Abstract
PurposeMost guidelines about fertility preservation are predominantly focused on scientific evidence, but are less practically orientated. Therefore, practically oriented recommendations are needed to support the clinician in daily practice.MethodsA selective literature search was performed based on the clinical and scientific experience of the authors, focussing on the most relevant diseases and gynaecological cancers. This article (Part I) provides information on topics that are essential for the fertility preservation indication, such as disease prognosis, disease therapy and its associated risks to fertility, recommending disease-specific fertility preservation measures. Part II specifically focusses on fertility preservation techniques.ResultsIn breast cancer patients, fertility preservation such as ovarian tissue and oocyte cryopreservation is especially recommended in low-stage cancer and in women < 35 years of age. In Hodgkin’s lymphoma, the indication is mainly based on the chemotherapy regime as some therapies have very low, others very high gonadotoxicity. In borderline ovarian tumours, preservation of fertility usually is achieved through fertility sparing surgery, ovarian stimulation may also be considered. In cervical cancer, endometrial cancer, rheumatic diseases and other malignancies such as Ewing sarcoma, colorectal carcinoma, non-Hodgkin lymphoma, leukaemia etc., several other factors must be considered to enable an individual, stage-dependent decision.ConclusionThe decision for or against fertility preservation depends on the prognosis, the risks to fertility and individual factors such as prospective family planning.
Highlights
Breast cancerFertility preservation techniques have become an established part of oncology, rheumatology and many other areas
These recommendations have been updated, focusing on indications for fertility preservation, as well as on fertility preservation techniques in women who require therapies which can potentially lead to ovarian failure
We aim to focus on topics that are essential in deciding for or against fertility preservation such as disease prognosis, disease-specific therapy and associated risks to fertility and to recommend disease-specific fertility preservation measures (Fig. 1)
Summary
Breast cancerFertility preservation techniques have become an established part of oncology, rheumatology and many other areas. Fertility preservation is recommended in women with breast cancer with a good prognosis, with a moderate to high POI risk and/or age > 35 years at the time of expected pregnancy. A combination of fertility preserving measures, GnRH agonists, and freezing of ovarian tissue followed by ovarian stimulation may be an option, if gonadotoxic risk is high, prognosis is good and time is sufficient.
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