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## Complete Summary

#### GUIDELINE TITLE

American Society of Clinical Oncology recommendations on fertility
preservation in cancer patients.

#### BIBLIOGRAPHIC SOURCE(S)

Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K,
Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology
recommendations on fertility preservation in cancer patients. J Clin
Oncol 2006 Jun 20;24(18):1-15. \[167 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Fertility/Infertility\
Cancer

#### GUIDELINE CATEGORY

Counseling\
Treatment

#### CLINICAL SPECIALTY

Oncology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To provide guidance to oncologists about available fertility
preservation methods and related issues in cancer patients

#### TARGET POPULATION

Men, women, and children with cancer who are of reproductive age and are
at risk for treatment-related infertility

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Preservation of Male Fertility**

1.  Sperm cryopreservation after masturbation or alternative methods of
    collection

2.  Gonadal shielding during radiotherapy

3.  Testicular tissue cryopreservation, testis xenografting, or
    spermatogonial isolation (Note: This intervention has not been
    tested in humans)

4.  Hormonal gonadoprotection (considered but not recommended)

**Preservation of Female Fertility**

1.  Embryo cryopreservation

2.  Oocyte cryopreservation

3.  Ovarian cryopreservation and transplantation

4.  Gonadal shielding during radiotherapy

5.  Ovarian transposition

6.  Trachelectomy

7.  Minimization of normal tissue resection

8.  Hormonal therapies to protect ovarian tissue

**Also Considered**

1.  Preservation of fertility in postpubertal and prepubertal children

2.  Talking points and referral guidelines for oncologists

#### MAJOR OUTCOMES CONSIDERED

Primary outcomes of interest included:

-   Pregnancies

-   Live births

The following were also considered:

-   Fertility maintenance

-   Resumption/maintenance of menses

-   Number of oocytes recovered

-   Number of embryos recovered

-   Fertilization rates

-   In vitro fertilization (IVF) outcome

-   Risks associated with the fertility intervention

-   Quality of life

-   Patient and/or family satisfaction

-   Patient education or increased awareness

-   Economic evaluation (e.g., cost-effectiveness, cost utility)

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The following electronic databases were searched from 1987 through March
2005: MEDLINE, PreMEDLINE, and the Cochrane Collaboration Library. The
National Cancer Institute\'s (NCI) PDQ database of clinical trials, and
the National Library of Medicine\'s (NLM) *ClinicalTrials.gov* database
were also searched for ongoing trials. Results were supplemented with
hand searching of selected reviews and personal files. The following
MeSH terms and text words were used in a core search: \"fertility,\"
\"infertility,\" and \"neoplasms.\" In separate searches, results were
cross-referenced with \"pregnancy,\" \"pregnancy outcomes,\"
\"reproductive techniques,\" \"premature ovarian failure,\" and
\"premature menopause.\" Supplemental searches were done for each
intervention using terms specific for that intervention (eg, \"sperm
banks,\" \"semen preservation\"). Due to the very limited number of
randomized controlled trials in this field of research, study design was
not limited to randomized controlled trials, but was expanded to include
cohort designs, case series, and where no other data were available,
case reports and selected abstracts. Letters, commentaries, and
editorials were excluded.

Articles were selected for inclusion in the systematic review of the
evidence if they met the following criteria: (1) the study discussed a
fertility intervention and reported primary data; and (2) the study
population consisted of cancer patients scheduled for or undergoing
cancer treatments that threaten fertility (other populations could be
considered where data were lacking in cancer patients). Articles were
excluded from further consideration if they did not report specifically
on a fertility intervention and did not report primary data. However,
due to the limited nature of the data in many areas, the Panel made an a
priori decision to also retain high-quality reviews or background
papers, and these articles were described as such in the coding process.

An initial article abstract screen was performed by the American Society
of Clinical Oncology (ASCO) staff. The ASCO Panel reviewed all remaining
potentially relevant abstracts identified in the original literature
searches to select studies pertinent to its deliberations. Two Panel
members independently reviewed each abstract for its relevance to the
clinical questions, and disagreements were resolved by third-party
review.

