With significant improvement in survival rates for various types of malignancies, mainly due to the recent advancements in early diagnosis and treatment, more and more patients with either current or past diagnosis of cancer are now seeking infertility treatment.

The other important reason for assisted reproduction specialists to come across these patients more often is that infertile patients are reported to have higher incidence of cancer [1].

The infertile nulliparous women especially those with unexplained infertility have been associated with an increased risk of developing ovarian and uterine cancers (standardized incidence ratio [SIR] 2.64 [95 % CI 1.10–6.35] and 4.59 [95 % CI 1.91–11.0] respectively) [2].

Several confounding factors such as infertility itself rather than the medications may well be the reason for the increased incidence of cancer among infertile women [1].

Infertility practitioners can be faced with two different subgroups of cancer patients. The first group consists of those women recently diagnosed with cancer and have been recommended either surgery or chemotherapy/radiotherapy with potential to cause significant compromise to their reproductive ability. These women may not have had subfertility issues as such, but they wish to preserve their chance of having a child in the future. The treatment of this group presents several unique challenges. Cancer may affect multiple tissues throughout the body and can result in a variety of complications during controlled ovarian stimulation [3]. A multidisciplinary approach including the oncologist, psychologist, and reproductive medicine specialist is imperative to counsel and help the patient to make an informed choice. The task is especially difficult as the patient and family are still going through the shock and acute distress of being diagnosed with cancer and their maximum focus is to get the treatment started at the earliest.

Multiple strategies have emerged in the recent times aiming to preserve fertility in such women. These include embryo and oocyte (both mature and immature) cryopreservation, cortical and whole ovary cryopreservation, ovarian transplantation, ovarian transposition, and GnRH agonist protection [4]. Recent advances in the technology of vitrification of human oocytes and embryos have increased the opportunities for this group of women [5]. Current statistics of chances of live birth from cryopreserved ovarian tissue are depressingly poor, with a handful of births reported worldwide [5]. Currently, embryo and mature oocyte cryopreservation following in vitro fertilization (IVF) are the only techniques endorsed by the American Society of Reproductive Medicine, and all other methods are still considered to be investigational [6, 7]. Ovarian stimulation for these patients in order to retrieve good quality sufficient number of oocytes under the time pressure with minimum side effects is extremely important and remains a challenging task.

The second group of patients is those who had suffered and survived the cancer either during their childhood or reproductive age. More than 7,90,000 new female cancer cases were estimated to be diagnosed in 2012 in the United States [8]. Substantial improvements in cancer treatment have greatly increased 5-year survival rates in these women. From 2002 to 2012, 83 % of women younger than 45 years diagnosed with cancer survived [9]. The treatment for most of the cancer types in reproductive-age women involves either removal of the reproductive organs or cytotoxic treatment (chemotherapy and/or radiotherapy that may partially or definitively affect reproductive function) [10]. Infertility is reported to be a major concern as a long-term effect of these treatments, especially in female cancer survivors [11, 12].

Quantification of the risk of reproductive dysfunction after cancer treatment (radiotherapy to pelvic organs and chemotherapy regimens containing alkylating agents) is a major challenge [13]. Menstruation is not a sensitive way to identify the gonadotoxic effects of treatment [14]. Barton et al [13] noted an increased risk of infertility in cancer survivors at very young ages, even though many resumed menstruation, showing that the menstrual function does not equate to normal fecundity. The fertility preservation should be considered in these cancer survivors if they are not ready to attempt conception [13].