Fertility Preservation In Young Patients Research Articles

Breast Cancer and Fertility Preservation in Young Female Patients: A Systematic Review of the Literature.

Breast cancer affects almost 1.5 million women worldwide below the age of 45 years each year. Many of these women will be advised to undergo adjuvant chemotherapy to minimize the risk of death or recurrence of the tumor. For these patients, chemotherapy is a known cause of infertility, as it can damage primordial follicles, which can lead to early menopause or premature ovarian insufficiency. This systematic review aims to synthesize the current evidence of the most suitable treatments for fertility preservation. This review was performed following the PRISMA guidelines. The authors conducted an extensive search from the last 15 years. Relevant studies were pursued in PubMed, Embase, and the Cochrane Library up until 31 July 2023. A total of seven eligible studies were identified. From the reviewed literature, ovarian suppression with gonadotropin-releasing hormone agonists showed promising results in preserving fertility for breast cancer patients undergoing chemotherapy. Additionally, oocyte and embryo cryopreservation demonstrated successful outcomes, with embryo cryopreservation being the most effective option. Notably, the slow-freezing and vitrification methods were both effective in preserving embryos, with vitrification showing superior results in clinical-assisted reproductive technologies. Ovarian tissue cryopreservation emerged as a viable option for prepubertal girls and those unable to undergo conventional ovarian stimulation. The potential of in vitro maturation (IVM) as an alternative method presents a promising avenue for future fertility preservation research. The most suitable treatments for fertility preservation in young patients is the temporary suppression with luteinizing hormone-releasing analogs, while the patient undergoes chemotherapy and cryopreservation. For cryopreservation, the physicians might deem it necessary to either cryopreserve ovarian tissue taken from the patient before any treatment or cryopreserve embryos/oocytes. Cryopreservation of oocytes and/or embryos is the most effective solution for fertility preservation in women of reproductive age, who have a sufficient ovarian reserve and are diagnosed with breast cancer, regardless of the histological type of the tumor. Because approximately 50% of young breast cancer patients are interested in becoming pregnant right after completion of therapy, the evolution and development of fertility preservation techniques promise to be very exciting.

Leading a Fair Fight for Fertility Preservation in Young Patients

Leading a Fair Fight for Fertility Preservation in Young Patients

Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients.

Young individuals, aged <40 years, represent 7% of all patients with early breast cancer (EBC), most of whom receive chemotherapy. Preserving future fertility in these patients has become a major concern. This prospective study assessed ovarian function during and after chemotherapy according to patient and tumor characteristics and evaluated the outcome of controlled ovarian hyperstimulation (COH). Ovarian reserve was evaluated in terms of amenorrhea duration and by longitudinal serum anti-Müllerian hormone (AMH) level variations measured at study entry, during treatment and until 24 months thereafter. COH has been proposed for patients receiving adjuvant chemotherapy. We studied the association between clinical factors and ovarian function using Cox models and logistic regression. In this young population (age < 38 years, median=32), 85 of 90 evaluable patients (94%) experienced chemo-induced amenorrhea, including six persistent amenorrhea and one chemotherapy-induced definitive ovarian failure. Overall, 33% of patients still had undetectable AMH values 12 months after the end of chemotherapy, although most had recovered spontaneous and regular menstrual function. No specific factor was associated with clinical or biological late ovarian dysfunction, except for age and baseline AMH value. Overall, 58 patients underwent COH. The mean number of total retrieved oocytes and metaphase II oocytes were of 11.7 and 6.9, respectively. Thus, our study confirms the importance of fertility preservation in young patients with EBC. Our findings indicate that sequential chemotherapy is associated with a higher risk of persistent amenorrhea. There was no significant association between tumor characteristics, fertility preservation or recovery of ovarian reserve.

Genomic Consideration in Chemotherapy-Induced Ovarian Damage and Fertility Preservation.

Chemotherapy-induced ovarian damage and fertility preservation in young patients with cancer are emerging disciplines. The mechanism of treatment-related gonadal damage provides important information for targeting prevention methods. The genomic aspects of ovarian damage after chemotherapy are not fully understood. Several studies have demonstrated that gene alterations related to follicular apoptosis or accelerated follicle activation are related to ovarian insufficiency and susceptibility to ovarian damage following chemotherapy. This may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions after chemotherapy. This review highlights the importance of genomic considerations in chemotherapy-induced ovarian damage and multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.

