Immune checkpoint inhibitors (ICIs) have reshaped melanoma care, yielding durable remissions even in high-risk stages. As survival improves, fertility becomes a key survivorship concern for young women, yet the reproductive safety of ICIs remains insufficiently characterised. We performed a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis synthesizing preclinical and clinical evidence to evaluate the rationale for fertility preservation (FP) prior to checkpoint inhibitor therapy. Preclinical models of PD-1/CTLA-4 blockade demonstrate ovarian immune activation, cytokine release (e.g., TNF-α), and follicular loss. Conversely, human data are limited to correlative analyses suggesting potential declines in ovarian reserve markers. In conclusion, while prospective studies are required to definitively quantify risk, proactive fertility preservation counselling should be routinely offered prior to treatment initiation to safeguard reproductive autonomy without compromising oncologic safety.

Background/Objectives: Renal cell carcinoma (RCC) care has been reshaped by immune checkpoint inhibitors (ICIs), now used across adjuvant and metastatic settings as PD-1/PD-L1 blockade alone, combined with anti-CTLA-4 agents, or in combination with vascular endothelial growth factor (VEGF)-targeting tyrosine kinase inhibitors (TKIs). As survival improves and systemic therapy courses extend, survivorship priorities—including fertility preservation, reproductive endocrine health, contraception, and pregnancy counselling—become increasingly relevant, even though RCC-specific oncofertility evidence remains sparse. This review examines the biological rationale and clinical considerations underpinning reproductive counselling for women of reproductive age exposed to ICIs (alone or with TKIs) in RCC. Methods: A narrative review was conducted in accordance with the SANRA framework, integrating targeted PubMed/MEDLINE searches up to 20 February 2026 and consultation of regulatory product labels to synthesize mechanistic, clinical, and safety data relevant to fertility, endocrine function, contraception, pregnancy, and breastfeeding in RCC. Results: We delineate the contemporary RCC treatment landscape to identify feasible timepoints for fertility preservation discussions and propose a pragmatic, implementation-oriented counselling framework that distinguishes evidence-secure recommendations (pregnancy avoidance during therapy, endocrine monitoring, agent-specific washout) from extrapolative domains (long-term ovarian reserve effects and post-ICI periconception safety beyond label intervals). Conclusions: By integrating a ‘multi-hit’ biological rationale, treatment context, and available human data, this review highlights RCC-specific research priorities while supporting transparent, evidence-aligned, and multidisciplinary counselling for both fertility preservation and pregnancy safety in the ICI era.

Background/Objectives: Breast cancer is the most common malignancy in young women, many of whom face fertility impairment due to gonadotoxic treatments and prolonged endocrine therapy. Ovarian tissue cryopreservation (OTC) has emerged as an alternative fertility preservation (FP) strategy, particularly when controlled ovarian stimulation is not feasible. This study aimed to evaluate the role of OTC in breast cancer patients, with the aim of clarifying its current clinical role and future perspectives within fertility preservation counselling for this population. Methods: A structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis was conducted based on the current literature, addressing clinical efficacy, safety, and applicability of OTC in breast cancer patients. Results: Key strengths of OTC include the absence of delay in cancer treatment and the potential to restore both endocrine and reproductive function. However, limitations include the need for surgery, the theoretical risk of reintroducing malignant cells, and variable, less predictable reproductive outcomes compared with gamete-based strategies. Opportunities lie in advances in cryopreservation, transplantation techniques, and integration with in vitro maturation. Major threats include limited data in breast cancer-specific populations, challenges in BRCA mutation carriers, and low utilization rates affecting cost-effectiveness and healthcare sustainability. Conclusions: OTC represents a valuable complementary FP option for selected breast cancer patients, particularly in urgent settings. Despite promising outcomes, its use should remain individualized within multidisciplinary counseling, considering patient-specific oncological and reproductive factors, while further research is needed to clarify long-term safety and efficacy.

