Fertility Preservation for Reproductive-aged Women with Breast Cancer: A Contemporary Review

Abstract

Breast cancer is the most common malignancy in reproductive-age women, and its incidence is rising fastest in those under 50 as early-stage survival exceeds 90%. This review synthesizes current evidence on fertility preservation in breast cancer, focusing on the safety, efficacy, and available options. Early referral for fertility preservation does not meaningfully delay treatment, and ovarian stimulation and assisted reproduction appear oncologically safe, including in hormone receptor–positive disease. Oocyte and embryo cryopreservation remain a mainstay technique, refined by random-start and double-stimulation protocols, while ovarian tissue cryopreservation and GnRH-agonist co-treatment can further extend options. Aromatase inhibitor-based stimulation limits estrogen exposure without reducing yield, and the POSITIVE trial showed that interrupting endocrine therapy to conceive does not compromise short-term outcomes. For hereditary carriers, preimplantation genetic testing reduces variant transmission. Fertility preservation is a safe, effective, central component of breast cancer care in reproductive aged patients who desire the option for biological offspring in the future. The principal remaining barriers are structural, including cost, coverage, and access disparities.