Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer

Abstract

Fertility preservation in the young cancer survivor is recognized as a key survivorship issue by the American Society of Clinical Oncology and the American Society of Reproductive Medicine. Thus, health-care providers should inform women about the effects of cancer therapy on fertility and should discuss the different fertility preservation options available. It is also recommended to refer women expeditiously to a fertility specialist in order to improve counseling. Women’s age, diagnosis, presence of male partner, time available, and preferences regarding use of donor sperm influence the selection of the appropriate fertility preservation option. Embryo and oocyte cryopreservation are the standard techniques used while ovarian tissue cryopreservation is new, yet promising. Despite the importance of fertility preservation for cancer survivors’ quality of life, there are still communication and financial barriers faced by women who wish to pursue fertility preservation.

Current management of pregnancy-associated breast cancer

“…27 Embryo or oocyte cryopreservation is the main method to preserve female fertility. 36 Ovarian stimulation is carried out before commencing chemotherapy, but may result in relative delay in oncological treatment and increase serum oestradiol levels. This may be of concern in hormone-driven tumours like breast cancer.…”

Controversies over the use of GnRH agonists for reduction of chemotherapy-induced gonadotoxicity

“…Others such as ovarian tissue preservation are new, yet promising, fertility preservation treatments, with the first live birth after autotransplantation of human ovarian tissue reported in 2004. To date, there have been at least 60 live births after ovarian tissue reimplantation, with an estimated pregnancy rate of 25.0% in the largest series 9 . Unfortunately, this method does not preserve ovarian function but is the preferred method in prepubertal girls to preserve fertility.…”

New promising strategies in oncofertility

“…Reviews by Loutradi et al (2008) and AbdelHafez et al (2010), suggest human embryos preserved through vitrification yield higher survival rates post-thaw than those preserved using a slow-freeze method [53, 54]. As a method of fertility preservation, embryo cryopreservation yields pregnancy rates as high as 59% and a live birth rate of approximately 50% [55], depending on factors such as the age of the woman at the time of cryopreservation. As data in the US are not collected specifically among cancer patients and the use of cryopreservation, it is not known how or if these rates vary in this population.…”

“…Oocyte cryopreservation is more precarious compared to embryo cryopreservation as it involves a higher risk of damage during the preservation process and yields slightly lower overall pregnancy rates. Oocyte cryopreservation collection success has shown freeze-thaw survival rates of 90% to 95%, and pregnancy-per-transfer rates of 50% to 65% in prospective studies [35, 55, 57-59]. Most recent statistics on success rates of oocyte cryopreservation rates are combined with embryo cryopreservation rates; however, data form the Italian national registry of IVF centers suggests that the rates of lives births resulting from oocyte cryopreservation were slightly less than those of embryo cryopreservation [60, 61].…”

“…Pregnancy rates of ∼25% have been reported cancer survivors [35, 55]. In a recent study among post-menarchal women who had completed cytotoxic therapy, the live birth rate was 23% after a first transplantation and premature ovarian insufficiency [78].…”