Background: Preserving fertility in young women with cancer is crucial for comprehensive care. Based on GBD 2023 estimates, approximately 1000 women aged 15–39 are diagnosed with haematological malignancies annually in Italy. Guidelines recommend timely fertility preservation (FP) counselling for all at-risk patients, yet real-world access data remain limited. Methods: This multicentre, retrospective observational study analysed FP counselling for women aged 15–39 with haematological malignancies from 2015 to 2023. Counselling data were extracted from the Italian Assisted Reproductive Technology Registry (IARTR). This data collection system, known as PreFerIta, was developed within a project supported by the Italian Ministry of Health to collect data on Fertility Preservation (FP) treatments in oncology patients and/or those at risk of iatrogenic infertility, provided in seven specialised ART centres across Italy. The PreFerIta database includes data on both oocyte cryopreservation and ovarian tissue cryopreservation. Annual visits were related to the estimated regional incidence of new haematological malignancies (GBD 2023). Counselling-to-incidence ratios, absolute/relative gaps, and 95% confidence intervals (CIs) were calculated. Results: From 2015 to 2023, an estimated 4473 new haematological malignancies occurred in the catchment regions. Concurrently, 1200 FP counselling visits were recorded. While incidence modestly declined, counselling activity remained high. The counselling-to-incidence ratio increased from 17.33% in 2015 to 31.92% in 2018, stabilising between 26% and 31% thereafter (30.98% in 2023). The relative counselling gap decreased from 82.67% to 69.02%. These ratios represent lower-bound estimates of access to specialised oncofertility consultations. Conclusions: In this Italian network, approximately one in four to one in three incident haematological malignancies in young women were associated with specialised FP counselling. This reflects a substantial integration of oncofertility services into haematology care, highlighting opportunities to further strengthen referral pathways and achieve full guideline concordance.

Non-invasive prenatal testing (NIPT) based on circulating cell-free DNA (cfDNA) has transformed prenatal screening for common aneuploidies, but its interpretation is less straightforward in pregnancies conceived with donor oocytes. In this setting, fetal chromosomal risk is largely donor-driven, whereas cfDNA interpretability is shaped mainly by the recipient and the placenta. Donor-oocyte pregnancies are enriched for advanced maternal age, obesity, hypertensive and immunologic complications, low-molecular-weight heparin exposure, multiple gestation, vanishing twin, and placental dysfunction – all factors that can destabilize the cfDNA signal. Fetal fraction should therefore be read not only as a technical quality metric but also as a biological marker of placental performance. Analytical platform behavior also matters; counting-based and single-nucleotide polymorphism-based approaches may behave differently in biologically complex samples, particularly for sex chromosome findings and in the setting of maternal confounding. In donor-oocyte pregnancies, a no-call result may be clinically informative rather than neutral. Pre-test counseling, explicit communication with the laboratory, availability of fetal-fraction reporting, and integration with first-trimester ultrasound are essential. Donor-oocyte pregnancy should be regarded as a biologically distinct model for cfDNA screening, one that exposes the limits of generic NIPT algorithms and argues for more tailored interpretation.

Early-onset colorectal cancer is increasing, making reproductive health an increasingly relevant survivorship issue. Immune checkpoint inhibitors have altered the management of deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) colorectal cancer, but their oncofertility implications remain insufficiently defined. We performed a focused narrative review, structured in line with the SANRA framework. PubMed/MEDLINE, international oncology and reproductive-medicine guidelines, colorectal cancer clinical practice guidelines and regulatory product information were searched up to 8 May 2026. Evidence was prioritized according to relevance to colorectal cancer treatment pathways, reproductive and sexual health, immune checkpoint inhibitor-related ovarian and endocrine effects, pregnancy and lactation safety, and fertility preservation counselling. Colorectal cancer should not be considered a single reproductive-risk scenario. Colon and rectal cancer differ anatomically, therapeutically and functionally; disease stage affects the window for fertility preservation; and dMMR/MSI-H status determines where immunotherapy is clinically relevant. Direct reproductive effects of immune checkpoint inhibitors remain uncertain and are supported mainly by biological plausibility, endocrine toxicity data, limited non-CRC ovarian-reserve data and pharmacovigilance. Conversely, indirect effects may be clinically important when immunotherapy reduces exposure to pelvic radiotherapy or radical surgery in selected dMMR/MSI-H rectal cancer patients. Counselling should be early, individualized and pathway-based.