Status and clinical response of fertility preservation in young patients with breast cancer

Cancer treatments may improve the long-term survival rate of young patients with breast cancer, but also lead to a decrease in fertility. With the younger incidence of breast cancer in China, the fertility needs of this group have received more attention, and fertility preservation technology suitable for cancer patients is developing continuously. However, there are still many problems in the implementation of fertility preservation for young breast cancer patients in China. Patients and breast surgeons have insufficient understanding and conservative attitudes towards fertility preservation technology. And there is a lack of reproductive experts in the treatment process. What's more, the long-term follow-up and information management of patients undergoing fertility preservation are defective. In response to the above, this paper discusses how to deal with patients with potential reproductive needs in clinical practice from the perspective of breast surgeons. The first is to improve their own understanding of fertility preservation, such as the progress of relevant technologies and applicable population, when to intervene, when and how to get pregnant after cancer treatment. Secondly, education for patients must be strengthened, which should include not only fertility preservation, but also scientific contraceptive methods during cancer treatment and treatment measures for unexpected pregnancy. Finally, hospitals and relevant units should standardize the multidisciplinary team of breast cancer, and strengthen the comprehensive management of young breast cancer patients, thus to provide young breast cancer patients with more scientific cancer treatment programs and more reproductive opportunities.

Fertility Preservation and Long-Term Monitoring of Gonadotoxicity in Girls, Adolescents and Young Adults Undergoing Cancer Treatment.

Simple SummaryAs cancer treatments become more effective and many patients have long term survival, concerns related to patient’s quality of life and reproductive health become relevant. It is especially important for girls and young females facing cancer therapy who have not yet started family planning. This review provides insight into current fertility preservation methods for pre- and post-pubertal girls and young adults undergoing cancer treatment. It contributes to this research area by providing evidence-based information on currently used methods, follow-up and survivorship care. Ethical considerations related to oncofertility in pediatric and adolescent patients were raised. Psychological aspects and possible issues that may occur at different timing (diagnosis, fertility preservation and follow-up) were evaluated.Chemo- and radio-therapy can often affect reproductive organs impairing hormonal regulation, fertility, and sexual function. As cancer treatments become more effective and many patients have long term survival, concerns related to patient’s quality of life and reproductive health become relevant. It is especially important for girls and young females facing cancer therapy who have not yet started family planning. Chemotherapy protocols using alkylating agents and abdominal radiotherapy, which are frequently used in the treatment of childhood and adolescent cancer, can cause gonadal injury. The most common clinical manifests are ovarian hormone insufficiency, premature ovarian insufficiency, early menopause and infertility. In this review we assess current literature and summarize current recommendations on the reproductive function of girls and young females undergoing cancer treatment and their follow-up. Fertility preservation methods are discussed, including psychological and ethical considerations and barriers. Improvement of reproductive health and quality of life of adolescents and young adults (AYA) undergoing cancer treatment is an important issue. Further research should be continued to develop efficient and accessible methods for fertility preservation in young patients. An expert panel including oncologists, radiation oncologists, endocrinologists and gynecologists should always consider fertility preservation in pediatric, adolescent and AYA cancer patients, minding patients’ medical condition, cancer staging and potential risk of treatment-related gonadotoxicity.

A survey of French gynecologists’ knowledge and attitudes toward conservative treatment for fertility preservation in young patients with endometrial cancer

