Default fertility preservation referral for every patient under 40 before treatment

Overview

• Protocol upgrade, graded proven but unevenly used on guideline-level evidence. ASCO's 2018 guideline asks clinicians to discuss the possibility of infertility as early as possible with patients treated in their reproductive years, to be prepared to refer all potential patients to reproductive specialists, and to document the discussion; sperm, oocyte and embryo cryopreservation are standard practice.
• Adoption gap, as measured: a systematic review of 25 United States studies of female adolescents and young adults found fertility preservation discussions ranging from 9 to 75 per cent, referrals from 0.9 to 57 per cent and completed procedures from 0.56 to 70.3 per cent; institutional interventions improved access but did not remove the disparities by race, income, insurance and rurality (Algave, 2026).