#### NUMBER OF SOURCE DOCUMENTS

Preliminary searches identified 1,675 potential articles. The initial
abstract screen performed by the American Society of Clinical Oncology
(ASCO) staff eliminated 807 abstracts that failed to meet any of the
inclusion criteria. The ASCO Panel conducted dual independent review of
all remaining 868 potentially relevant abstracts identified in the
original systematic review. The Panel eliminated 463 abstracts at this
stage of the review; the remaining 405 articles were reviewed in full
for the interventions and outcomes described above. One hundred
twenty-nine articles that did not report primary data on a fertility
preserving intervention were excluded from further consideration. Two
hundred thirty-three articles met the inclusion criteria, and an
additional 43 articles met the a priori criteria as supplementary
studies or reviews.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus (Committee)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Full text articles were reviewed for all selected abstracts. The Panel
designed a coding sheet to complete the review of identified potentially
relevant studies, and the Co-Chairs assigned each Panel member a subset
of articles to review. Data were extracted on the source of the threat
to fertility, the intervention being considered, the outcomes assessed,
the number of patients and types of cancer, and study design.

A meta-analysis was not performed because the studies were judged to be
too small and heterogeneous for meaningful quantitative synthesis.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The entire Panel participated in monthly teleconferences. Preliminary
teleconferences refined the questions addressed by the guideline;
subsequent teleconferences addressed the process of the systematic
review and the allocation of writing assignments for respective
sections. All members of the Panel participated in the preparation of
the guideline.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

Studies document that some physicians believe that the cost of fertility
preservation interventions is prohibitive. For example, 51% of
oncologists in a United States study believed that most men could not
afford to bank sperm because of out-of-pocket costs. However,
oncologists overestimated these costs and their deterrent effect; in a
companion survey of young men, only 7% cited financial reasons for not
banking sperm.

#### METHOD OF GUIDELINE VALIDATION

Comparison with Guidelines from Other Groups\
External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Feedback from external reviewers was solicited. The content of the
guideline and the manuscript were reviewed and approved by the Health
Services Committee (HSC) and by the American Society of Clinical
Oncology (ASCO) Board of Directors before dissemination.

**Comparison with Guidelines for Other Groups**

Consensus statements have also been developed by some professional
societies, including the British Fertility Society
(<http://www.britishfertilitysociety.org.uk/practicepolicy/documents/fccpaper.pdf>),
the European Society of Human Reproduction and Embryology (ESHRE) Task
Force ([http://www.eshre.com](http://www.eshre.com/)), and the American
Society for Reproductive Medicine. The Panel has evaluated the
Guidelines produced by reproductive specialist societies and found them
to be consistent with the ASCO guidelines.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Oncologists should address the possibility of infertility with patients
treated during their reproductive years. Fertility preservation is often
possible, but to preserve the full range of options, fertility
preservation approaches should be considered as early as possible during
treatment planning.

