Preservation of Fertility in Female Cancer Patients Desiring Future Child Bearing; What is Available and What can be Offered

Abstract

The aim of this review is to present an overview of available methods for preservation of ovarian function and fertility in female cancer patients who desire to maintain their child-bearing capacity for future pregnancies. A Medline search was conducted. Published articles from American and European studies from 1976 to present were reviewed. The effect of cancer treatment on the ovary, as well as different methods of fertility preservation and their reproductive outcomes are presented. Pregnancy rates vary according to the type of primary malignancy, stage of disease, method of fertility preservation (for example, hormonal therapy, cryopreservation, fertility-sparing surgery), and other confounding factors such as the patient’s age, reproductive capacity, status of partnership, and genetic disposition. The highest rates of successful pregnancy were observed with embryo cryopreservation. Today, higher cure rates and longer survival are a result of earlier cancer diagnosis and treatment. In conjunction with the advances in assisted reproduction, the preservation of ovarian function and fertility is a major part of multidisciplinary care that should be offered to any young female patient with cancer. Fertility preservation in young cancer patients raises a number of ethical issues particularly regarding standard versus experimental therapies, and long-term financial cost.

A 19 year old with heavy vaginal bleeding; unlikely diagnosis of uterine carcinsarcoma

“…Oncologists treating young female patients with cancer should be aware of two important issues; first, the effect of cancer treatment on the patient's fertility and second, the available options to preserve ovarian function and chances of future pregnancy. 15 To date, there are no national consensus guidelines that have been established for the management of uterine carcinsarcoma in the pre or post menopausal patient. 12 The primary treatment remains surgery; however, high rates of relapse and metastases postoperatively necessitate effective adjuvant therapies.…”

Female Fertility

“…[ 9 ] Thus, a woman could bear children even after chemotherapy or menopause, as well as store eggs extracted for an in vitro fertilization (IVF) cycle. [ 10 ] Ever since the first baby born from a frozen embryo in 1983,[ 11 ] and the first pregnancy achieved from a frozen oocyte in 1986,[ 12 ] interests in cryopreservation techniques are growing tremendously. Over the past 30 years, techniques for cryopreservations of human embryos, oocytes, and ovarian tissues have been developed, with two main techniques commonly being used: the traditional, slow-freezing method, and vitrification, a novel technique combining ultra-rapid cooling time with high cryoprotectant concentration, engendering glass-like formation to avoid damaging ice crystals.…”

Systematic Review of Available Guidelines on Fertility Preservation of Young Patients with Breast Cancer

“…For these reasons, quality of life remains an important consideration for patients surviving BC, particularly those <40 years of age, and interdisciplinary collaboration has become an essential part of survivor management. Among various side effects of BC, the issues of fertility have been recognized with great importance for young women diagnosed with breast cancer (Sonmezer and Oktay, 2004;Ewertz and Jensen, 2010;Rodriguez-Wallberg and Oktay, 2010;Christinat and Pagani, 2012;Husseinzadeh and Husseinzadeh, 2013;. After the publication of first guidelines on fertility preservation (FP) for cancer patients by American Society of Clinical Oncology (ASCO) in 2006 (Lee et al, 2006), and National Institute for Health and Clinical Excellence (NICE) in 2004 (National Collaborating Center for Women's and Children's Health (UK), 2004), oncologists are recommended to discuss the influences of cancer therapies on fertility with their young patients as early as possible and consider fertility preservation as a part of care.…”

“…Fertility preservation options have also been used for other diseases such as lupus, glomerulonephritis, myelodysplasia, and premature ovarian failure as well as in women who wish to preserve their ovarian function for future reproductive potential and delayed childbearing age (Posada et al, 2001;Imhof et al, 2004;Demeestere et al, 2007;Maltaris et al, 2007;Isachenko et al, 2007;Ajala et al, 2010;Rahimi et al, 2010;Dolmans et al, 2010;Michaeli et al, 2012;Husseinzadeh, 2013). Despite rapid progress in cryopreservation technology and existing other resources and infrastructure, fertility preservation for young breast cancer patients is in its early stage with many challenges (Posada et al, 2001;Imhof et al, 2004; National Collaborating Center for Women's and Children's Health (UK), 2004; Sonmezer and Oktay, 2004;Lee et al, 2006;Demeestere et al, 2007;Isachenko et al, 2007;Maltaris et al, 2007;Ajala et al, 2010;Dolmans et al, 2010;Ewertz and Jensen, 2010;Rahimi et al, 2010;Christinat and Pagani, 2012;Klemp and Kim, 2012;King et al, 2012;Michaeli et al, 2012;Klemp and Kim, 2012;King et al, 2012;Fields et al, 2013;Husseinzadeh, 2013;Husseinzadeh and Husseinzadeh, 2013;Leclere et al, 2013;Loren et al, 2013;Ronn and Holzer, 2013). The present study aimed to systematically review available guidelines on preservation of fertility in breast cancer patients.…”