Abstract
Progress in recent years in the efficacy of oncologic treatment and early diagnosis of cancer has determined an increase in life expectance in cancer patients. About 10% of all cancer cases affect women younger than 45 years; therefore nowadays approximately 5-6% of the population in childbearing age consists in cancer survivors. A crucial issue is the high risk of premature ovarian insufficiency due to possible gonadotoxic effects of oncologic treatments. Considering combined chemotherapy, radiation therapy, and bone marrow transplantation, this risk can reach 92-100%, depending on the age and ovarian reserve of the patient, as well as the schedule and type of therapy. International guidelines recommend addressing all the patients diagnosed with a neoplasia treatable with potentially gonadotoxic therapies to fertility preservation. Moreover, fertility preservation also seems to reserve fascinating implications for women who want to delay childbearing for social reasons or women affected with endometriosis, who could receive unexpected opportunities. At present, the most widespread techniques to preserve fertility in adult women are embryo or oocyte cryopreservation, depending on the presence of a partner or according to legislative issues, but these procedures require time for ovarian stimulation. In prepubertal patients or when there is no possibility of delaying chemotherapy, ovarian tissue cryopreservation and subsequent transplantation represent the main strategy.
Highlights
The issue of infertility epidemic is actual and troubling in most western countries as well in large part of the developed world
It is crucial to give each patient adequate counselling regarding her risk of developing premature ovarian insufficiency (POI) after oncologic treatment, but it is extremely difficult to forecast an exact percentage of risk
Especially with Polymerase Chain Reaction (PCR), cancer cells have been identified in ovarian cortical samples in more than 50% of women affected by acute leukemia [3]
Summary
The issue of infertility epidemic is actual and troubling in most western countries as well in large part of the developed world. Progress in the efficacy of oncologic treatment and in early diagnosis of cancer has determined an increase in life expectancy in cancer patients [2]. An unpleasant side effect of some chemo- and radiotherapy is premature ovarian insufficiency (POI) after treatment. When these treatments are combined with bone marrow transplantation, the risk of POI is even greater [4]. It is well known that the effects of gonadotoxic drugs are not always the same, depending on type and dose of drug and on age and pretreatment ovarian reserve of the patient [4]. The effect can range from complete premature ovarian insufficiency (POI) to partial reduction of ovarian reserve
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