Abstract
With the evolution of the treatment of malignant neoplasms, the survival rates of patients undergoing chemo- or radiotherapy are increasing. The continuous development of techniques of assisted human reproduction has led to important strategies in an attempt to maintain reproductive function in patients subjected to treatment of neoplastic diseases, among them cryopreservation of embryos, gametes, and ovarian cortical tissue. The freezing of ovarian tissue is currently being proposed with the primary purpose of preserving ovarian function in these patients. Currently, the major challenge of groups working with preservation of fertility is the use of cryopreserved ovarian tissue after disease remission. The main alternatives presented today are the implantation of hetero- or orthotopic tissue and isolation of immature follicles from ovarian tissue followed by in vitro maturation and assisted reproduction procedures.
Highlights
Invasive cancer is diagnosed in more than 600,000 persons per year in the United States, with 269,800 of affected patients being women, 8% of whom are younger than 40 years [1]
Treatment and survival are the main focus of both health professionals and cancer patients, it is important to consider the quality of life of the latter after treatment, including the possibility to have children [6]
The cytotoxic action of ionizing radiation and chemotherapeutic agents frequently leads to the occurrence of premature ovarian failure (POF), with serious long-term consequences such as reduction of bone mass leading to osteoporosis, to an increased incidence of cardiovascular diseases, and to the premature onset of climacteric and infertility symptoms [7]
Summary
Invasive cancer is diagnosed in more than 600,000 persons per year in the United States, with 269,800 of affected patients being women, 8% of whom are younger than 40 years [1]. Treatment and survival are the main focus of both health professionals and cancer patients, it is important to consider the quality of life of the latter after treatment, including the possibility to have children [6]. The temporary or permanent absence of the endocrine and reproductive ovarian functions mainly depends on the age of the patient at the time of gonadotoxic treatment and on the doses administered. Surviving adults tend to be more interested in the preservation of fertility, it is important to remember that other options should be made available to young cancer patients. Health professionals should be prepared to discuss fertility with their patients regardless of the age or marital status of the latter at the time when therapy is started, so that they may understand the possible consequences of cancer treatment and the alternatives available for the preservation of fertility [13]. The continuous evolution of assisted human reproduction techniques has permitted several strategies to be considered for the maintenance of reproductive function in female patients who complete treatment for neoplastic diseases, such as hormone manipulation, ovary transposition, and cryopreservation of embryos, gametes, and ovarian cortical tissue
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