What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines

Rives, Nathalie; Courbière, Blandine; Almont, Thierry; Kassab-Chahmi, D.; Berger, Claire; Grynberg, Michaël; Papaxanthos, Aline; Decanter, Christine; Eléfant, Élisabeth; Dhédin, Nathalie; Barraud-Lange, Virginie; Béranger, Marie-Christine; Frédérique, Nicollet; Gabrel, Lydie; Duperray, Marianne; Vermel, Christine; Hoog-Labouret, Natalie; Pibarot, M.; Provansal, Magali; Quéro, L.; Lejeune, Hervé; Méthorst, C.; Saïas, Jacqueline; Véronique-Baudin, Jacqueline; d′Estaing, Sandrine Giscard; Farsi, Fadila; Poirot, Catherine; Huyghe, É.

doi:10.1016/j.ejca.2022.05.013

Cited by 34 publications

(29 citation statements)

References 306 publications

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“…In 2020, the European Society of Human Reproduction and Embryology (ESHRE) published a detailed guideline 'written by a multidisciplinary group with gynecologists and fertility specialists, oncologists, a psychologist, a bioethicist, an embryologist, a scientist, and patient representatives' [19]. The same goes for other guidelines developed in the US, Spain or France [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors share that consideration and strongly highlight that the provision of information about fertility preservation in cancer patients is strongly indicated and bene cial to them: it protects their mental health and promotes their quality of life, enables patients to better cope with their cancer-related stress, can 'boost their con dence in treatment', 'reduces their long-term regret or disappointment concerning fertility', and facilitates patients in making well-informed decisions on their cancer care [3,20,22,23,27,30,31]. It is argued that it is physicians' (particularly oncologists and reproductive endocrinologists') responsibility and moral obligation to address 'fertility preservation options with all reproductively -active women prior to any cancer therapy' [3,19,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Rives et al state, 'Ovarian tissue preservation is indicated in case of very high risk of infertility'[23]. Henry et al argue that cryopreservation of ovarian tissue is considered 'a secure tool in human fertility preservation'[43].…”

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confidence: 99%

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Perceptions and experiences of fertility preservation in Greek female cancer patients

Taniskidou

Voultsos

Tarlatzis

et al. 2023

Preprint

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Background As advances in oncology have led to remarkable and steady improvements in the survival rates of cancer patients and anticancer treatment can cause premature ovarian failure in women, fertility preservation has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, fertility preservation remains underutilized for cancer patients. There are substantial gaps in our knowledge about women’s experience and perceptions on the issue. This study aims to contribute to bridging that gap. Methods This prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semi-structured interviews with nineteen reproductive-age women with a recent cancer diagnosis. Data were classified and analyzed by a thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women’s attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis did not receive adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied from the information they received because they either received the information they requested or remained in denial to get informed (i.e. because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable fertility preservation option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women’s decision making about fertility preservation. Finally, male partners’ opinions played a secondary role in most participants’ decision-making about fertility preservation. If embryo cryopreservation was the selected option, partners would have a say because they were involved with their genetic material. Conclusions The findings that emerged from data analysis were partly consistent with prior literature. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perceptions and experiences of fertility preservation in Greek female cancer patients

Taniskidou

Voultsos

Tarlatzis

et al. 2023

Preprint

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“…OVARIAN FOLLICULAR RESERVE Any patient of reproductive age about to be subjected to potentially gonadotoxic treatments must be informed about this risk; in the case of children and adolescents, parents or a responsible adult should be advised. 10 Despite the fact that nowadays many oncologic therapies provide remission and cure, their side effects might include impairment of ovarian function. These iatrogenic effects occur in both acute and long-term manners, causing menopause symptoms in adult women, and delaying puberty and bone development in girls.…”

Section: Impacts Of Cancer Treatments On Thementioning

confidence: 99%

“…PRESERVING FEMALE FERTILITY a. OOCYTE CRYOPRESERVATION According to established guidelines from European countries, oocyte cryopreservation is the first-line method to be proposed for prevention of iatrogenic infertility in women of reproductive age. 10 In this technique, unfertilized mature oocytes are stored for future in vitro fertilization (IVF) or intracytoplasmic sperm injection. In general, patients of reproductive age are candidates for this technique, independently of the availability of a partner at the time of oocyte cryopreservation.…”

