Fertility preservation in females requiring gonadotoxic therapy should be more than freezing measures before therapy - secondary fertility preservation and menopause care management after therapy should also be considered.

To date, fertility preservation has mainly been offered to patients prior to gonadotoxic treatment. Ovarian reserve is assessed by analysing blood levels of anti-müllerian hormone (AMH), and gonadal cells or tissue are cryopreserved if indicated and requested by the patient. If primary fertility preservation (Primary FertiProtekt) before gonadotoxic treatment was not performed or was ineffective, secondary fertility preservation should be considered approximately one year after treatment based on a more extensive ovarian reserve analysis including menstrual cycle pattern, antral follicle count, and serum levels of AMH, estradiol and follicle stimulating hormone. Ovarian reserve analysis is also required to consider endocrine treatment in (pre) menopausal patients. Both approaches require the fertility preservation treatment to be tailored to the ovarian reserve status, type of gonadotoxic therapy. For secondary fertility preservation (Secondary FertiProtekt), oocyte freezing may be considered if ovarian reserve is not too low. Monthly treatment cycles, natural cycle or minimal stimulation protocols and follicle aspiration without anesthesia should be preferred. Menopause care management (MenoProtekt) involves acute menopausal symptom relief and prevention of chronic non-communicable diseases. The management needs to be individualized based on type of disease (hormone-dependent or -independent).