryopreservation. Before treatment, patients undergo an assessment of ovarian reserve using antimullerian hormone (AMH) testing and pelvic ultrasound evaluation. Controlled ovarian stimulation followed by egg retrieval may often be completed within a few weeks.
For patients who cannot delay cancer treatment, alternative options may be available. "Ovarian tissue cryopreservation involves surgically removing and freezing ovarian tissue for future reimplantation," Dr. Ainsworth says. "The approach is particularly valuable for pediatric patients who have not yet reached puberty and therefore cannot undergo egg retrieval and cryopreservation."
Ovarian transposition, also referred to as oophoropexy, can help preserve ovarian function for patients requiring pelvic radiation by surgically relocating the ovaries outside the radiation field prior to treatment.
While oophoropexy leaves the possibility of retrieving eggs for in vitro fertilization, its protection is limited to the ovaries. Uterine transposition, pioneered in Brazil, is an emerging procedure that moves the patient's uterus, cervix, fallopian tubes and ovaries high into the upper abdomen. "We're currently coordinating with our colleagues in gastroenterology, radiology and oncology to begin offering uterine transposition soon," Dr. Langstraat says.
Mayo Clinic's reproductive endocrinology and infertility program also is leading efforts to streamline care for patients with endometrial cancer. "Essentially, we're further integrating care for patients who are diagnosed with early-stage, low-grade endometrial cancer who want to preserve their fertility," says Shariska Harrington, M.D., a gynecologic oncologist at Mayo Clinic in Rochester, Minnesota.
"This particular type of endometrial cancer is driven by estrogen," Dr. Harrington says. "Because excess estrogen can also be associated with comorbidities, we're more cognizant of streamlining appointments with our weight management team, genetic counseling and the reproductive endocrinology team at diagnosis. These efforts help ensure a smooth transition through each stage of a patient's treatment plan."
Emerging evidence shows that combining two treatment modalities — progesterone treatment and hysteroscopic resection — can improve outcomes for patients with endometrial cancer. "Studies show that response rates exceed 90% when both approaches are combined, compared with about 60% to 70% for blind D&C with hormonal therapy alone," Dr. Harrington says.
As cancer survival rates continue to improve overall, considerations for quality of life after cancer treatment are crucial. "Future family building is often a major part of that conversation," Dr. Langstraat says. "Even when fertility preservation might not be feasible, studies suggest that patients experience less regret when the options are discussed proactively. Ultimately, having these conversations earlier can help ensure a comprehensive evaluation of the options available."
For more information
Refer a patient to Mayo Clinic.