Cancer and fertility preservation: international recommendations from an expert meeting

Abstract

In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians.In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of “cancer and fertility preservation”. A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation.Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America

“…Hence, further educational initiatives and 19 . Hence, taking into account all these findings, after adequate treatment and follow-up, pregnancy in breast cancer survivors, including in those with hormone receptor-positive disease, should not be discouraged anymore 20 .…”

“…1). Final results from the MOMMY study, an ongoing individual patient data meta-analysis investigating the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients (PROSPERO registration number: CRD42014015638) 20 , are awaited to provide final evidence regarding the efficacy and safety of this procedure.…”

“…Some safety issues are still under investigation, especially regarding the possibility of reintroducing malignant cells during a transplantation procedure 20 . Luyckx, et al analyzed 13 thawed ovarian tissues from advanced breast cancer patients using histology, immunohistochemistry, xenografting to mice, and quantitative polymerase chain reaction for gene expression of mammaglobin 2 (MGB2) 59 .…”

Anticancer chemotherapy in teenagers and young adults: managing long term side effects

“…• Meta-analyses indicate may improve future pregnancy rates, particularly in patients with breast cancer 34 …”

Pharmacotherapy to protect ovarian function and fertility during cancer treatment

“…In recent years, modern anticancer treatments have led to significant survival improvements; however, in premenopausal women, the administration of these therapies is also associated with potential unwanted side effects such as treatment-related premature ovarian failure (POF) and subsequent reduced fertility [1]. At the time of cancer diagnosis, the maintenance of gonadal function and fertility has crucial importance for many patients.…”