Fertility preservation in post-pubescent female cancer patients: A practical guideline for clinicians

Abstract

Abstract. Increasing accessibility of fertility preservation (FP) options has permitted women to retain fertility following anticancer therapies. Several published guidelines have made recommendations for FP however their implementation into practice is currently unknown. In this review, we aim to provide oncology clinicians practical information about FP options for post-pubescent female cancer patients and recommendations for care delivery in order to answer preliminary questions and help triage whether FP referral is appropriate. Herein, we present a resource for oncology providers to guide them with FP discussions. Key points that are discussed in this critical review include: i) All cancer patients beginning a new plan of care should be informed of potential fertility risk. ii) If a woman requests further information on FP interventions, referral to a FP clinic should be made. iii) Given the evolving technologies in this area, patients should be informed of those which are proven and unproven, with oocyte and embryo preservation recognized as standard practice. iv) Random start (independent of menstrual cycle day) techniques are available to minimize oncologic treatment delays. v) Specific protocols for ovarian stimulation may be center-specific. vi) There is unlikely an increased cancer recurrence risk as a result of stimulation protocols in women with hormone-sensitive cancers. vii) Lastly, given the absence of consensus in the literature, routine use of GnRH analogs is not recommended for all cancer patients, however may be considered in select cases, such as high-risk women in whom definitive FP is not possible or feasible.

Ovarian follicular waves during the menstrual cycle: physiologic insights into novel approaches for ovarian stimulation

“…Collectively, there is now evidence to validate the idea that multiple waves of antral folliculogenesis occur throughout the human menstrual cycle, similarly to those previously reported in several other mammalian species (23,24). The concept of follicular waves has challenged traditional models of ovarian physiology and led to the optimization of ovarian stimulation protocols for women undergoing assisted reproduction (25)(26)(27).…”

“…Rapid access to strategies for preserving fertility is required in this population, owing to the gonadotoxic nature of chemotherapy (76). Random-start stimulation has now become standard practice for women requiring fertility preservation before chemotherapy (26). DuoStim has also been shown to increase the total number of oocytes available for cryopreservation in these women without delaying cancer therapy (123).…”

Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach

“…For instance, ovarian stimulation in patients with early-stage breast cancer is safe in the long term [3]. Women diagnosed with cancer who have eggs or embryos cryopreserved before anticancer treatment have good chances for successful assisted reproductive technology performance and good perinatal outcomes [8][9][10]. In addition, the efficacy and safety of temporary ovarian suppression with gonadotropin-releasing hormone agonist during chemotherapy might be an available option to reduce the likelihood of chemotherapy-induced primary ovarian insufficiency and to improve future fertility in premenopausal patients with early breast cancer [11].…”

“…In addition, the efficacy and safety of temporary ovarian suppression with gonadotropin-releasing hormone agonist during chemotherapy might be an available option to reduce the likelihood of chemotherapy-induced primary ovarian insufficiency and to improve future fertility in premenopausal patients with early breast cancer [11]. It is worth noting that there is consensus in medical society that the long-term survival rate of the disease is not lower for any of the three types of fertility preservation [8][9][10][11]. Thus, if age, reproductive function, and the cancer stage allow, patients can choose their preferred fertility preservation method.…”

iPSC-Derived Ovarian Tissue Restores Ovarian Function in Subfertile Mice and After Gonadotoxic Chemotherapy

“…Many chemotherapeutic regimens are gonadotoxic, leaving women with compromised fertility after treatment. Currently, the most reliable method for fertility preservation is pre-chemotherapy fertility treatment cycles using ART to induce the growth of multiple oocytes for cryopreservation, either as oocytes or after fertilization as embryos 2,3 . Unfortunately, referral rates for ART prior to commencing gonadotoxic chemotherapy are low 4 .…”