ObjectiveTo describe knowledge and attitudes toward fertility preservation (FP) in patients with endometrial atypical hyperplasia or adenocarcinoma (EC/AH) among French gynecologists Materials and MethodsA national survey among French gynaecologists: one questionnaire with one common part and two specific parts for gynecological surgeon (GS) or for specialists in reproductive medicine (SRM) was sent from April 2017 to April 2018. Knowledge and attitudes toward FP in EC/AH were evaluated with a “knowledge score” and an “attitudes score” using a four- or five-point Likert scale. ResultsOne hundred forty physicians completed the survey (87 GS, 53 SRM). The knowledge score was low (59.3% medium/low), but it was significantly higher for GS compared to SRM. The better-known treatments were oral progestins and hysteroscopic resection. Among the participants treating EC/AH, 52.6% found it “difficult” to manage patients and 61.8% regretted the lack of official recommendations. Most physicians seemed to be uncomfortable/unsupportive with FP in EC/AH (57.2% “attitude score’ below 11/20). There was a positive correlation between knowledge and attitude scores.GS “usually/always” give advice to patients about FP before EC/AH treatment. After maximum 3–6 months, 56.6% of SRM chose In Vitro Fecundation (IVF) to reduce time-to-pregnancy, with GnRH antagonist protocols (28%) or mild-stimulation (15.1%) to avoid hyperoestrogenism. ConclusionsDespite reassuring results in the literature, French gynecologists are uncomfortable with FP using EC/AH conservative management, which may be because of a lack of confidence in their knowledge. Specific guidelines are needed to help physicians manage these young patients and their fertility.

Impact of first-line cancer treatment on the follicle quality in cryopreserved ovarian samples from girls and young women.

STUDY QUESTIONDoes first-line chemotherapy affect the quality of ovarian pre-antral follicles and stromal tissue in a population of young patients?SUMMARY ANSWERExposure to first-line chemotherapy significantly impacts follicle viability, size of residual intact follicles, steroid secretion in culture and quality of the stromal compartment.WHAT IS KNOWN ALREADYFirst-line chemotherapy is considered to have a low gonadotoxic potential, and as such, does not represent an indication for fertility preservation. Studies investigating the effects of chemotherapy on the quality of ovarian tissue stored for fertility preservation in young patients are limited and the results sometimes contradictory.STUDY DESIGN, SIZE, DURATIONWe conducted a retrospective cohort study including young patients referred to three centers (Helsinki, Oslo and Tampere) to perform ovarian tissue cryopreservation for fertility preservation between 2003 and 2018.PARTICIPANTS/MATERIALS, SETTING, METHODSA total of 43 patients (age 1–24 years) were included in the study. A total of 25 were exposed to first-line chemotherapy before cryopreservation, whereas 18 patients were not. Density and size of follicles divided by developmental stages, prevalence of atretic follicles, health of the stromal compartment and functionality of the tissue in culture were evaluated and related to age and chemotherapy exposure. Activation of dormant follicles and DNA damage were also assessed.MAIN RESULTS AND THE ROLE OF CHANCEPatients exposed to first-line chemotherapy showed a significantly higher density of atretic primordial and intermediary follicles than untreated patients. The intact primordial and intermediary follicles were significantly smaller in size in patients exposed to chemotherapy. Production of steroids in culture was also significantly impaired and a higher content of collagen and DNA damage was observed in the stromal compartment of treated patients. Collectively, these observations may indicate reduced quality and developmental capacity of follicles as a consequence of first-line chemotherapy exposure. Neither increased activation of dormant follicles nor elevated levels of DNA damage in oocyte nuclei were found in patients exposed to chemotherapy.LIMITATIONS, REASONS FOR CAUTIONThe two groups were not homogeneous in terms of age and the patients were exposed to different treatments, which did not allow us to distinguish the effect of specific agents. The limited material availability did not allow us to perform all the analyses on the entire set of patients.WIDER IMPLICATION OF THE FINDINGSThis study provides for the first time a comprehensive analysis of the effects of first-line chemotherapy on the health, density and functionality of follicles categorized according to the developmental stage in patients under 24 years of age. When exposed to these treatments, patients were considered at low/medium risk of infertility. Our data suggest a profound impact of these relatively safe therapies on ovarian health and encourages further exploration of this effect in follow-up studies in order to optimize fertility preservation for young cancer patients.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by the Swedish Childhood Cancer Foundation, the Finnish Cancer Society, the Finnish Pediatric Research Foundation, the Väre Foundation for Pediatric Cancer Research, The Swedish Research Council, the Stockholm County Council (ALF project) and Karolinska Institutet. The authors have no conflict of interest to declare.

7. Complications of Ovarian Tissue Cryopreservation in Adolescent Patients Undergoing Bone Marrow Transplant

Myeloablative therapy prior to bone marrow transplant (BMT) can cause irreversible primordial follicle damage and premature ovarian insufficiency (POI). One option for fertility preservation in young patients is ovarian tissue cryopreservation (OTC). There is limited literature on the possible impact on ovarian reserve, death, and complications following OTC. We hypothesize that patients undergoing OTC and BMT will have no difference in complications compared to those who have undergone BMT alone.

