Cryopreservation Options to Preserve Fertility in Female Cancer Patients: Available Clinical Practice and Investigational Strategies from the Oncology Guidelines Point of View

Abstract

In recent years, advances in cancer treatment have improved the survival rate of cancer patients significantly. However, destructive damage to ovaries due to the therapies or cancer itself can cause different degrees of infertility in women of reproductive age that can affect their quality of life seriously. In this study, fertility cryopreservation options for female cancer patients in oncology guidelines were reviewed. Cryopreservation methods have a long history in reproductive biology and oncology. However, embryo and oocyte cryopreservation were the eligible restoration strategies in clinical oncology practice. Ovarian tissue cryopreservation (OTC) is the latest option recommended for fertility preservation in pre-pubertal and adult patients who cannot delay their treatment or in whom taking IVF hormones may have adverse effects on their cancer. Reports show that frozen-thawed ovarian tissue transplantation has led to more than 130 live births so far in patients, most of whom were cancer patients. Although OTC is indeed generally recognized as an investigational method, it is recommended in some important guidelines, such as ASCO 2018. Therefore, based on many clinical pieces of evidence , it is predicted that the investigational label will soon be removed, and OTC might be considered as one of the main fertility preservation options for female cancer patients in clinical oncology practice.

Fertility preservation strategies for cancerous women: An updated review

“…This approach described some diseases, including genetic abnormalities such as Turner’s syndrome ( 31 ) , gynecological diseases ( 32 ) , systemic and endocrine disorders, autoimmune disease ( 33 ) , and endometriosis leading to premature ovarian insufficiency ( 34 ) . It is the only option available for pre-pubertal girls and women with estrogen-sensitive malignancies ( 35 , 36 ) . However, OTC is a useful procedure that allows for restoring ovarian function and natural pregnancy ( 37 ) .…”

In-vivo oogenesis of oogonial and mesenchymal stem cells seeded in transplanted ovarian extracellular matrix

“…In women, chemotherapy or radiotherapy treatments can damage the ovaries and cause loss of endocrine and reproductive system functions [ 1 ]. Ovarian tissue cryopreservation is currently the only approach to fertility preservation for patients undergoing gonadotoxic treatment [ 2 , 3 ]. However, this method is not appropriate for patients who have certain types of cancers because there is a risk of the retention of cancer cells in the cryopreserved tissue [ 4 ].…”