Fertility Preservation and Sexual Health After Cancer Therapy

Abstract

Recent developments in cancer diagnostics and treatments have considerably improved long-term survival rates. Despite improvements in chemotherapy regimens, more focused radiotherapy and diverse surgical options, cancer treatments often have gonadotoxic side-effects that can manifest as loss of fertility or sexual dysfunction, particularly in young cancer survivors. In this review, we focus on two pertinent quality-of-life issues in female cancer survivors of reproductive age-fertility preservation and sexual function. Fertility preservation encompasses all clinical and laboratory efforts to preserve a woman's chance to achieve future genetic motherhood. These efforts range from well-established protocols such as ovarian stimulation with cryopreservation of embryos or oocytes, to nascent clinical trials involving cryopreservation and re-implantation of ovarian tissue. Therefore, fertility preservation strategies are individualized to the cancer diagnosis, time interval until initiation of treatments must begin, prognosis, pubertal status, and maturity level of patient. Some patients choose not to pursue fertility preservation, and the conversation then centers around other quality of life issues. Not all cancer treatments cause loss of fertility; however, most treatments can directly impact the physical and psychosocial aspects of sexual function. Cancer treatment is also associated with fear, anxiety, and depression, which can further decrease sexual desire, function, and frequency. Sexual dysfunction after cancer treatment is generally ascertained by compassionate inquiry. Strategies to promote sexual function after cancer treatment include pelvic floor exercises, clitoral therapy devices, pharmacologic agents, as well as couples-based psychotherapeutic and psycho-educational interventions. Quality-of-life issues in young cancer survivors are often best addressed by utilizing a multidisciplinary team consisting of physicians, nurses, social workers, psychiatrists, sex educators, counselors, or therapists.

Medical egg freezing: How cost and lack of insurance cover impact women and their families

“…Indeed, more and more women around the world are being referred for MEF over time, as has been suggested in a number of recent global assessments ( Rashedi et al, 2018a , Rashedi et al, 2018b , Salama and Woodruff, 2017 ). Thus, the time will come when MEF is viewed as both a rational and ethical measure for women needing fertility preservation, especially as cancer survival rates improve around the globe ( Pereira and Schattman, 2017 ). As this study suggests, removing barriers to access MEF by reducing the cost and providing universal insurance coverage will have a major positive impact on women and their families.…”

Decellularization and recellularization of the ovary for bioengineering applications; studies in the mouse

“…Radiotherapy and chemotherapy against cancer are commonly associated with reproductive disorders. These treatment-induced gonadotoxic effects may include a reduction in the number of primordial follicles, vascular damage and ovarian cortical fibrosis [ 1 , 2 ]. Many treated women therefore experience premature ovarian insufficiency that is associated with early menopause and infertility.…”

Decellularization of the mouse ovary: comparison of different scaffold generation protocols for future ovarian bioengineering

“…Recent advancements in cancer therapy have significantly improved survival rates, but fertility dysfunction after therapy is common due to negative side effects. Concerning women and cancer therapy, even low doses of radiation significantly reduce the number of primordial follicles [1, 2]. In addition, the ovaries are particularly sensitive to alkylating cytotoxic drugs [3], and chemotherapies have been associated with vascular damage and ovarian cortical fibrosis [4, 5].…”