Abstract
Chemotherapy, pelvic radiotherapy and ovarian surgery have known gonadotoxic effects that can lead to endocrine dysfunction, cessation of ovarian endocrine activity and early depletion of the ovarian reserve, causing a risk for future fertility problems, even in children. Important determinants of this risk are the patient’s age and ovarian reserve, type of treatment and dose. When the risk of premature ovarian insufficiency is high, fertility preservation strategies must be offered to the patient. Furthermore, fertility preservation may sometimes be needed in conditions other than cancer, such as in non-malignant diseases or in patients seeking fertility preservation for personal reasons. Oocyte and/or embryo vitrification and ovarian tissue cryopreservation are the two methods currently endorsed by the American Society for Reproductive Medicine, yielding encouraging results in terms of pregnancy and live birth rates. The choice of one technique above the other depends mostly on the age and pubertal status of the patient, and personal and medical circumstances. This review focuses on the available fertility preservation techniques, their appropriateness according to patient age and their efficacy in terms of pregnancy and live birth rates.
Highlights
Gonadotoxic chemotherapy and pelvic irradiation at reproductive age are known to damage the ovaries, which can lead to endocrine dysfunction, cessation of ovarian endocrine activity and early depletion of the ovarian reserve, with the risk of permanent infertility [1]
Oocyte vitrification yields the best results in adult women with benign diseases, those who wish to preserve their fertility for personal reasons and cancer patients if their therapy can be put on hold; and ovarian tissue cryopreservation (OTC) is best for prepubertal girls and women whose
It is commonly accepted that alternative controlled ovarian stimulation (COS) protocols should be applied according to the steroid sensitivity of the cancer in question
Summary
Gonadotoxic chemotherapy and pelvic irradiation at reproductive age are known to damage the ovaries, which can lead to endocrine dysfunction, cessation of ovarian endocrine activity and early depletion of the ovarian reserve, with the risk of permanent infertility [1]. The risk of premature ovarian insufficiency (POI) depends on factors such as patient age, the existing ovarian reserve and the type of treatment and dose; and it is higher if alkylating drugs or total body irradiation are used [2]. Premature menopause negatively impacts fertility potential, but may seriously affects health and quality of life, with cardiovascular disease, neurodegenerative conditions and osteoporosis posing a threat [5,6,7]. Quality of life after cancer remission, needs to be urgently addressed, and fertility preservation represents a key challenge in these women [8]. Meeting the rising demand for fertility preservation is challenging [9], and women for whom fertility preservation is needed are growing in number (Table 1)
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