Fertility preservation in women with cancer

Abstract

Enhanced long-term survival rates of young women with cancer and advances in reproductive medicine and cryobiology have culminated in an increased interest in fertility preservation methods in girls and young women with cancer. Present data suggest that young patients with cancer should be referred for fertility preservation counselling quickly to help with their coping process. Although the clinical application of novel developments, including oocyte vitrification and oocyte maturation in vitro, has resulted in reasonable success rates in assisted reproduction programmes, experience with these techniques in the setting of fertility preservation is in its infancy. It is hoped that these and other approaches, some of which are still regarded as experimental (eg, ovarian tissue cryopreservation, pharmacological protection against gonadotoxic agents, in-vitro follicle growth, and follicle transplantation) will be optimised and become established within the next decade. Unravelling the complex mechanisms of activation and suppression of follicle growth will not only expand the care of thousands of women diagnosed with cancer, but also inform the care of millions of women confronted with reduced reproductive fitness because of ageing.

A win-win for women’s reproductive health: A nonsteroidal contraceptive and fertoprotective neoadjuvant

“…Fertoprotective (fertility protective) neoadjuvant therapies are urgently needed because the survival rate for young people with cancer has reached nearly 85% for some cancers (6,7). This improved survival of the ovarian reserve means the fertility-related threats of the life-preserving treatments are no longer acceptable to many patients and their families.…”

Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy May Increase Pregnancy Rate in Survivors

“…Several options have been put forward for preserving female fertility: ovarian transposition, cryopreservation of embryos, unfertilized oocytes, and/or ovarian tissue, and administration of GnRHa in an attempt to decrease the gonadotoxic effects of chemotherapy by simulating a prepubertal hormonal milieu [1][2][3][4][5][6]. Unfortunately, none of the suggested methods is ideal, and none guarantees future fertility in survivors.…”

First French live-birth after oocyte vitrification performed before chemotherapy for fertility preservation

“…Unfortunately, many treatments affect fertility; fertility preservation (FP) has become an important step in the management of young patients [1,2]. In female patients, FP techniques indications depends on various parameters; vitrification of mature oocytes has emerged as an established method in the past years [3]. Currently, in the context of FP before cancer treatment, dozens of live births have been published after ovarian cortex cryopreservation and subsequent grafting [4].…”