Comparison of Fertility-Related Recommendations Across National Comprehensive Cancer Network, ASCO, Clinical Oncology Society of Australia, and European Society for Medical Oncology Guidelines for People With Cancer Comparing Fertility Recommendations for People With Cancer

PURPOSE: Oncofertility, a multidisciplinary field that integrates oncology and reproductive medicine, is a vital component of comprehensive cancer care. This review compares fertility-related recommendations for adults with newly diagnosed cancer who are considering fertility preservation (FP) before treatment. Guidelines reviewed include the 2025 National Comprehensive Cancer Network (NCCN) Survivorship Guideline, 2025 ASCO Guideline on FP, 2022 Clinical Oncology Society of Australia (COSA) FP Guideline, and 2020 European Society for Medical Oncology (ESMO) Clinical Practice Guideline. METHODS: Recent guidelines from NCCN, ASCO, COSA, and ESMO were reviewed and compared for recommendations on fertility risk discussions, female and male preservation methods, multidisciplinary care, future pregnancy, and contraception. RESULTS: All guidelines emphasize early, patient-centered discussions about fertility risks and preservation options before initiating cancer treatment. Embryo and oocyte cryopreservation are universally recommended as standard and effective FP methods for women. Ovarian tissue cryopreservation and ovarian transposition are recommended as alternative options. Sperm cryopreservation is strongly recommended, with ASCO and NCCN additionally supporting testicular sperm extraction for post-treatment FP. The use of gonadotropin-releasing hormone agonists is supported by COSA, ESMO, and NCCN in people with breast cancer at diagnosis, while ASCO limits its recommendation to adjunct use alongside established FP techniques. All guidelines highlight the importance of multidisciplinary care, including specialized oncofertility counseling and referrals to fertility and mental health specialists. Pregnancy after cancer treatment is generally considered safe across all guidelines, and only COSA and ESMO provide specific recommendations regarding contraception. CONCLUSION: There is a strong consensus on FP methods and the importance of early counseling. However, further high-quality research is necessary to strengthen the evidence base and improve guideline recommendations for fertility in people with cancer.