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Traditional protocols, including total body irradiation (TBI) and busulfan\u2010based regimens, can impair fertility. This review explores the potential of gonadal shielding during TBI and treosulfan\u2010based conditioning as strategies to optimize treatment efficacy while preserving fertility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PubMed search up to February 2025 was performed for English, peer\u2010reviewed articles on hematologic malignancies, HSCT, shielding, and treosulfan. Studies on oncologic outcomes and fertility in pediatric and AYA patients were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Findings<\/jats:title>\n                    <jats:p>Ovarian shielding during myeloablative conditioning with TBI effectively reduces ovarian radiation exposure, resulting in improved menstrual recovery and hormone profiles. A treosulfan\u2010based regimen demonstrated higher antitumor activity than a reduced\u2010intensity busulfan\u2010based regimen in randomized controlled trials. In a retrospective analysis, the treosulfan\u2010based regimen exhibited lower gonadal toxicity than the busulfan\u2010based regimen, although careful attention must be paid to dosing settings of the regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ovarian shielding during TBI and a treosulfan\u2010based regimen hold the potential to preserve the reproductive capacity of patients undergoing HSCT. Future clinical studies that appropriately assess both oncological outcomes and fertility are needed to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/rmb2.12648","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T23:55:36Z","timestamp":1744934136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Optimizing treatment efficacy and fertility preservation in patients undergoing hematopoietic stem cell transplantation: A narrative review of ovarian shielding with total\u2010body irradiation or treosulfan\u2010based conditioning regimens"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-8151","authenticated-orcid":false,"given":"Yuji","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Shiga University of Medical Science  Otsu Shiga 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