**Summary of Fertility Preservation Options in Males**

+----------------+----------------+------------+----------------------+
| **             | **Definition** | *          | **Considerations**   |
| Intervention** |                | *Comment** |                      |
+================+================+============+======================+
| Sperm          | Freezing sperm | The most   | -   Outpatient       |
| cr             | obtained       | e          |     procedure        |
| yopreservation | through        | stablished |                      |
| (S) after      | masturbation   | technique  | -   Approximately    |
| masturbation   |                | for        |     \$1,500 for      |
|                |                | fertility  |     three samples    |
|                |                | pr         |     stored for 3     |
|                |                | eservation |     years, storage   |
|                |                | in men;    |     fee for          |
|                |                | large      |     additional       |
|                |                | cohort     |     years\*          |
|                |                | studies in |                      |
|                |                | men with   |                      |
|                |                | cancer     |                      |
+----------------+----------------+------------+----------------------+
| Sperm          | Freezing sperm | Small case | Testicular sperm     |
| cr             | obtained       | series and | extraction           |
| yopreservation | through        | case       | outpatient surgical  |
| (S) after      | testicular     | reports    | procedure            |
| alternative    | aspiration or  |            |                      |
| methods of     | extraction,    |            |                      |
| sperm          | elec           |            |                      |
| collection     | troejaculation |            |                      |
|                | under          |            |                      |
|                | sedation, or   |            |                      |
|                | from a         |            |                      |
|                | pos            |            |                      |
|                | t-masturbation |            |                      |
|                | urine sample   |            |                      |
+----------------+----------------+------------+----------------------+
| Gonadal        | Use of         | Case       | -   Only possible    |
| shielding      | shielding to   | series     |     with selected    |
| during         | reduce the     |            |     radiation fields |
| radiation      | dose of        |            |     and anatomy      |
| therapy (S)    | radiation      |            |                      |
|                | delivered to   |            | -   Expertise is     |
|                | the testicles  |            |     required to      |
|                |                |            |     ensure shielding |
|                |                |            |     does not         |
|                |                |            |     increase dose    |
|                |                |            |     delivered to the |
|                |                |            |     reproductive     |
|                |                |            |     organs           |
+----------------+----------------+------------+----------------------+
| Testicular     | Freezing       | Has not    | Outpatient surgical  |
| tissue         | testicular     | been       | procedure            |
| cry            | tissue or germ | tested in  |                      |
| opreservation; | cells and      | humans;    |                      |
| Testis         | reimplantation | successful |                      |
| xenografting;  | after cancer   | a          |                      |
| Spermatogonial | treatment or   | pplication |                      |
| isolation (I)  | maturation in  | in animal  |                      |
|                | animals        | models     |                      |
+----------------+----------------+------------+----------------------+
| Testicular     | Use of         | Studies do |                      |
| suppression    | hormonal       | not        |                      |
| with           | therapies to   | support    |                      |
| gonadotr       | protect        | the        |                      |
| opin-releasing | testicular     | eff        |                      |
| hormone (GnRH) | tissue during  | ectiveness |                      |
| analogs or     | chemotherapy   | of this    |                      |
| antagonists    | or radiation   | approach   |                      |
| (I)            | therapy        |            |                      |
+----------------+----------------+------------+----------------------+

Abbreviations: S, standard; I, investigational

\*Costs are estimates.

**Quality of Evidence Supporting Current and Forthcoming Options for
Preservation of Fertility in Males**

*Sperm cryopreservation*. Sperm cryopreservation is effective, and
oncologists should discuss sperm banking with appropriate patients. It
is strongly recommended that sperm be collected before initiation of
cancer therapy because the quality of the sample and sperm DNA integrity
may be compromised even after a single treatment session. Although
planned chemotherapy may limit the number of ejaculates,
intracytoplasmic sperm injection allows the successful freezing and
future use of a very limited amount of sperm.

*Hormonal gonadoprotection*. Hormonal therapy in men is not successful
in preserving fertility when highly sterilizing chemotherapy is
administered.

*Other considerations*. Men should be advised of a potentially higher
risk of genetic damage in sperm stored after initiation of therapy.
Testicular tissue or spermatogonial cryopreservation and transplantation
or testis xenografting have not yet been tested successfully in humans.
Of note, such approaches are also the only methods of fertility
preservation potentially available to prepubertal boys.

