Anticancer treatments and female fertility: clinical concerns and role of oncologists in oncofertility practice

Abstract

Introduction: Anticancer treatments such as aggressive chemotherapy and radiotherapy have deleterious gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women. Areas Covered: In order to preserve fertility of young women and girls with cancer, several established, experimental, and debatable options can be offered in the emerging field of oncofertility. This article reviews the effects of anticancer treatments on female fertility and discusses the current challenges and future directions of fertility preservation options that can be offered to the female patients with cancer. Expert Commentary: Although promising, several medical, economic, social and legal barriers face oncofertility practice around the globe especially in underserved areas. To overcome such barriers, more effective solutions should be provided to spread awareness and enhance communication between patients, oncologists and gynecologists. Early referral by oncologists before initiation of chemotherapy and radiotherapy is an important key factor for success in female fertility preservation strategies.

From bench to bedside: Current developments and future possibilities of artificial human ovary to restore fertility

“…Although experimental, artificial human ovary technology may be the only option to preserve and restore fertility in some patients when other fertility preservation and restoration options are contraindicated, infeasible, unavailable, rejected or unsuccessful . Contraindications of the major options for female fertility preservation and restoration are listed in Table .…”

“…Although experimental, artificial human ovary technology may be the only option to preserve and restore fertility in some patients when other fertility preservation and restoration options are contraindicated, infeasible, unavailable, rejected or unsuccessful. [17][18][19][20][21][22][23] Contraindications of the major options for female fertility preservation and restoration are listed in Table 1. Although experimental, three major categories of patients (age <40 years) may benefit from artificial ovary technology to preserve and restore fertility:…”

Technologies for the Production of Fertilizable Mammalian Oocytes

“…Very encouraging results in fact reveal that, in young women with malignancies, ovarian reserve, response to gonadotropins, number and quality of oocytes retrieved for in vitro fertilization (IVF) in the field of fertility preservation (see below) remain unaffected by the neoplastic process [9,10]. On the other hand, aggressive anticancer treatments such as chemotherapy and radiotherapy may have massive gonadotoxic side effects, leading to iatrogenic loss of fertility in treated women [11]. In detail, more than 35,000 women between 15 and 39 years of age are diagnosed with cancer every year.…”

“…The availability of clinical practice guidelines on fertility preservation care represents an important goal [111], although several clinical, socioeconomic, legal, ethical and religious barriers limit oncofertility practice worldwide [112]. Appropriate counseling by physicians and oncologists, in particular, is still inadequate in several countries [11]. To date, only two networks exist, the FertiPROTEKT [113] and Oncoferility Consortium [114].…”

“…To date, only two networks exist, the FertiPROTEKT [113] and Oncoferility Consortium [114]. The first links fertility centers in all German-speaking countries (Germany, Austria and Switzerland), while the second involves fertility preservation centers in USA and worldwide [11,112]. Precise indications from ethical committees-even if ethical laws may differ from one country to another-may be crucial for a wider and safer application of fertility preservation protocols [115].…”