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.
- Ovarian-tissue cryopreservation can be considered when treatment cannot wait for stimulation or for selected prepubertal patients, but requires a specialist service and disease-specific assessment of malignant-cell reseeding risk.
- Gonadotrophin-releasing hormone agonist ovarian suppression may reduce ovarian failure during some chemotherapy but is an adjunct, not a substitute for proven cryopreservation when that is feasible.
- Cancer imaging and treatment during pregnancy are selected by gestation, tumour biology and maternal benefit; necessary maternal diagnosis should not be abandoned because of fetal radiation anxiety.
- Avoid methotrexate, tamoxifen and other known teratogens during pregnancy; most cytotoxic chemotherapy is avoided in the first trimester, while selected regimens can be used after organogenesis through a specialist protocol.
- Plan the final treatment dose and delivery interval to allow marrow recovery, avoid elective iatrogenic prematurity where possible, and agree neonatal assessment, breastfeeding compatibility and postpartum treatment restart before birth.
Key red flags
A new cancer diagnosis in pregnancy must not be deferred automatically until after delivery; delay may reduce the chance of cure.
Fever after systemic anticancer treatment is suspected neutropenic sepsis irrespective of pregnancy and needs immediate empirical antibiotics.
Breathlessness, pleuritic pain, unilateral leg swelling or collapse raises pregnancy- and cancer-associated venous thromboembolism risk and requires urgent assessment.
Pelvic pain, vaginal bleeding, fluid loss, reduced fetal movement or contractions needs same-day maternity triage alongside oncology review.
Any planned gonadotoxic treatment, pelvic radiotherapy or reproductive-organ surgery creates a time-limited fertility discussion before treatment starts.
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.
- Choose sperm, oocyte, embryo or tissue preservation with the specialist team, document limitations and legal storage consent, and confirm that treatment start remains owned by oncology.