**Fertility Preservation Options in Females**

+---------------+--------------+--------------+-----------------------+
| **I           | **           | **Comment**  | **Considerations\***  |
| ntervention** | Definition** |              |                       |
+===============+==============+==============+=======================+
| Embryo        | Harvesting   | The most     | -   Requires 10-14    |
| cry           | eggs, in     | established  |     days of ovarian   |
| opreservation | vitro        | technique    |     stimulation from  |
| (S)           | f            | for          |     the beginning of  |
|               | ertilization | fertility    |     menstrual cycle   |
|               | (IVF), and   | preservation |                       |
|               | freezing of  | in women     | -   Outpatient        |
|               | embryos for  |              |     surgical          |
|               | later        |              |     procedure         |
|               | implantation |              |                       |
|               |              |              | -   Requires partner  |
|               |              |              |     or donor sperm    |
|               |              |              |                       |
|               |              |              | -   Approximately     |
|               |              |              |     \$8,000 per       |
|               |              |              |     cycle, \$350 per  |
|               |              |              |     year storage fees |
+---------------+--------------+--------------+-----------------------+
| Oocyte        | Harvesting   | Small case   | -   Requires 10-14    |
| cry           | and freezing | series and   |     days of ovarian   |
| opreservation | of           | case         |     stimulation from  |
| (I)           | unfertilized | reports; as  |     the beginning of  |
|               | eggs         | of 2005, 120 |     menstrual cycle   |
|               |              | deliveries   |                       |
|               |              | reported,    | -   Outpatient        |
|               |              | a            |     surgical          |
|               |              | pproximately |     procedure         |
|               |              | 2% live      |                       |
|               |              | births per   | -   Approximately     |
|               |              | thawed       |     \$8,000 per       |
|               |              | oocyte (3-4  |     cycle, \$350/yr   |
|               |              | times lower  |     storage fees      |
|               |              | than         |                       |
|               |              | standard     |                       |
|               |              | IVF)         |                       |
+---------------+--------------+--------------+-----------------------+
| Ovarian       | Freezing of  | Case         | -   Not suitable when |
| cry           | ovarian      | reports; as  |     risk of ovarian   |
| opreservation | tissue and   | of 2005, two |     involvement is    |
| and           | re           | live births  |     high              |
| tr            | implantation | reported     |                       |
| ansplantation | after cancer |              | -   Same day          |
| (I)           | treatment    |              |     outpatient        |
|               |              |              |     surgical          |
|               |              |              |     procedure         |
+---------------+--------------+--------------+-----------------------+
| Gonadal       | Use of       | Case series  | -   Only possible     |
| shielding     | shielding to |              |     with selected     |
| during        | reduce the   |              |     radiation fields  |
| radiation     | dose of      |              |     and anatomy       |
| therapy (S)   | radiation    |              |                       |
|               | delivered to |              | -   Expertise is      |
|               | the          |              |     required to       |
|               | reproductive |              |     ensure shielding  |
|               | organs       |              |     does not increase |
|               |              |              |     dose delivered to |
|               |              |              |     the reproductive  |
|               |              |              |     organs            |
+---------------+--------------+--------------+-----------------------+
| Ovarian       | Surgical     | Large cohort | -   Same day          |
| transposition | r            | studies and  |     outpatient        |
| (oophoropexy) | epositioning | case series  |     surgical          |
| (S)           | of ovaries   | suggest      |     procedure         |
|               | away from    | a            |                       |
|               | the          | pproximately | -   Transposition     |
|               | radiation    | 50% chance   |     should be         |
|               | field        | of success   |     performed just    |
|               |              | due to       |     before radiation  |
|               |              | altered      |     therapy to        |
|               |              | ovarian      |     prevent return of |
|               |              | blood flow   |     ovaries to former |
|               |              | and          |     position          |
|               |              | scattered    |                       |
|               |              | radiation    | -   May need          |
|               |              |              |     repositioning or  |
|               |              |              |     IVF to conceive   |
+---------------+--------------+--------------+-----------------------+
| Trachelectomy | Surgical     | Large case   | -   Inpatient         |
| (S)           | removal of   | series and   |     surgical          |
|               | the cervix   | case reports |     procedure         |
|               | while        |              |                       |
|               | preserving   |              | -   Limited to early  |
|               | the uterus   |              |     stage cervical    |
|               |              |              |     cancer; no        |
|               |              |              |     evidence of       |
|               |              |              |     higher cancer     |
|               |              |              |     relapse rate in   |
|               |              |              |     appropriate       |
|               |              |              |     candidates        |
|               |              |              |                       |
|               |              |              | -   Expertise may not |
|               |              |              |     be widely         |
|               |              |              |     available         |
+---------------+--------------+--------------+-----------------------+
| Other         | Minimization | Large case   | -   Expertise may not |
| conservative  | of normal    | series and   |     be widely         |
| gynecologic   | tissue       | case reports |     available         |
| surgery (S/I) | resection    |              |                       |
+---------------+--------------+--------------+-----------------------+
| Ovarian       | Use of       | Small        | -   Medication given  |
| suppression   | hormonal     | randomized   |     before and during |
| with GnRH     | therapies to | studies and  |     treatment with    |
| analogs or    | protect      | case series. |     chemotherapy      |
| antagonists   | ovarian      | Larger       |                       |
| (I)           | tissue       | randomized   | -   Approximately     |
|               | during       | trials in    |     \$500/mo          |
|               | chemotherapy | progress     |                       |
|               | or radiation |              |                       |
|               | therapy      |              |                       |
+---------------+--------------+--------------+-----------------------+

