Innovations for Optimizing Fertility and Ovarian Functionality in Female Cancer Patients

Abstract

The survival rates and quality of life of patients undergoing cancer treatments have significantly increased in recent years. However, these advanced treatments are known to exert a potentially gonadotoxic effect, impairing the female population of germ cells and, consequently, leading to ovarian failure through hormonal dysfunction and premature menopause. Nowadays, it is strongly recommended that oncologists discuss the risks of infertility and alternatives with each patient individually, recommending a consultation with a reproductive specialist as early as possible. In this context, remarkable progress has been made in assisted reproductive techniques aimed at fertility preservation for female patients. The main currently applied methods to avoid total loss of ovarian activity as a result of chemo or radiotherapy include oocyte, embryo, or ovarian tissue cryopreservation. This topic review summarizes the recent advances in these techniques, which have increased the chances of fertility preservation and family planning, as well as providing hope for cancer survivors. Oocyte cryopreservation followed by in vitro fertilization and embryo transfer are currently the recommended first-line fertility preservation approaches. However, for prepubertal individuals, the technique of ovarian tissue cryopreservation is advised; this is, moreover, the best method for efficient maintenance of the follicular reserve and allows future tissue transplantation, which not only restores fertility but also resumes natural ovarian hormonal activity. Recently, the discussion about the reestablishment of ovarian function in a defective tissue has raised compelling arguments, based on the theory about the presence of germ stem cells in the ovary. Despite the relevance of the results and the psychological benefits, the number of female patients diagnosed with cancer who are offered any method of fertility preservation is low. Multidisciplinary teams working jointly with oncologists and fertility specialists are essential for better outcomes regarding the wellness of patients who recover from cancer. Although further studies are needed to improve some of the available approaches, for now, comprehensive availability of oocyte/embryo or ovarian tissue freezing services is necessary worldwide to meet patient needs.