Abstract
Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.
Highlights
Cure rates for oncologic disease in children, teenagers and premenopausal patients have improved significantly in recent years with the increasing administration of chemotherapy
With the significant improvement in cure rates for oncologic disease in children, teenagers and young adults, preserving fertility and gonadal function has become a central aspect of therapy planning
Developments in reproductive medicine which can preserve fertility in postpubertal women and men with oncologic disease include the cryopreservation of oocytes and sperm and the cryopreservation of ovarian tissue and testicular tissue
Summary
Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. Cure rates for oncologic disease in children, teenagers and premenopausal patients have improved significantly in recent years with the increasing administration of chemotherapy. The following methods can be used to preserve fertility: drug-induced ovarian suppression prior to oncologic systemic therapy, cryopreservation of oocytes and ovarian tissue, or the surgical relocation of the ovaries out of the radiation field prior to the planned radiation of the pelvis.
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