Cancer treatment is the most frequent cause of reduced fertility in cancer patients, with up to 80% of survivors affected. None of the established or experimental fertility preservation methods can assure parenthood; instead it may provide a future opportunity to overcome treatment induced sterility. Previous research demonstrated that fertility counselling has clinical and psychological benefit. Therefore, such patient services are recommended by internationally recognized guidelines. Around 70-75% of young cancer survivors in retrospective studies are reported to desire parenthood but the numbers of patients who use fertility preservation services prior treatment are significantly lower. Moreover, despite existing guidelines healthcare professionals worldwide lack practical knowledge and have personal biases which prevent addressing fertility preservation issues adequately. Surveys of healthcare professionals report the following barriers: lack of time and knowledge about existing options, poor prognosis, and delay in treatment, patient's age, partnership status, existing children, sexual orientation and socioeconomic situation. Moreover, fertility preservation consultation is not limited to medical aspects. Patient's fears, expectations and priorities shaped by personal values have to be addressed in a light of medical necessities, realistic survival prognosis, socio-cultural environment and availability of resources. We call for a need of framework for patient centred fertility counselling with a proposal that such framework should include support in decision making which would help patients to understand medical aspects of their cancer, realistic fertility preservation options, identify their preferences based on personal values and goals. Optional support services could also include legal guidance, psychological and spiritual support and financial counselling.

DeCo is useful to facilitate decision making and reduce decisional conflict. It plays a role in the perception of being informed while not directly providing clinical information. This model of decisional support intervention, in which information is provided only by the clinician and decisional support is focused on personal aspects that influence the decision, could improve shared decision making between patient and clinicians.

Thanks to the recent advances in reproductive medicine, more and more young women with breast cancer may be offered the possibility of preserving their fertility. Fertility can be endangered by chemotherapy, by treatment duration and by patient’s age at diagnosis. The currently available means to preserve a young woman’s fertility are pharmacological protection with gonadotrophin-releasing hormone analogues during chemotherapy, and ovarian tissue or oocyte/embryo freezing before treatment. New future venues, including in vitro maturation, will improve the feasibility and efficacy of the fertility preservation methods in breast cancer patients.