Infertility and Hematologic Malignancies in Low-Resource Settings: Challenges and Perspectives.

Infertility represents a significant challenge in reproductive health, with implications extending beyond individual well-being to public health systems worldwide. Despite its high prevalence, fertility impairment remains insufficiently integrated into cancer survivorship care, particularly in settings with limited healthcare resources. Hematologic malignancies constitute a distinct clinical context in which infertility risk is especially relevant, as these diseases often affect adolescents and young adults and are increasingly associated with long-term survival. However, standard treatments such as high-dose chemotherapy, radiotherapy, and hematopoietic stem cell transplantation carry a substantial risk of gonadal toxicity and long-term reproductive impairment. More recently, immunotherapy and targeted therapies have emerged as effective therapeutic options, yet their long-term effects on fertility remain poorly characterized and warrant further investigation. Although effective fertility preservation strategies are available, including sperm cryopreservation, oocyte vitrification, and embryo freezing, access to these interventions remains limited due to financial, structural, and logistical barriers, as well as insufficient clinician awareness. Integrating fertility preservation into routine hematologic care through enhanced education, institutional protocols, and supportive health policies is essential to address this under-recognized complication and improve long-term quality of life for cancer survivors in resource-limited settings.