Fertility Issues in Young Patients with Breast Cancer

Objective To review the need for fertility preservation in young patients with breast cancer.

Strategies for fertility preservation in young patients with cancer

Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.

Fertility Preservation in Young Patients with Endometrial Cancer

Fertility Preservation in Young Patients with Endometrial Cancer

Fertility preservation in young patients with epithelial ovarian tumors of low malignant potential: How does it impact disease outcome?

Fertility preservation in young patients with epithelial ovarian tumors of low malignant potential: How does it impact disease outcome?

Fertility preservation in young patients with cancer.

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

Fertility preservation in young patients with ovarian cancer – a retrospective analysis of patients from a university hospital and from the FertiPROTEKT network

Ovarian cancer is generally depicted as being a rare disease, however with the highest mortality rate. Nevertheless, women of fertile age must be informed about the possibility of fertility preserving surgery and fertility preservation methods. The aim of this study was to investigate the incidence of the different histological types of ovarian tumours in young women and to determine and discuss the possibility of fertility preservation. This is a retrospective analysis of all patients under the age of 40 who presented to the University Hospital for Women in Tuebingen for an ovarian tumour between January 2001 and December 2010, including data from the FertiPROTEKT network. The patient's age and pregnancy history, the type of surgery, subsequent chemotherapy and radiotherapy, were considered. A total of 51 patients were treated in Tuebingen within this period. The mean age of the patients was 29.3 years. 41.2% patients underwent primary fertility preserving surgery. A total hysterectomy and bilateral adnexectomy was performed primarily in 58.8% of the women. In the fertility preservation surgery group, 52.4% received adjuvant chemotherapy. After successful treatment, a total of seven pregnancies were recorded in five patients. From the FertiPROTEKT network, 26/41 patients (63.4%) decided to undergo fertility preservation. There were no complications and postponement of chemotherapy in any patients as a result of the fertility preservation procedures. With careful consideration of the risks, the correct indication and diligent aftercare, the realisation of conception is possible also for patients with ovarian cancer.

Post-thaw function during 3-dimesional (3D) culture of isolated secondary follicles vitrified in a closed system: a new option for fertility preservation in young patients with cancer

Post-thaw function during 3-dimesional (3D) culture of isolated secondary follicles vitrified in a closed system: a new option for fertility preservation in young patients with cancer

Strategies for Fertility Preservation in Young Patients with Cancer: A Comprehensive Approach

As a result of treatment innovations, the survival rates of young people with cancer have increased substantially. The cancers most frequently diagnosed in adults aged 25-49years include breast, colorectal and cervical cancer and malignant melanoma (Cancer Research UK, 2009). The 5-year survival rates of over 90% for many malignancies are now reported in young people. But the diagnosis and treatment of cancer often poses a threat to fertility. Methods of fertility preservation are evolving quickly and awareness needs to grow in the medical community regarding these methods. Studies suggest that the ability to have biological children is of great importance to many people. The possible future effects of chemotherapy or radiotherapy on fertility should be discussed with all cancer patients who have reproductive potential. Moreover, fertility preservation should be considered for all young people undergoing potentially gonadotoxic treatment. This article covers the various methods of fertility preserving options in young men and women with respect to the various treatment modalities that they may be subjected to. Sperm banking is a simple and low cost intervention. Embryo cryopreservation is the only established method of female fertility preservation. Oocyte cryopreservation offers a useful option for women without a male partner. Emergency ovarian stimulation and cryopreservation of ovarian tissue (followed by tissue transplantation or in-vitro maturation of oocytes) are experimental techniques for women who require urgent cancer treatment. Large, well-controlled studies are also required to identify any unexpected long-term sequelae of cryopreservation of oocytes and ovarian tissue.

Fertility preservation in young patients' with cancer.

