Infertility in reproductive‐age female cancer survivors
- 3 February 2015
- Vol. 121 (10), 1532-1539
- https://doi.org/10.1002/cncr.29181
Abstract
Improved survival rates among reproductive‐age females diagnosed with cancer have increased the focus on long‐term quality of life, including maintenance of the ability to conceive biological children. Cancer‐directed therapies such as high‐dose alkylating agents and radiation to the pelvis, which deplete ovarian reserve, radiation to the brain, which affects the hypothalamic‐pituitary‐gonadal axis, and surgical resection of reproductive structures can decrease the likelihood of having biological children. Standard fertility preservation strategies such as embryo and oocyte cryopreservation before the onset of therapy offer the opportunity to conserve fertility, but they may not be feasible because of the urgency to start cancer therapy, financial limitations, and a lack of access to reproductive endocrinologists. Ovarian tissue freezing is considered experimental, with limited data related to pregnancies, but it minimizes treatment delay. Studies evaluating gonadotropin‐releasing hormone analogues have had mixed results, although a recent randomized, prospective study in women with breast cancer demonstrated a protective effect. Fertility preservation programs are increasingly being developed within cancer programs. In this article, we describe risks to infertility and options for preservation, raise psychosocial and ethical issues, and propose elements for establishing an effective fertility preservation program. Cancer 2015. © 2015 American Cancer Society.This publication has 63 references indexed in Scilit:
- Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysisFertility and Sterility, 2013
- Pretreatment antimüllerian hormone levels determine rate of posttherapy ovarian reserve recovery: acute changes in ovarian reserve during and after chemotherapyFertility and Sterility, 2013
- Testing and interpreting measures of ovarian reserve: a committee opinionFertility and Sterility, 2012
- Implementing a Systematic Approach to Meeting Patients' Cancer and Fertility Needs: A Review of the Fertile Hope Centers of Excellence ProgramJournal of Oncology Practice, 2012
- Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancerJournal of Assisted Reproduction and Genetics, 2012
- Fertility preservation in women—a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKTArchiv für Gynäkologie, 2011
- Association of cyclophosphamide drug–metabolizing enzyme polymorphisms and chemotherapy-related ovarian failure in breast cancer survivorsFertility and Sterility, 2010
- Current achievements and future research directions in ovarian tissue culture, in vitro follicle development and transplantation: implications for fertility preservationHuman Reproduction Update, 2010
- Insuring Against Infertility: Expanding State Infertility Mandates to Include Fertility Preservation Technology for Cancer PatientsThe Journal of Law, Medicine & Ethics, 2010
- Preservation of Fertility in Patients with CancerNew England Journal of Medicine, 2009