This article outlines counselling pathways that support reproductive preservation during oncologic care, emphasising multidisciplinary coordination, timely referrals, and realistic expectations for outcomes. It covers how HPV-related screening and diagnostics inform treatment choices, the fertility implications of surgery, radiotherapy and chemotherapy, considerations for immunotherapy, and the role of survivorship, palliative care and rehabilitation in reproductive planning. This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalised guidance and treatment.

HPV and screening

Counselling often begins at the point of diagnosis or abnormal screening. Where HPV is implicated, clinicians should explain how screening results and diagnostic investigations shape potential treatment and fertility-preservation pathways. Patients benefit from clear discussion about disease stage, pathology findings, and the relative risks of conservative versus definitive interventions. For some early lesions identified through screening, fertility-sparing surgical options may be clinically appropriate; for others, a more extensive approach may be required. Good counselling outlines timelines for decision-making, the need for fertility referrals before definitive therapy, and how screening follow-up will be structured during survivorship.

Surgery and diagnostics

Surgical options range from conservative excisional procedures to radical resections, each with different implications for reproductive capacity. Diagnostics including imaging and pathology reports determine the extent of resection required and help identify candidates for fertility-preserving procedures such as cone biopsy or radical trachelectomy. Counselling should clearly explain potential impacts on cervical competence, uterine integrity, and adjacent pelvic structures, as well as possible reconstructive measures. When surgery threatens fertility, referral to reproductive medicine specialists to discuss oocyte or embryo cryopreservation, ovarian transposition, or other techniques is essential. Documentation of patient preferences and coordination between surgical and fertility teams reduces delays and preserves choice.

Radiotherapy and chemotherapy

Both radiotherapy and chemotherapy can reduce ovarian reserve and alter uterine function; risks vary by agent, dose, field and patient age. Counselling should describe short- and long-term reproductive effects such as premature ovarian insufficiency, changes in menstrual function, and potential difficulties achieving and sustaining pregnancy. Practical options that may be offered include ovarian suppression with GnRH analogues during systemic chemotherapy, oocyte or embryo cryopreservation prior to treatment, and shielding or surgical relocation of the ovaries when pelvic radiotherapy is planned. Clear information on timing is critical: many preservation methods require a brief window before treatment begins, so rapid assessment and referral pathways should be established to avoid missed opportunities.

Immunotherapy and pathology

Immunotherapy and newer targeted treatments are increasingly used and may have different reproductive risk profiles than conventional therapies. Pathology and molecular diagnostics guide the use of these agents, but evidence about long-term fertility effects is still developing for some drugs. Counselling must therefore balance existing data with acknowledged uncertainties, advising consultation with reproductive specialists when necessary. Discussion should include how molecular pathology affects both cancer-directed choices and fertility options, whether fertility-sparing approaches are compatible with the planned systemic therapy, and contingency plans should disease progression require a change in treatment strategy.

Survivorship, palliative care and rehabilitation

Long-term planning for survivorship should incorporate reproductive goals alongside surveillance for late effects. Counselling in this phase includes discussion of timing for family-building, assessment of uterine and ovarian function, and monitoring for treatment-related complications that could affect pregnancy. Rehabilitation services can address sexual health, pelvic floor function, and psychosocial support that influence reproductive outcomes. When palliative care is part of the care plan, sensitive conversations should still respect patients’ reproductive values and discuss realistic options for family-building, including third-party reproduction or adoption where appropriate. Multidisciplinary follow-up helps align survivorship care with fertility goals.

Access, guidelines and outcomes

Access to fertility-preservation services varies by geography, insurance coverage and local availability of assisted reproductive technology. Counselling should provide clear information about local services or referral centres in your area, expected timelines, and how clinical guidelines inform recommended options. Outcome discussions must be factual: present evidence-based success rates for cryopreservation and assisted reproduction, typical timelines from referral to intervention, and potential complications. Clinicians should document informed consent and use guideline-aligned pathways to ensure equitable access. Transparent communication about possible outcomes helps set realistic expectations and supports shared decision-making.

Conclusion

Effective counselling pathways for reproductive preservation during oncologic care combine timely, evidence-based information on HPV-related screening and diagnostics with clear explanation of how surgery, radiotherapy, chemotherapy and immunotherapy may affect fertility. Coordinated multidisciplinary care, attention to survivorship and rehabilitation needs, and practical guidance about access and guideline-informed options support informed decision-making and realistic expectations about outcomes.