Preservation of fertility is an important issue in the management of young cancer patients. Though embryo cryostorage is a well-established procedure, it can only be availed by couples. Recent studies have indicated increasing success rates with mature and immature oocyte cryopreservation. Cryostorage induces injuries on the human oocytes which can be minimized by slow freezing and vitrification. Selection of candiidates is crucial so that the most suitable technique can be offered without any delay in initiation of cancer therapy. Factors affecting suitability are age of patient, assessment of ovarian reserve, hormonal status and type and stage of neoplastic disease. Encouraging results have been obtained with oocyte in vitro maturation (IVM) followed by vitrification for cryostorage. Data on the use of vitrified eggs in routine in vitro fertilization (IVF) show that pregnancy rates can be comparable to those achieved with fresh oocytes.

Barriers to Fertility Preservation in Male Adolescents With Cancer: It's Time for a Multidisciplinary Approach that Includes Urologists

A cancer diagnosis can be devastating news for a child and his or her family. Fortunately, advances in the treatment of childhood cancers have resulted in 5-year survival rates close to 80%. 1 Wallace W.H. Anderson R.A. Irvine D.S. Fertility preservation for young patients with cancer: who is at risk and what can be offered?. Lancet Oncol. 2005; 6: 209-218 Abstract Full Text Full Text PDF PubMed Scopus (642) Google Scholar Late effects of cancer treatment, such as infertility, have thus become an active area of research; a recent study found that male cancer survivors were only half as likely to sire a pregnancy as healthy males. 2 Green D.M. Kawashima T. Stovall M. et al. Fertility of male survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2010; 28: 332-339 Crossref PubMed Scopus (257) Google Scholar Surgery, chemotherapy, and radiation exposure can all result in temporary or permanent damage to sperm production, and fertility may be compromised soon after treatment has begun. 3 Bahadur G. Ozturk O. Muneer A. et al. Semen quality before and after gonadotoxic treatment. Hum Reprod. 2005; 20: 774-781 Crossref PubMed Scopus (92) Google Scholar , 4 Romerius P. Ståhl O. Moëll C. et al. Hypogonadism risk in men treated for childhood cancer. J Clin Endocrinol Metab. 2009; 94: 4180-4186 Crossref PubMed Scopus (65) Google Scholar In addition to preserving reproductive capacity, sperm cryopreservation in young adults appears to have other benefits; for example, sperm banking has been reported to help young men endure the emotional battle against cancer. 5 Saito K. Suzuki K. Iwasaki A. et al. Sperm cryopreservation before cancer chemotherapy helps in the emotional battle against cancer. Cancer. 2005; 104: 521-524 Crossref PubMed Scopus (167) Google Scholar For all of these reasons, boys who are able to produce a semen sample are encouraged to bank sperm before starting oncological treatment.

Matched-case comparison of neoadjuvant chemotherapy in patients with FIGO stage IB1-IIB cervical cancer to establish selection criteria

ObjectiveNeoadjuvant chemotherapy (NACT) for cervical cancer still remains controversial. NACT was evaluated to establish selection criteria. MethodsA matched-case comparison was designed for the NACT group (n=707) and primary surgery treatment (PST; n=707) group to investigate short-term responses and high/intermediate risk factors (HRFs/IRFs). The 5-year disease-free survival (DFS) and overall survival (OS) rates were stratified by NACT response, HRFs/IRFs, International Federation of Gynecology and Obstetrics (FIGO) stage and tumour size, respectively. ResultsThe clinical and pathological response rates were 79.3% and 14.9% in the NACT group. In comparison to the PST group, IRFs but not HRFs were significantly decreased (P<0.05), and the 5-year DFS rate was significantly improved in the NACT group (88.4% versus 83.1%, P=0.021). Moreover, the 5-year DFS and OS rates were favourably increased in the clinical responders in comparison to the PST group and the clinical non-responders (P<0.05). Compared to those of clinical non-responders, the 5-year DFS and OS rates of clinical responders, with or without HRFs, were also significantly increased (P<0.01). In stage IB2, the 5-year DFS and OS rates were significantly increased, whereas operation duration declined in the NACT group (P<0.05). For patients with stage IB tumours of 2–5cm, the 5-year DFS and OS rates of clinical responders were significantly improved (P<0.05). ConclusionsNACT is a suitable option for patients with cervical cancer, especially for NACT responders and patients with stage IB, which provides a new concept of fertility preservation for young patients.