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Fertility preservation before gonadotoxic chemotherapy — DFSRH MCQ

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HardFertilityFertility preservation before gonadotoxic chemotherapyDFSRH

A 34-year-old woman with newly diagnosed Hodgkin lymphoma is due to start alkylating-agent-containing chemotherapy in 3 weeks. Her oncology team considers the treatment likely to cause permanent ovarian insufficiency, but confirms that one cycle of ovarian stimulation and oocyte retrieval can be completed safely without delaying chemotherapy. Her prognosis is good. She has one living child from a previous relationship. She has no current partner and does not wish to use donor sperm. The local integrated care board ordinarily excludes people with living children from NHS-funded conventional IVF. She wishes to preserve the possibility of a genetically related pregnancy. Which is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Offer oocyte cryopreservation now, without applying conventional IVF access criteria, and counsel that those criteria apply when stored oocytes are used.

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

This patient should be offered oocyte cryopreservation before gonadotoxic treatment. Her planned chemotherapy is likely to impair fertility, stimulation can be completed without delaying treatment, and oocyte storage permits preservation without requiring partner or donor sperm. NICE specifies that conventional fertility-treatment eligibility criteria should not be applied when deciding whether to provide NHS-funded fertility preservation. However, she must be told that the applicable NHS assisted-conception criteria will be considered when she later seeks to use the stored material. A is incorrect because having a living child may affect local access to conventional IVF but should not preclude medically indicated cryopreservation. B is inappropriate because she does not consent to donor sperm and embryo formation is not necessary when oocyte cryopreservation is feasible. D is a plausible alternative when stimulation or oocyte retrieval is not feasible—for example, before puberty or when treatment cannot be delayed—but absence of a partner does not prevent oocyte storage. E misses the effective preservation window: the discussion and referral should occur at the earliest opportunity before fertility-impairing treatment, because post-treatment ovarian reserve assessment cannot reverse chemotherapy-induced loss of follicles.

Reference: Fertility problems: assessment and treatment — Fertility preservation for medical indications (31 March 2026) — https://www.nice.org.uk/guidance/ng257/chapter/Fertility-preservation-for-medical-indications Fertility problems — Quality statement 9: Cryopreservation (31 March 2026) — https://www.nice.org.uk/guidance/qs73/chapter/Quality-statement-9-Cryopreservation