How to preserve fertility before chemotherapy
(2009) Belgian Journal of Medical Oncology — Vol. 3, n° 1, p. 7-15 (2009)
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- Abstract
- Advances in the diagnosis and treatment of childhood, adolescent and adult cancer have greatly increased the life expectancy of premenopausal women with cancer. Unfortunately, aggressive chemo- and radiotherapy can result in the loss of both endocrine and reproductive functions, leading to premature menopause and infertility. It is thus our duty to evaluate the effects of specific cancer treatments on fertility and discuss fertility preservation options with these young women prior to cancer treatment. The different cryopreservation options available for fertility preservation in cancer patients are embryo cryopreservation, oocyte cryopreservation and ovarian tissue cryopreservation. There is conflicting evidence on the use of GnRH analogs to preserve fertility in women undergoing chemotherapy, and GnRH analogs are not indicated for patients undergoing radiotherapy. The only established method of fertility preservation is embryo cryopreservation, but this requires the patient to be of pubertal age, have a partner, and be able to undergo a cycle of ovarian stimulation. Cryopreservation of ovarian tissue is the only option available for prepubertal girls, and for woman who cannot delay the start of chemotherapy. Twenty-five cases of orthotopic reimplantation of cryopreserved ovarian tissue have so far been reported and six live births have been achieved, yielding a pregnancy rate of almost 25%. With all the advances in ovarian tissue cryobanking and reproductive technology, fertility preservation is now a real possibility for patients whose gonadal function is threatened by radioor chemotherapy. For this reason, it should be a medicolegal obligation for gynecologists, oncologists and pediatricians to systematically propose cryopreservation before initiating cancer therapy that could impair future fertility.
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Donnez, J., Jadoul, P., Donnez, O., Squifflet, J.-L., Gilliaux, S., & Dolmans, M.-M. (2009). How to preserve fertility before chemotherapy. Belgian Journal of Medical Oncology, 3(1), 7-15. https://hdl.handle.net/2078.5/152703 (Original work published 2009)