Fertility preservation and reproductive outcomes in young women with breast and gynecological cancers: a new challenge for the clinician

The increasing survival rates among young women diagnosed with cancer have shifted attention toward long-term quality-of-life issues, particularly fertility preservation and reproductive outcomes. Advances in cancer therapies have significantly improved prognosis in breast and gynecological malignancies; however, chemotherapy, radiotherapy, and radical surgery may severely compromise ovarian function and reproductive potential, leading to premature ovarian failure, infertility, and important psychological consequences. This review aims to summarize the current evidence regarding fertility preservation strategies and reproductive outcomes in young women with breast and gynecological cancers. An extensive literature review was conducted through MEDLINE, Embase, PubMed, and Cochrane databases, selected studies focusing on fertility counseling, fertility-sparing treatments, cryopreservation techniques, and reproductive outcomes in young women affected by cancer. Current evidence highlights the importance of early reproductive counseling and a multidisciplinary approach involving oncologists, gynecologists, reproductive specialists, and psychologists. Counseling should address ovarian reserve assessment, treatment-related gonadotoxicity, available fertility preservation options, and future pregnancy perspectives. Several fertility preservation strategies are currently available, including gonadotropin-releasing hormone agonists, oocyte and embryo cryopreservation, ovarian tissue cryopreservation, and fertility-sparing surgical approaches. In breast cancer, these strategies have demonstrated encouraging reproductive outcomes without compromising oncologic safety. In gynecological malignancies, conservative treatments such as hormonal therapy for endometrial cancer, conization or trachelectomy for cervical cancer, and fertility-sparing surgery for selected ovarian cancers may preserve reproductive potential in carefully selected patients. Available data suggest that pregnancy after fertility-sparing treatment is generally feasible and safe, although an increased risk of adverse obstetric outcomes, including preterm birth and low birth weight, has been reported. Despite significant progress in reproductive medicine and conservative oncologic surgery, several challenges remain unresolved, including optimal timing for pregnancy after cancer treatment, long-term follow-up strategies, and patient selection criteria. Ongoing research and multidisciplinary collaboration are essential to optimize fertility preservation protocols and improve both oncologic and reproductive outcomes in young cancer survivors.