Improving survival for many cancers that affect children and young adults, together with advances in fertility preservation, make a cancer-free future that includes a family a realistic possibility for patients who desire this option. Although it is difficult for many clinicians and patients to reconcile fears surrounding a life-threatening diagnosis with hope for long-term survival and even a future family, addressing this vital survivorship issue early in the course of diagnosis and treatment is imperative if the fullest range of fertility-preserving options is to be offered.Oncological therapies, including chemotherapy, radiation and surgery, pose various threats to fertility. Children, adolescents and young men and women with cancer have different options for maintaining their ability to have biological children. The current state of the science for fertility preservation in each of these demographic groups is discussed in this article. A multidisciplinary approach to the care of young cancer patients, a timely assessment of threats to fertility and opportunities for intervention provide young cancer patients with the best chance for a healthy future that includes biological offspring.
KeywordsFertility preservation, oncofertility, cancer, chemotherapy, embryo cyropreservation A discussion of a patient's desires for future fertility is a challenging topic to raise in the early stages of a cancer diagnosis. It is difficult for many clinicians and patients to reconcile fears surrounding a life-threatening diagnosis with hope for long-term survival and even a future family. Yet improved survival rates for many cancers that affect young patients and recent advances in fertility preservation, taken together, make planning for a cancer-free life that includes a family a reality. Both men and women have similar threats to fertility inherent to treatment for cancer, but the opportunities to intervene are quite different. The following is a review of the current state of the science of fertility preservation for cancer patients.
Men with CancerFertility challenges in men with cancer are the most straightforward because of the relative ease of obtaining and cryopreserving sperm. This is not to say that significant threats to fertility do not exist.Treatments for cancer can cause direct damage to the germinal epithelium of the testis, disrupt the hypothalamic-pituitary-gonadal axis and cause psychological depression, which also affects fertility. High-dose pelvic irradiation used to treat these malignancies, as well as rectal malignancies, may also permanently damage testicular and erectile function.2 Radiation not directed towards the pelvis can also be toxic to sperm due to internal scatter, even at low doses. 3,4 Spermatogenesis is a process that is extremely vulnerable to the damaging effects of cytotoxic chemotherapy, and azoospermia or oligospermia frequently result.
5-7Cryopreservation of human sperm is an accepted technology in common use and there are reports of viable fertilisation with sperm store...