Cancer and fertility: strategies to preserve fertility

Abstract

Fertility preservation is a key component of cancer management in young people. The Fourth Evian Annual Reproduction Workshop Meeting was held in April 2009 to discuss cancer and fertility in young adults. Specialists in oncology, assisted reproduction, embryology and clinical genetics presented published data and ongoing research on cancer and fertility, with particular focus on strategies to preserve fertility. This report is based on the expert presentations and group discussions, supplemented with publications from literature searches and the authors’ knowledge. Fertility preservation should be considered for all young people undergoing potentially gonadotoxic cancer treatment. A variety of options are required to facilitate safe and effective fertility preservation for individual patients. Sperm banking is a simple and low-cost intervention. Embryo cryopreservation is the only established method of female fertility preservation. Oocyte cryopreservation offers a useful option for women without a male partner. Emergency ovarian stimulation and cryopreservation of ovarian tissue (followed by tissue transplantation or in-vitro maturation of oocytes) are experimental techniques for women who require urgent cancer treatment. Further prospective studies are required to validate cryopreservation of oocytes and ovarian tissue, in-vitro maturation of oocytes and new vitrification techniques and to identify any long-term sequelae of slow freezing of embryos. Cancer treatment often involves aggressive radiotherapy or chemotherapy, which may permanently impair reproductive function. Therefore, fertility preservation is a key component of cancer management for young people. The Fourth Evian Annual Reproduction Workshop Meeting was held in April 2009 to evaluate current information on cancer and fertility in young adults. Specialists in cancer, assisted reproduction, embryology and clinical genetics gave presentations based on published data and ongoing research on cancer and fertility, with particular focus on strategies to preserve fertility. This report is based on the expert presentations and group discussions and was supplemented with publications from electronic literature searches and the authors’ knowledge. The experts agreed that fertility preservation should be considered for all young people undergoing any cancer treatment that could permanently impair reproductive function. Safe and effective options for fertility preservation are required to optimize outcomes for individual patients. Sperm banking is a simple and low-cost intervention for men who require fertility preservation. Embryo cryopreservation is the only established method of female fertility preservation. However, oocyte cryopreservation offers a useful option for women without a male partner. Emergency ovarian stimulation protocols (to obtain oocytes) and freezing of ovarian tissue (followed by tissue transplantation or maturation of oocytes in vitro) are experimental techniques for women who require urgent cancer treatment. Further studies are required to prospectively validate outcomes of freezing of oocytes and ovarian tissue, in-vitro maturation of oocytes and new rapid freezing (vitrification) techniques and to identify any long-term safety issues after conventional slow-freezing of embryos.