Abstract
In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians.In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of “cancer and fertility preservation”. A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation.Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.
Highlights
Cancer incidence increases with age and peaks after the age of 50, thousands of young women and men are diagnosed with cancer every year [1]
We summarize and discuss the up-to-date knowledge on ten controversial topics in the field of fertility preservation in young patients with cancer
A meta-analysis of 14 retrospective control-matched studies showed that breast cancer patients who became pregnant following diagnosis and treatment had a 41 % reduced risk of death compared to women who did not get pregnant [22]
Summary
Cancer incidence increases with age and peaks after the age of 50, thousands of young women and men are diagnosed with cancer every year [1]. The threat or experience of treatment-related infertility can lead to psychological distress [3], and many patients are interested in maintaining fertility and future reproductive function at the time of cancer diagnosis [4, 5]. International guidelines recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions [9,10,11]. Several issues remain controversial with regard to the safety and efficacy of fertility preservation strategies in cancer survivors. We summarize and discuss the up-to-date knowledge on ten controversial topics in the field of fertility preservation in young patients with cancer
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