Synopsis
Protect reproductive options before gonadotoxic treatment and deliver time-critical cancer care during pregnancy through coordinated oncology, fertility, fetal-medicine, obstetric, neonatal and psychosocial planning.
- Ask about future fertility and pregnancy possibility at diagnosis, before surgery, systemic treatment or radiotherapy closes an option; record the patient's values without assuming them from age, parity, sex or relationship status.
- First-line fertility triage assesses treatment urgency, ovarian or testicular reserve, expected gonadotoxicity and safe time available; urgent referral runs in parallel with cancer staging rather than after it.
- Embryo or oocyte cryopreservation is the established option for many post-pubertal patients with ovaries when a short delay is oncologically safe; sperm cryopreservation is preferred before gonadotoxic treatment for patients producing sperm.
Key red flags
A new cancer diagnosis in pregnancy must not be deferred automatically until after delivery; delay may reduce the chance of cure.
Bleeding, contractions, reduced fetal movement, hypertension or sepsis needs immediate maternity assessment while cancer complications are evaluated in parallel.
Investigation priorities
Define pregnancy status, treatment urgency, expected gonadotoxicity and the patient's reproductive goals before therapy.
Management branches
A reproductive-age or prepubertal patient is offered potentially gonadotoxic treatment.
- Explain the estimated treatment-specific risk, ask what future biological parenthood means to the patient and obtain consent for urgent fertility referral and storage decisions.
- Send a complete referral with diagnosis, stage, proposed regimen, start deadline, infection and blood-count constraints, and whether ovarian stimulation or a procedure is oncologically safe.
Key medicines
Goserelin ovarian suppressionWhen selected as an adjunct, give goserelin 3.6 mg by subcutaneous implant every 28 days, starting before or as close as feasible to chemotherapy and continuing through the gonadotoxic course under the oncology protocol.
Cytotoxic chemotherapy after organogenesisUse the full maternal, body-surface-area-based disease regimen selected by the specialist MDT after the first trimester; do not empirically reduce dose because of pregnancy and stop sufficiently before planned delivery for marrow recovery.