Fertility Preservation: An Integrated Review of Male and Female Strategies, Techniques, Outcomes, and Future Directions

Background/Objectives: Fertility preservation (FP) has become an integral component of multidisciplinary care for patients at risk of treatment- or disease-related infertility. Although several established and emerging fertility preservation strategies are currently available, important challenges remain regarding patient selection, timing of intervention, long-term reproductive outcomes, and the translation of experimental approaches into routine clinical practice. This review critically appraises the current evidence on female and male fertility preservation, highlighting established techniques, emerging technologies, unresolved clinical challenges, and future research priorities. Oocyte vitrification remains the preferred strategy for postpubertal women when ovarian stimulation is feasible, whereas ovarian tissue cryopreservation has become an established option for selected patients requiring urgent treatment or for prepubertal girls. In men, sperm cryopreservation remains the standard of care, while fertility preservation in prepubertal boys is still investigational. Despite excellent laboratory outcomes, the real-world utilization of cryopreserved reproductive material remains unexpectedly low, highlighting persistent barriers in patient referral, counselling, and long-term follow-up.