Approximately 10% of women diagnosed with cancer are of reproductive age. As survival rates improve, there is an increased focus on the complex issues surrounding cancer survivorship, particularly for younger women of reproductive age. Among young women diagnosed with cancer, concerns regarding future fertility are secondary only to concerns regarding survival. Guidelines from the American Society of Clinical Oncology (ASCO) and American Society for Reproductive Medicine (ASRM) state that healthcare providers should discuss the risk of infertility and fertility preservation options with all reproductive age patients diagnosed with cancer. This chapter reviews the proposed mechanisms of chemotherapy induced ovarian toxicity and how to assess baseline ovarian reserve. Fertility preservation options are discussed, including medical and conservative surgical management for select patients with gynecologic malignancies, oocyte and embryo cryopreservation, ovarian tissue cryopreservation and ovarian suppression. Data regarding the safety of ovarian stimulation and subsequent pregnancy are included.

Endometrial cancer is the most common gynecologic malignancy in the United States, and is rising in both incidence and associated mortality. In 2023 an estimated 66,000 new cases of uterine cancer will be diagnosed in the United States and over 400,000 women will be affected globally. Risk factors for the development of endometrial cancer include advancing age, obesity and and conditions associated with metabolic syndrome, such as diabetes. Obesity is the most important risk factor for endometrial cancer, and as rates of obesity rise, so does the incidence of endometrial cancer. Surgery is the mainstay of initial management of endometrial cancer, and staging now includes sentinel lymph-node mapping, along with a minimally invasive surgical approach for removal of the uterus, fallopian tubes, and ovaries. Fortunately, 75% of patients with endometrial cancer have International Federation of Gynecologic and Obstetrics (FIGO) stage I disease, and 5-year overall survival rates exceed 90%. High-risk stage I patients are often recommended to receive adjuvant therapy and women with locally advanced disease and/or distant disease typically require multimodality treatment that can include some combination of surgery, chemotherapy, and radiotherapy. Endometrial cancer is more often being detected in young obese women. In women of childbearing age in whom endometrial cancer is diagnosed and wish to retain their ability to have children, a conservative alternative to hysterectomy for these women is the use of oral progestin or a levonorgestrel intrauterine system (LNG-IUS).

Many benign and malignant conditions are treated with fertility-threatening medical or surgical therapies. Fertility preservation is a recourse critical to discuss prior to initiation of these therapies. This chapter describes contemporary and future fertility preservation approaches while also exploring barriers in access to their use as well as key decision-making strategies helpful for clinicians caring for patients with a range of medical conditions.

Most laboratories use HEPES buffer solution for oocyte retrieval because it provides pH stability through buffering action. In contrast, there are laboratories that use workstations which provide CO₂ and temperature stability during oocyte collection. When this type of workstation is used, HEPES buffer solution is not required. In laboratories working without a dedicated workstation, the recovery and processing of oocytes should be done quickly to maintain optimal oocyte temperature and pH conditions.

This chapter provides an overview of the hormonal and surgical interventions available to transgender and nonbinary (TNB) people, what is known about how these interventions affect fertility, fertility preservation options at different stages of pubertal development, TNB individuals’ attitudes toward family building and experiences with fertility counseling and fertility preservation, barriers to fertility counseling, and recommendations for best practice for fertility counseling for TNB people based on the known literature to date.

Ovaries are the reproductive organs of women, producing the gametes and sex hormones.

The production of sex hormones is important for the regulation of ovarian function and menstrual cyclicity. Trans men undergo testosterone treatment or/and gender re-affirming surgery in order to overcome gender dysphoria. This treatment might result in the cessation of the normal ovarian function. For trans men that wish to retain their fertility options, ovarian function remains a prerequisite for genetically related offspring. Fertility treatments for trans men may occur before or in between testosterone treatment. Treatments following testosterone supplementation may have an effect in the proper ovarian function. This chapter deals in detail with the effects of testosterone on the ovarian anatomy and physiology.

Fertility preservation has become a hot issue in transgender medicine. Today counseling on this aspect prior to the start of treatment is regarded mandatory. However, reproductive consequences and options in the context of gender-affirmative treatment remain far from clear. Transgender people face multiple medical and legal problems when trying to achieve parenthood using the help of assisted reproduction. This is a result of two main causes: (1) In many cases, the knowledge of fertility preservation is not available to the concerned parties before gender reassignment, as well as the methods of fertility treatments afterwards. There is also a lack of such knowledge within the health system; (2) National laws do not take into consideration the special needs and challenges of this patient group as they consist solely of general rules for cis couples trying to conceive.

This chapter offers a list of assisted reproductive technology (ART) methods available for transgender people and points out their medico-legal challenges. The authors think ahead and think through the consequences of various constellations for assisted reproduction. The chapter is an inexhaustible source for providing up-dated information on fertility options for trans- and gender diverse people. Moreover, this chapter points to the numerous legal weaknesses in legislation on reproductive issues and the discriminatory consequences for people beyond the gender binary.

Egg freezing was initially introduced as a fertility preservation measure in women without a male partner who were about to undergo gonadotoxic treatments. The use of oocyte cryopreservation for social reasons has been an increasingly popular strategy for women to preserve their fertility potential, a term most referred to as ‘social egg freezing’ (SEF). As well as for career progression or waiting until they are financially more secure, some women may be single, or may decide to egg freeze to relieve pressure on a relationship, until they decide they are ready to have children with their partner. Upon introduction, success rates with SEF were low due to poor oocyte survival rates. With the advent of oocyte vitrification techniques, assisted reproductive technology (ART) procedures using frozen oocytes have shown a similar live birth rate (LBR) to those using fresh oocytes. Due to this growing evidence for the efficacy of egg freezing, both the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) changed their stances and no longer consider oocyte freezing to be an experimental technique.

Cervical cancer is the fourth most common cancer of women, with a wide range of variation of incidence across the globe. It continues to be a major public health problem particularly in countries with poorly resourced healthcare. Persistent infection with high-risk HPV and ineffective clearance of HPV are central to causation of cellular changes at the squamocolumnar junction, leading to the development of invasive cancer. A global initiative of preventative vaccination, screening and treatment has developed to eradicate cervical cancer as a public health problem. Diagnosis of early invasive cancer is seen in well-established screening programmes. This chapter reviews the management of early invasive and recurrent cervical cancer.