Section: Current Feasible Alternatives Formentioning

confidence: 99%

Innovations for Optimizing Fertility and Ovarian Functionality in Female Cancer Patients

Leonel

2022

MRAJ

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The survival rates and quality of life of patients undergoing cancer treatments have significantly increased in recent years. However, these advanced treatments are known to exert a potentially gonadotoxic effect, impairing the female population of germ cells and, consequently, leading to ovarian failure through hormonal dysfunction and premature menopause. Nowadays, it is strongly recommended that oncologists discuss the risks of infertility and alternatives with each patient individually, recommending a consultation with a reproductive specialist as early as possible. In this context, remarkable progress has been made in assisted reproductive techniques aimed at fertility preservation for female patients. The main currently applied methods to avoid total loss of ovarian activity as a result of chemo or radiotherapy include oocyte, embryo, or ovarian tissue cryopreservation. This topic review summarizes the recent advances in these techniques, which have increased the chances of fertility preservation and family planning, as well as providing hope for cancer survivors. Oocyte cryopreservation followed by in vitro fertilization and embryo transfer are currently the recommended first-line fertility preservation approaches. However, for prepubertal individuals, the technique of ovarian tissue cryopreservation is advised; this is, moreover, the best method for efficient maintenance of the follicular reserve and allows future tissue transplantation, which not only restores fertility but also resumes natural ovarian hormonal activity. Recently, the discussion about the reestablishment of ovarian function in a defective tissue has raised compelling arguments, based on the theory about the presence of germ stem cells in the ovary. Despite the relevance of the results and the psychological benefits, the number of female patients diagnosed with cancer who are offered any method of fertility preservation is low. Multidisciplinary teams working jointly with oncologists and fertility specialists are essential for better outcomes regarding the wellness of patients who recover from cancer. Although further studies are needed to improve some of the available approaches, for now, comprehensive availability of oocyte/embryo or ovarian tissue freezing services is necessary worldwide to meet patient needs.

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Long-term effect of chemotherapy after ovarian decortication on the ovarian function in women surviving cancer

Ortiz,

Peña,

Hidalgo

et al. 2023

J Assist Reprod Genet

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Purpose Ovarian decortication may affect ovarian function. We investigated the status of ovarian reserve after ovarian decortication plus chemotherapy at a stage of presumed stabilized recovery in women surviving cancer. Methods We searched our database for cancer survivors subjected to ovarian decortication and chemotherapy at least 3 years previously. Ovarian function was explored for levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol (E2), and menstrual pattern. Results Forty women (mean age 29.6 (SD, 6.1) years) were assessed at a mean of 4.7 (1.5) years after surgery. The predecortication levels of AMH and FSH changed at post-treatment from 2.2 (1.4) to 0.5 (1.3) ng/mL for AMH (p < 0.001) and from 4.7 (2.1) to 16.7 (21. 6) IU/L for FSH (p < 0.001). Amenorrhea consistent with primary ovarian insufficiency (POI) was diagnosed in 11 women, and normal ovarian reserve (AMH ≥ 1.0 ng/mL) was found in 4 of the 21 women who recovered regular cycles. Logistic regression confirmed AMH as an independent predictor of diminished ovarian reserve (OR = 0.24, 95% CI: 0.04-0.63, p = 0.025) and POI (OR = 0.11, 95% CI: 0.01–0.52, p = 0.027), and age was predictive of POI (OR = 1.36, 95% CI: 1.08–1.96, p = 0.035) and of irregular menstrual cycle (OR = 1.20, 95% CI: 1.03–1.46, p = 0.034). Conclusion Ovarian decortication plus chemotherapy had a deleterious effect when assessed at a stage of stabilized ovarian recovery, but whether ovarian decortication had a specific impact cannot be revealed from our data.

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What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines

Cited by 34 publications

References 306 publications

Perceptions and experiences of fertility preservation in Greek female cancer patients

Perceptions and experiences of fertility preservation in Greek female cancer patients

Innovations for Optimizing Fertility and Ovarian Functionality in Female Cancer Patients

Long-term effect of chemotherapy after ovarian decortication on the ovarian function in women surviving cancer

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