Abbreviations: S, standard; I, investigational; IVF, in vitro
fertilization

\*Costs are estimates

**Quality of Evidence Supporting Current and Forthcoming Options for
Preservation of Fertility in Females**

*Embryo cryopreservation*. Embryo cryopreservation is considered an
established fertility preservation method because it has routinely been
used for storing surplus embryos after in vitro fertilization.
Approximately 2 weeks of ovarian stimulation with daily injections of
follicle-stimulating hormone is required and must be started within the
first 3 days of the menstrual cycle.

*Cryopreservation of unfertilized oocytes*. Cryopreservation of
unfertilized oocytes is an option, particularly for patients without a
partner or those with religious or ethical objections to embryo
freezing. Ovarian stimulation is required as described in the preceding
section. Oocyte cryopreservation should only be performed in centers
with the necessary expertise, and the Panel recommends participation in
institutional review board (IRB)-approved protocols.

*Ovarian tissue cryopreservation*. Ovarian tissue cryopreservation and
transplantation procedures should be performed only in centers with the
necessary expertise under IRB-approved protocols that include follow-up
for recurrent cancer. A concern with reimplanting ovarian tissue is the
potential for reintroducing cancer cells, although in fewer than 20
procedures reported thus far, there are no reports of cancer recurrence.

*Ovarian suppression*. Currently, there is insufficient evidence
regarding the safety and effectiveness of GnRH analogs and other means
of ovarian suppression on fertility preservation. Women interested in
this technique are encouraged to participate in clinical trials.

*Ovarian transposition*. Ovarian transposition (oophoropexy) can be
offered when pelvic radiation is administered as cancer treatment.
Because of the risk of remigration of the ovaries, this procedure should
be performed as close to the radiation treatment as possible.

*Conservative gynecologic surgery*. It has been suggested that radical
trachelectomy be restricted to stage IA2-IB disease with diameter less
than 2 cm and invasion less than 10 mm. In the treatment of other
gynecologic malignancies, interventions to spare fertility have
generally centered on doing less-radical surgery and/or lower-dose
chemotherapy with the intent of sparing the reproductive organs as much
as possible.

*Other considerations*. Of special concern in breast and gynecologic
malignancies is the possibility that fertility preservation
interventions and/or subsequent pregnancy may increase the risk of
cancer recurrence. Although several studies have not shown a decrement
in survival or an increase in risk of breast cancer recurrence with
pregnancy, the studies are all limited by significant biases, and
concerns remain for some women and their physicians.

**Special Considerations: Fertility Preservation in Children**

Use of established methods of fertility preservation (semen
cryopreservation and embryo freezing) in postpubertal minor children
requires patient assent and parental consent. The modalities available
to prepubertal children to preserve their fertility are limited by the
sexual immaturity of the children and are essentially experimental.
Efforts to preserve fertility of children using experimental methods
(e.g., gonadal tissue cryopreservation) should be attempted only under
IRB approved protocols.

**The Role of the Oncologist in Advising Patients About Fertility
Preservation Options**

As with other potential complications of cancer treatment, oncologists
have a responsibility to inform patients about the risk that their
cancer treatment will permanently impair fertility. An algorithm for
triaging fertility preservation referrals is presented in the original
guideline document and suggested talking points are illustrated in a
sidebar.

