Abstract
Many premenopausal patients who develop breast cancer have not yet completed their family planning, so measures of fertility protection to preserve their fertile potential would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles – irrespective of whether in a neoadjuvant or adjuvant setting – and this can sometimes result in permanent infertility. Depending on which cytostatic agents are used and on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified as low, moderate or high. Options of fertility preservation include: a) cryopreservation of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes are retrieved by transvaginal follicle aspiration, after which they are cryopreserved, either unfertilised or on completion of IVF or ICSI treatment. During b) cryopreservation of ovarian tissue, about 50% of the ovarian cortex of one ovary is resected with the aid of a laparoscopic procedure and cryopreserved. The application of c) GnRH agonists as a medicinal therapy option is an attempt at endocrine ovarian suppression in order to protect oocytes, granulosa cells and theca cells from the cytotoxic effect of chemotherapy.
Highlights
The survival rate of cancer patients has been steadily rising over the past decades due to optimisation and efficiency of oncological therapy concepts [1].Cancer is predominantly a disease of the older person, whereas adolescents and young adults are relatively rarely affected by it
In a multicentre, randomised study involving 124 premenopausal patients, Ruddy et al [20] showed that anti-Mullerian hormone (AMH) levels measured before chemotherapy can serve as a biomarker for chemotherapyassociated amenorrhoea
All premenopausal patients who have not completed family planning should be informed about the options of fertility preservation before gonadotoxic chemotherapy
Summary
The survival rate of cancer patients has been steadily rising over the past decades due to optimisation and efficiency of oncological therapy concepts [1].Cancer is predominantly a disease of the older person, whereas adolescents and young adults are relatively rarely affected by it. ▶ Table 1 Amenorrhoea rates after chemotherapy in premenopausal patients with breast cancer, overview, taken from [13]. The patients age plays an important role in the development and duration of ovarian failure: older women, who already have a physiological reduction of their primordial follicle pool, have a higher risk of developing infertility; in addition, cyclophosphamide already produces gonadal toxicity at lower doses than would be the case in younger women [18].
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