Fertility Preservation for Premenopausal Women with Cutaneous Lymphoma

Guideline Recommendations

The American Society of Clinical Oncology (ASCO) 2025 guideline recommends that all premenopausal women with cutaneous lymphoma be offered established fertility‑preservation (FP) methods—embryo cryopreservation, oocyte cryopreservation, or ovarian‑tissue cryopreservation—prior to gonadotoxic systemic therapy. 1
Oocyte or embryo cryopreservation is identified as the most established and effective FP method for post‑pubertal females with cancer, including cutaneous lymphoma. 1

When ≥ 2 weeks are available before chemotherapy initiation, ovarian stimulation followed by oocyte or embryo cryopreservation is the preferred approach. [2][3]
“Random‑start” stimulation protocols permit initiation of ovarian stimulation at any point in the menstrual cycle, shortening the overall timeline compared with conventional cycles. [2][3]
When < 2 weeks remain before chemotherapy, ovarian‑tissue cryopreservation becomes the primary option because it requires no hormonal pretreatment and allows chemotherapy to start the next day. [2][3]

For patients ≤ 35 years, aiming to retrieve ≈ 12 oocytes is associated with a ≈ 62 % cumulative live‑birth rate. 4
For patients 36–40 years, aiming to retrieve ≈ 10 oocytes is associated with a ≈ 43 % cumulative live‑birth rate. 4

Double stimulation (two consecutive stimulation cycles within ~4 weeks) can be considered in women with low ovarian reserve when cancer treatment can be safely delayed; this strategy roughly doubles the oocyte yield. [2][4]
In patients slated for highly gonadotoxic regimens, combining ovarian stimulation with ovarian‑tissue cryopreservation maximizes the chance of future reproductive success. [2][4]

Ovarian‑tissue cryopreservation performed via laparoscopic cortex biopsy or unilateral oophorectomy is now classified as an established (non‑experimental) procedure by the American Society for Reproductive Medicine (ASRM). [1][2]
Administration of GnRH agonists during chemotherapy may be offered as an adjunctive measure, although its role as a primary FP method remains less established. 1
Post‑treatment oocyte or embryo cryopreservation remains a viable option for patients who did not undergo FP before therapy or who require additional gametes after treatment. 1

Current evidence demonstrates no adverse impact on cancer‑specific survival for women undergoing ovarian stimulation for FP, including those with breast cancer and other malignancies. [2][4]
Use of letrozole during ovarian stimulation can safely lower estrogen exposure without compromising oocyte yield or quality, supporting oncologic safety in estrogen‑sensitive tumors. [2][4]

Discontinuation of GLP‑1 receptor agonist therapy before initiating ovarian stimulation is advised because the drug’s gastrointestinal adverse effects (nausea, vomiting, delayed gastric emptying) can interfere with the stimulation regimen and compromise nutritional status during this metabolically demanding procedure. 5

The first step in a fertility‑preservation algorithm is to evaluate the urgency of egg freezing (e.g., imminent cancer treatment versus elective timing) to guide scheduling and counseling. 5

Standard or random‑start gonadotropin protocols may be employed for oocyte retrieval, with the option to add letrozole when estrogen‑sensitive disease is a concern; this approach is endorsed for patients undergoing fertility preservation. 5

Ovarian stimulation and oocyte retrieval as part of fertility preservation do not adversely affect oncologic outcomes or overall survival, even in individuals with hormone‑sensitive cancers. 5