Oncologists should answer basic questions about whether fertility
preservation options decrease the chance of successful cancer treatment,
increase the risk of maternal or perinatal complications, or compromise
the health of offspring. Patients should be encouraged to participate in
registries and clinical studies as available to define further the
safety of these interventions and strategies. Currently, women with a
history of cancer and cancer treatment should be considered high risk
for perinatal complications and would be prudent to seek specialized
perinatal care.

Oncologists should refer interested and appropriate patients to
reproductive specialists as soon as possible. Referral to psychosocial
providers may be beneficial when a patient has moderate to severe
distress about potential infertility.

#### CLINICAL ALGORITHM(S)

An algorithm is provided in the original guideline document for Triage
of Fertility Preservation Referrals.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

Most recommendations are supported by case reports, case series, and
cohort studies. Only a few randomized or definitive trials were found in
the literature review.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate fertility preservation approaches in people undergoing
treatment for cancer

#### POTENTIAL HARMS

-   Delay in cancer treatment (early referral to a subspecialist can
    minimize this delay)

-   Risk of tumor recurrence

-   Potential negative (physical and psychological) effects of fertility
    preservation attempts

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   Guidelines cannot always account for individual variation among
    patients. Guidelines are not intended to supplant physician judgment
    with respect to particular patients or special clinical situations
    and cannot be considered inclusive of all proper methods of care or
    exclusive of other treatments reasonably directed at obtaining the
    same result. The American Society of Clinical Oncology (ASCO)
    considers adherence to these guidelines to be voluntary, with the
    ultimate determination regarding their application to be made by the
    physician in light of each patient\'s individual circumstances. In
    addition, these guidelines describe the use of procedures and
    therapies in clinical practice; they cannot be assumed to apply to
    the use of these interventions performed in the context of clinical
    trials, given that clinical studies are designed to evaluate or
    validate innovative approaches in a disease for which improved
    staging and treatment is needed.

-   Review of the fertility preservation literature reveals a paucity of
    large and/or randomized studies. Most data come from cohort studies,
    case series, small nonrandomized clinical trials or case reports.
    Fertility preservation methods are still applied relatively
    infrequently in the cancer population, limiting greater knowledge
    about success and effects of different potential interventions.
    Other than risk of tumor recurrence, less attention is paid to the
    potential negative effects (physical and psychological) of fertility
    preservation attempts.

-   Little is known about the emotional impact of infertility or
    utilization of fertility preservation options on cohorts that are
    diverse in ethnicity and socioeconomic status, groups that face even
    greater barriers to fertility preservation.

-   The Panel encourages additional well-designed studies evaluating
    methods of fertility preservation in people with cancer to help
    answer these questions. However, the Panel also notes that the
    traditional gold standard of randomized, controlled, and blinded
    therapeutic studies may not be possible in this area.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Patient Resources\
Personal Digital Assistant (PDA) Downloads\
Quick Reference Guides/Physician Guides\
Slide Presentation

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K,
Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology
recommendations on fertility preservation in cancer patients. J Clin
Oncol 2006 Jun 20;24(18):1-15. \[167 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Jun 20

#### GUIDELINE DEVELOPER(S)

American Society of Clinical Oncology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Society of Clinical Oncology

#### GUIDELINE COMMITTEE

American Society of Clinical Oncology (ASCO) Expert Panel

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: Stephanie J. Lee, MD MPH (*Co-Chair*); Kutluk Oktay, MD
(*Co-Chair*); Lawrence V. Brennan, MD; Lindsay Nohr Beck; Ann H.
Partridge, MD MPH; Pasquale Patrizio, MD MBE; Leslie R. Schover, PhD; W.
Hamish Wallace, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following
authors or immediate family members indicated a financial interest.

