Fertility preservation in gynecologic cancers

Abstract

A number of fertility-preservation techniques have been developed and many others are in the experimental stages. Consistent with recent ASCO clinical guidelines, all young individuals with gynecologic cancer should be counseled about the available fertility preservation techniques.

Procedures for fertility preservation in female cancer patients

“…Ice crystal formation, mentioned above, and problems with penetration of cryoprotective agents plays here a role, too [32]. Vitrification seems preferable for cryopreserving more complex and heterogeneous biological systems such as whole ovaries [18]. One possibility would be to vitrify the whole ovaries with their lumbo-aortic vascular pedicle so as to reduce follicle loss on graft revascularisation.…”

“…Nevertheless, the safety of using GnRH analogues in conjunction with chemotherapy has not been clearly established. Moreover, not only are GnRH analogues are expensive and cause severe menopausal symptoms, but the long-term use may also be associated with irreversible bone loss [5,18].…”

“…It has been suggested that the ovaries be transposed at least 3 cm from the upper border of the radiation field, but overstretching the infundibulopelvic ligament may result in compromised ovarian blood flow or adnexal torsion. Furthermore, its value is limited to young cancer patients who are treated with radiation only [18]. n REVIEWS n …”

Oocyte Cryopreservation for Elective Preservation of Reproductive Potential

“…Many oncologists are supportive of their patients' desire to preserve fertility, even in light of the potential delay of chemotherapy and need for gonadotropin stimulation. Women who require immediate initiation of chemotherapy or pediatric cancer patients may benefit from ovarian tissue cryopreservation, though studies of this technique are still quite small and this strategy has not yet been widely used (Oktay & Sönmezer, 2007).…”

“…Cervical cancer often requires pelvic radiation and endometrial cancer is frequently treated with hysterectomy and bilateral salpingoophorectomy. Therapy for breast cancer, the most common cancer in women in the United States, commonly utilizes cyclophosphamide, which has well-known ovary-toxic effects and leads to premature ovarian failure (Oktay & Sönmezer, 2007). Ovarian stimulation is necessary for both oocyte and embryo cryopreservation for these patients; stimulation protocols have been developed to avoid excessive estrogen exposure in women with estrogen-responsive cancers.…”