ESHRE guideline: female fertility preservation
Open accessAbstract
STUDY QUESTION: What is the recommended management for women and transgender men with regards to fertility preservation (FP), based on the best available evidence in the literature? SUMMARY ANSWER: The ESHRE Guideline on Female Fertility Preservation makes 78 recommendations on organization of care, information provision and support, pre-FP assessment, FP interventions and after treatment care. Ongoing developments in FP are also discussed. WHAT IS KNOWN ALREADY: The field of FP has grown hugely in the last two decades, driven by the increasing recognition of the importance of potential loss of fertility as a significant effect of the treatment of cancer and other serious diseases, and the development of the enabling technologies of oocyte vitrification and ovarian tissue cryopreservation (OTC) for subsequent autografting. This has led to the widespread, though uneven, provision of FP for young women. STUDY DESIGN SIZE DURATION: The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 November 2019 and written in English were included in the review. PARTICIPANTS/MATERIALS SETTING METHODS: Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE: This guideline aims to help providers meet a growing demand for FP options by diverse groups of patients, including those diagnosed with cancer undergoing gonadotoxic treatments, with benign diseases undergoing gonadotoxic treatments or those with a genetic condition predisposing to premature ovarian insufficiency, transgender men (assigned female at birth), and women requesting oocyte cryopreservation for age-related fertility loss.The guideline makes 78 recommendations on information provision and support, pre-FP assessment, FP interventions and after treatment care, including 50 evidence-based recommendations-of which 31 were formulated as strong recommendations and 19 as weak-25 good practice points and 3 research only recommendations. Of the evidence-based recommendations, 1 was supported by high-quality evidence, 3 by moderate-quality evidence, 17 by low-quality evidence and 29 by very low-quality evidence. To support future research in the field of female FP, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION: Most interventions included are not well studied in FP patients. As some interventions, e.g. oocyte and embryo cryopreservation, are well established for treatment of infertility, technical aspects, feasibility and outcomes can be extrapolated. For other interventions, such as OTC and IVM, more evidence is required, specifically pregnancy outcomes after applying these techniques for FP patients. Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS: The guideline provides clinicians with clear advice on best practice in female FP, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in FP. STUDY FUNDING/COMPETING INTERESTS: The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. R.A.A. reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work; D.B. reports grants from Merck Serono and Goodlife, outside the submitted work; I.D. reports consulting fees from Roche and speaker's fees from Novartis; M.L. reports personal fees from Roche, Novartis, Pfizer, Lilly, Takeda, and Theramex, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER: ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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The utility of oocyte cryopreservation in individuals with TS who have underlying ovarian insufficiency is unknown.
“However, the utility of oocyte cryopreservation in individuals with TS who have underlying ovarian insufficiency is unknown.578,593-595”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [595]
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Elective Egg Freezing for Non‐Medical Reasons
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Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study
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Optimizing Reproductive Outcome in Children and Young People With Cancer
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- Dezellus A Barriere P Campone M Lemanski C Vanlemmens L Mignot L Delozier T Levy C Bendavid C Debled M et al Prospective evaluation of serum anti-Mullerian hormone dynamics in 250 women of reproductive age treated with chemotherapy for breast cancer. Eur J Cancer 2017b; 79: 72– 80. 28463758
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Sorted by citations
Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
Nadesapillai, S., Mol, F., Broer, S. L., Stevens Brentjens, L. B. P. M., Verhoeven, M. O., Heida, K. Y., Goddijn, M., van Golde, R. J. T., Bos, A. M. E., van der Coelen, S., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12206502 · Cited by 13 · see citing works
Self-citationGatimel, N., Barbotin, A., Mery, L., Beauvillard, D., Bendayan, M., Boursier, A., Boueilh, T., Pereira, B., Chammas, J., Jacquet, J., et al. (2026) · Andrology · doi:10.1111/andr.70134 · Cited by 2 · see citing works
- Authors
- The ESHRE Guideline Group on Female Fertility Preservation, Anderson, R. A., Amant, F., Braat, D., D'Angelo, A., Chuva de Sousa Lopes, S. M., Demeestere, I., Dwek, S., Frith, L., Lambertini, M., Maslin, C., Moura-Ramos, M., Nogueira, D., Rodriguez-Wallberg, K., & Vermeulen, N.
- Affiliations
- MRC Centre for Reproductive Health (GB)
- Amsterdam UMC Location University of Amsterdam (NL)
- Swansea Bay University Health Board (GB)
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University, Cardiff, UK
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
- Université Libre de Bruxelles (BE)
- University of Liverpool (GB)
- Ospedale Policlinico San Martino (IT)
- University of Coimbra (PT)
- Reprodutive Medicine Unit, Unit of Clinical Psychology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Karolinska University Hospital (SE)
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- European Society of Human Reproduction and Embryology (BE)
- Corresponding author
- Anderson, Richard A
- ORCID
- Venue
- Human Reproduction Open
- Publisher
- Oxford University Press (OUP)
- Published
- 2020
- Volume
- 2020
- Issue
- 4
- Pages
- hoaa052-hoaa052
- ISSN
- 2399-3529 (ISSN-L)
- PMC
- PMC7666361
- OpenAlex
- W3105381727
- Cited by
- 748
- References
- 143
- Citations by year
- 2026: 129 · 2025: 143 · 2024: 158 · 2023: 134 · 2022: 113 · 2021: 69 · 2020: 2
- FWCI
- 59.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Human Reproduction Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc)
- Lirias (submittedVersion, cc-by-nc)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- European Society of Human Reproduction and Embryology
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Keywords
- female fertility preservation, oocyte vitrification, ovarian tissue cryopreservation, transgender men, gonadotoxic therapy, premature ovarian insufficiency, oocyte cryopreservation, embryo cryopreservation, ovulation induction, ovarian transposition, patient information and support, research recommendations, ESHRE
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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