  ---------------------------------------------------------------------------------------------------------------------------------------------------
  **Authors**                 **Employment**   **Leadership**   **Consultant**   **Stock**   **Honoraria**   **Research   **Testimony**   **Other**
                                                                                                             Funds**                      
  --------------------------- ---------------- ---------------- ---------------- ----------- --------------- ------------ --------------- -----------
  Stephanie J. Lee\*                                                                                                                       

  Leslie R. Schover\*                                                                                                                      

  Ann H. Partridge                                              Astra Zeneca (A)                                                           

  Pasquale Patrizio\*                                                                                                                      

  W. Hamish Wallace\*                                                                                                                      

  Karen Hagerty\*                                                                                                                          

  Lindsay N. Beck                              Fertile Hope (B)                                                                            

  Lawrence V. Brennan\*                                                                                                                    

  Kutluk Oktay\*                                                                                                                           

  **Dollar Amount Codes** (A)                                                                                                             
  \< \$10,000 (B)                                                                                                                         
  \$10,000--99,000 (C)                                                                                                                    
  [\<]{.underline}\$100,000                                                                                                               
  (N/R) Not Required                                                                                                                      
  ---------------------------------------------------------------------------------------------------------------------------------------------------

\*No significant financial relationships to disclose.

No conflict exists for drugs or devices used in a study if they are not
being evaluated as part of the investigation. For a detailed description
of the disclosure categories, or for more information about American
Society of Clinical Oncology\'s (ASCO\'s) conflict of interest policy,
please refer to the Author Disclosure Declaration and the Disclosures of
Potential Conflicts of Interest section in Information for Contributors.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Society of Clinical
Oncology (ASCO) Web
site](http://jco.ascopubs.org/cgi/content/full/24/18/2917).

Print copies: Available from American Society of Clinical Oncology,
Cancer Policy and Clinical Affairs, 1900 Duke Street, Suite 200,
Alexandria, VA 22314; E-mail: <guidelines@asco.org>.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   ASCO recommendations on fertility preservation in cancer patients:
    guideline summary. Alexandria (VA): American Society of Clinical
    Oncology; 2006 May. 4 p. Electronic copies: Available in Portable
    Document Format (PDF) from the [American Society of Clinical
    Oncology (ASCO) Web
    site](http://www.asco.org/portal/site/ASCO/menuitem.a3fb42726842a82627c4c291ee37a01d/?vgnextoid=d70b3608f9958010VgnVCM100000f2730ad1RCRD&index=y&pmid=16651642).

-   ASCO recommendations on fertility preservation in people treated for
    cancer: fertility preservation options & discussion points.
    Alexandria (VA): American Society of Clinical Oncology; 2006. 2 p.
    Electronic copies: Available in Portable Document Format (PDF) from
    the [American Society of Clinical Oncology (ASCO) Web
    site](http://www.asco.org/ASCO/Downloads/Cancer Policy and Clinical Affairs/Clinical Affairs (derivative products)/Fertility Options & Discussion.pdf).
    See the related QualityTool summary on the [Health Care Innovations
    Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=281).

-   Fertility preservation in people treated for cancer. Slide
    set. 2006. 50 p. Electronic copies: Available in Portable Document
    Format (PDF) from the [ASCO Web
    site](http://www.asco.org/ASCO/Downloads/Cancer Policy and Clinical Affairs/Fertility-v1.pdf).
    See the related QualityTool summary on the [Health Care Innovations
    Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=282).

Guidelines are available for Personal Digital Assistant (PDA) download
from the [ASCO Web
site](http://www.asco.org/ASCO/Downloads+%26+Technology/PDA+Services).

#### PATIENT RESOURCES

The following is available:

-   ASCO patient guide: fertility preservation. 2006 May. 3 p. Available
    in Portable Document Format (PDF) from the [Cancer.Net Web
    site](http://www.cancer.net/portal/site/patient/menuitem.169f5d85214941ccfd748f68ee37a01d/?vgnextoid=6a57ffdb060fa010VgnVCM100000ed730ad1RCRD).
    See the related QualityTool summary on the [Health Care Innovations
    Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=287).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on July 27, 2006.

#### COPYRIGHT STATEMENT

This summary is based on the original guideline, which is subject to the
American Society of Clinical Oncology\'s copyright restrictions.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
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Readers with questions regarding guideline content are directed to
contact the guideline developer.

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008