Fertility Preservation in 2026: Current Landscape in Europe and the United States for Children and Adolescents Undergoing Hematopoietic Stem Cell Transplantation - Recommendations on Behalf of the Westhafen Intercontinental Group

Advances in hematopoietic stem cell transplantation (HSCT) and other cellular therapies have continued to better the long-term outcomes for pediatric patients undergoing these treatments. However, treatment impacts on future fertility can have substantial impact on patient quality of life. Concurrent with improvements in transplantation, fertility preservation (FP) options and outcomes have also evolved. Options such as ovarian tissue cryopreservatation and testicular tissue cryopreservation are now more widely available and can be considered for very young patients. The timing and choice of FP to be offered can be complex and many considerations must be made when counseling patients and families. Cost and access is also variable depending on the country and region in which a patient resides. The aim of this paper is to provide an updated overview of the current strategies and recommendations for FP that should be offered to all children and adolescents undergoing an allo-HSCT. By summarizing contemporary evidence and practices, this paper may provide support to clinicians in delivering equitable, informed, and accessible FP counseling and care for all eligible patients.