Recognizing and Addressing Fertility Issues among Childhood Cancer Patients and Survivors in India – A Multi Stakeholder Position Statement and Call to Action

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Abstract Survival rates in childhood and adolescent cancers have improved substantially over the past decades, leading to a growing population of long-term survivors. In India, an estimated 76,000 children and adolescents are diagnosed with cancer annually, and approximately one-quarter receive treatments associated with a high risk of gonadal toxicity. Fertility impairment is therefore an increasingly important survivorship issue. Despite international recommendations advocating fertility counselling and preservation prior to treatment, access to such services in India remains limited. Barriers include low awareness among healthcare providers and families, limited availability of assisted reproductive technology (ART) services in the public sector, high costs, sociocultural factors, and regulatory uncertainties under the Assisted Reproductive Technology Act, 2021. Fertility preservation options are also constrained for prepubertal patients, for whom experimental approaches such as gonadal tissue cryopreservation are not widely available. This viewpoint summarizes the burden of fertility impairment among childhood cancer survivors in India, reviews current standards of care, and highlights key gaps in access and policy. We propose a multi-stakeholder call to action involving clinicians, policymakers, reproductive specialists, and survivor groups to improve counselling, expand services, develop India-specific guidelines, and integrate fertility preservation into pediatric oncology care pathways.