Abstract
The number of reported new cancer cases is increasing every year. The probability of surviving cancer is high and is continually improving. The cancer treatment may induce ovarian or testicular failure by damaging ovarian follicles in females and spermatogonia in the males. Gonadal failure may affect all aspects of reproductive health, including pubertal development, hormone production, and sexual function in adult life. Therefore, the primary goal for cancer treatment is to ensure the highest possibility of cure and to maintain the reproductive health. The cancer patients should be provided with maximal chance to make an optimal decision without any significant impact and delay in cancer treatment. As a result of treatment innovations, the survival rates of young people have increased substantially; therefore, the need of fertility preservation has increased as well. The sperm cryopreservation and embryo cryopreservation have been standard methods of fertility preservation. Recently, the American Society for Reproductive Medicine has removed the experimental label from oocyte cryopreservation. However, other fertility preservation options including ovarian tissue and whole ovary cryopreservation and testicular tissue cryopreservation for pre-pubertal boys are still considered experimental. A coordinated approach by gynecologists, urologists, oncologists, pediatricians, surgeons, fertility specialists and counselors is required to make use of available fertility preservation options. Timely and complete information on the impact of cancer treatment on fertility and fertility preservation options should be presented to all patients when a cancer treatment is planned. The possibility of fertility preservation removes a huge concern and enables cancer patients to concentrate on their treatment and getting better. The purpose of this review is to present different options currently available to preserve fertility in men, women and adolescent children diagnosed with cancer and undergoing gonadotoxic therapy. All options are listed in two tables for quick reference. Most of the information is extracted from recent publications and presented in such a manner that it is valuable for cancer patients and professionals associated with fertility preservation.
Highlights
Cancer spares no age group and loss of fertility is a major concern for patients after cancer treatment
Ejaculated sperm can subsequently be used for intra-uterine insemination, in vitro fertilization (IVF) using egg insemination or intracytoplasmic sperm injection (ICSI) depending on the sperm concentration and motility after cryopreservation and thaw
American Society of Clinical Oncology recommends that as part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients and be prepared to discuss possible fertility preservation options or refer patients to reproductive specialists offering fertility preservation [6]
Summary
Cancer spares no age group and loss of fertility is a major concern for patients after cancer treatment. Regardless of the source (ejaculated, epididymal or testicular) and embryo banking are the standard methods to preserve fertility for cancer patients [3]. In many instances the cancer may not allow enough time to get results for communicable diseases before cryopreservation and the decision to cryopreserve sperm, oocytes, embryos or gonadal tissue have to be made immediately. It is, highly recommended that the specimens are stored in closed systems to avoid cross contamination in storage. This article focuses on various options available to those females and males who are at risk of losing fertility due to surgery, chemotherapy, radiation or any other fertility threat
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