Fertility preservation and breast cancer: a review

Abstract

Breast cancer is the most common malignancy in women, and its incidence increases with age, with the majority of patients diagnosed after menopause. However, in 15–25% of cases, patients are premenopausal at the time of diagnosis, and about 7% of them are below the age of 40. Therefore, a considerable amount of young women are diagnosed with breast cancer during their reproductive life. Within this group, most cancer cases require cytotoxic chemotherapy and/or hormone therapy, which are responsible for a decrease in the patients’ reproductive function, along with their age. The efficacy of such treatments, among other factors, has led to a high five-year-survival rate, which results in an increasing number of young women who survive breast cancer before having fulfilled their reproductive wishes, especially considering the current trend to delay pregnancy until the late 30s or early 40s in developed countries. The combination of these factors justifies the importance of fertility preservation and reproductive counselling at the time of breast cancer diagnosis in young women.A wide range of fertility preservation techniques has been developed, such as ovarian suppression, oocyte and embryo cryopreservation, immature oocyte retrieval and in vitro maturation, and ovarian tissue cryopreservation.Early counselling and referral of these patients to fertility specialists are fundamental factors in order to maximise their chances of pregnancy. This review aims to update the knowledge about the influence of breast cancer in fertility, the influence of pregnancy and fertility preservation techniques in breast cancer patients and assessment of ovarian reserve for a better treatment choice. A special section dedicated to BRCA-mutation carriers has been included because of their specific features.A comprehensive literature search has been conducted, including publications from the last five years.

Caring for breast cancer survivors in primary care

“…Data now suggest that women can achieve a healthy pregnancy after breast cancer treatment, without negatively affecting their disease-free or overall survival, regardless of hormone receptor status. 19,35 For premenopausal women who do not desire future pregnancy, hormone-free contraception options include permanent sterilization (male or female), copper intrauterine devices, or barrier methods. Amenorrhea and elevated follicle-stimulating hormone levels are unreliable indicators of infertility in women who have received chemotherapy.…”

Assisted Reproduction and Preimplantation Genetic Diagnosis in Patients Susceptible to Breast Cancer

“…Pa cientky je třeba při sdělení diagnózy informovat o riziku neplodnosti a současně o dostupných metodách uchování plodnosti, včetně kryokonzervace oocytů a embryí před zahájením léčby [1]. Problematika plodnosti pa cientek po léčbě karcinomu prsu je podrobně rozebrána v několika přehledných článcích [2][3][4][5].…”

“…Zaniknou tak rostoucí a antrální folikuly s následnou amenoreou. Nové rostoucí folikuly se vyvinou z intaktních primordiálních folikulů s odstupem 3-6 měsíců, a proto amenorea může být přechodná při léčbě prostředky, které nepoškozující DNA a nemají vliv na ovariální rezervu [5].…”

Risk-benefit perception of pregnancy among breast cancer survivors

“…Evidence shows that the impact of chemotherapy on fertility is related to age-related baseline fertility and the type and dose of chemotherapy used (De Pedro et al, 2015;Hortobagyi, Buzdar, Marcus, & Smith, 1986;Mailliez, Decanter, & Bonneterre, 2011;Su, 2010). Evidence shows that the impact of chemotherapy on fertility is related to age-related baseline fertility and the type and dose of chemotherapy used (De Pedro et al, 2015;Hortobagyi, Buzdar, Marcus, & Smith, 1986;Mailliez, Decanter, & Bonneterre, 2011;Su, 2010).…”

“…therapy are vital issues for patients desiring pregnancy after breast cancer treatment. Evidence shows that the impact of chemotherapy on fertility is related to age-related baseline fertility and the type and dose of chemotherapy used (De Pedro et al, 2015;Hortobagyi, Buzdar, Marcus, & Smith, 1986;Mailliez, Decanter, & Bonneterre, 2011;Su, 2010). Hormonal drugs, such as aromatase inhibitors and tamoxifen, are prescribed for 5-10 years for oestrogen receptorpositive breast cancer treatment (Davies et al, 2013;Winer et al, 2005).…”