Breast Cancer and Reproductive Health: Integrating Oncofertility Into Contemporary Care

Abstract Purpose of Review Reproductive priorities extend beyond fertility preservation to influence treatment sequencing, surgical decision-making, and survivorship. This review addresses the full continuum, including underexamined areas such as surgical de-escalation and patient-reported outcomes, alongside fertility preservation and pregnancy after treatment. Recent Findings Random-start stimulation and letrozole-based protocols preserve fertility without meaningful delay, even in hormone receptor-positive disease. Updated POSITIVE trial results continue to support endocrine therapy interruption for pregnancy. Axillary and breast surgical de-escalation trials increasingly enroll premenopausal women, though fertility- and lactation-specific outcomes remain understudied. Patient-reported outcomes, including sexual health, decisional regret, and financial toxicity, meaningfully shape survivorship, while access remains constrained by institutional, insurance, and geographic barriers. Summary Reproductive goals should inform decision-making across the entire breast cancer continuum, requiring multidisciplinary coordination and system-level efforts to close persistent evidence and equity gaps.