With the continuous improvement of the treatment level of malignant tumors, hematological diseases and various rare diseases in China, the overall survival of more and more patients is extended, but radiotherapy and chemotherapy not only save lives, but also cause irreversible damage to gonadal function, resulting in serious consequences such as early-onset ovarian insufficiency (premature ovarian failure), loss of fertility, and early onset of various chronic diseases in female patients, affecting the quality of life and life and health of patients.

In recent years, under the guidance of the National Health Commission and the promotion of multidisciplinary collaboration model, China's fertility protection technology system has been gradually established, and the technology represented by ovarian tissue cryopreservation has continued to mature. Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University has created China's first ovarian tissue cryopreservation bank, and has carried out ovarian tissue cryopreservation for nearly 1,000 girls and female patients of childbearing age, and completed 55 cases of cryopreserved ovarian tissue transplantation, with a recovery rate of 100% ovarian endocrine function after transplantation. Among them, 2 patients with fertility intentions have successfully conceived naturally and delivered healthy babies after cryopreserving ovarian tissue transplantation, marking a major scientific and technological transformation of ovarian tissue cryopreservation and transplantation technology in clinical routine application in China.

However, the accessibility of fertility protection techniques is insufficient, and most female patients are unaware of the adverse effects of chemoradiotherapy on fertility. A survey of more than 600 patients across the country showed that more than 80% of female patients were not informed or received information about the serious effects of radiotherapy and chemotherapy on fertility and ovarian function before chemoradiotherapy, resulting in permanent loss of fertility without knowledge or full knowledge, and their lives and health were also seriously affected.

It is estimated that there are more than 1 million girls and female patients of childbearing age who may need fertility protection in China every year. In the context that relevant technologies have a foundation for clinical application and achieved phased results, further improving the medical notification system, strengthening multi-departmental coordination and policy support can better protect patients' informed choice and promote the standardized and orderly development of fertility protection. Based on years of clinical practice and national collaboration experience, the following suggestions are proposed:

The first is to establish and improve the medical notification system for the protection of fertility and gonadal function of patients as soon as possible. Medical institutions at all levels and types should fully implement the "Opinions on Promoting the Construction of Fertility-Friendly Hospitals" issued by the General Office of the National Health Commission in December 2024, fully inform patients (or guardians of minor patients) before cancer treatment or other treatments and operations that may harm fertility, and strengthen the protection of fertility function. The subjects that need to implement medical notification are all levels and types of medical institutions; The informed population includes all benign (malignant) tumors, rare diseases, and other children and patients of childbearing age who need to receive radiotherapy, chemotherapy, hematopoietic stem cell transplantation and gonadal surgery; The notification time node is after the disease is diagnosed and before the start of treatment; The content of the notification is the risk of gonadal function damage and irreversible fertility damage and other risk factors. Public hospitals at the county level and above shall establish fertility protection consultation clinics and train fertility protection experts. Incorporate informed consent for fertility protection into the medical record quality control system, as well as the fertility-friendly hospital review and hospital grade evaluation standard system, and implement the implementation and supervision of notification.

The second is to establish a multidisciplinary joint notification and referral mechanism. Fertility protection involves pediatrics, oncology, hematology, radiotherapy and chemotherapy, reproductive medicine, gynecology, endocrinology and other disciplines, and it is necessary to establish a working mechanism for multidisciplinary consultation and early assessment and comprehensive decision-making. For patients who need fertility protection, a green channel for consultation and referral should be established to complete fertility protection without affecting the timeliness of treatment of the primary disease.

The third is to improve policy guarantees such as medical insurance. In the face of the risk of fertility damage, the issue of cost is an important practical factor affecting patients' decision-making. It is recommended to gradually expand the payment scope of fertility protection projects at the medical insurance level, explore special assistance mechanisms for families with financial difficulties, and encourage the participation of commercial insurance and social funds to form a multi-level security system.

Fourth, strengthen the training of medical personnel and public science popularization. At present, some medical staff still have limited understanding of the indications, processes and technological progress of fertility protection. It is recommended to include relevant content in the standardized training and continuing education courses of residents; Rely on the strength of academic organizations to carry out training and improve multidisciplinary collaboration capabilities; Rely on mainstream media and health science popularization platforms to strengthen science popularization to the public and enhance patients' awareness of active consultation.

Promoting the comprehensive coverage and standardized implementation of fertility protection medical notices in all levels and types of medical institutions is a key measure to protect the reproductive health rights and interests of the masses and reduce iatrogenic fertility injuries from the source, which is conducive to promoting the construction of a fertility-friendly society and improving the level of reproductive health services throughout the life cycle.