Fertility considerations in young women with hematological malignancies

Abstract

The need for practice guidelines for fertility preservation in young women with hematological malignancies has been increased. To develop recommendations, publications relevant to fertility preservation and hematological cancers were identified through a PubMed database search and reviewed systematically, focusing on the effects of oncological treatments on fertility as well as on the efficacy, feasibility and risks of existing fertility preservation methods.

Challenges for Cancer Care Delivery to Adolescents and Young Adults: Present and Future

“…Regarding fertility preservation options, men are largely limited to sperm banking, which they should all be offered regardless of the risk of spermatic failure [36] . For women, options include in vitro fertilization, in vitro maturation or oopheropexy to move the ovaries out of a planned field of radiation [33] . Ovarian cortex cryopreservation is another choice that is still experimental.…”

“…Likewise for females, rates of birth after BEACOPP were 6.5% compared to 16.6% for non-BEACOPP regimens. It is reasonable in most cases to delay treatment for 1 ovulatory cycle in order to cryopreserve embryos or oocytes [33] . Men can have pretreatment fertility impairment, but sperm banking should still be offered [40] .…”

“…In chronic myeloid leukemia, imatinib is not felt to impair future fertility, but pregnancies are not advised while taking this medication [33] . Data regarding future fertility with later-generation tyrosine kinase inhibitors are sparse.…”

“…Myeloablative preparation using total body irradiation has a subsequent rate of successful pregnancy of less than 3%, while the overall rate of successful conception ranges from 0.6 to 11% depending on the study and preparative regimen used [43][44][45][46][47] . There is also a theoretical concern that pregnancy may lead to increased rates of disease relapse after HSCT due to the state of decreased immune surveillance, but this has not yet been clearly demonstrated by empirical data [33] .…”

Detection of Non-Hodgkin’s Lymphoma in ovarian cortex pieces during the process of cryopreservation

“…The incidence of premature ovarian failure in case of NHL is about 5 % after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), 14 % after hyper-CVAD (cyclophosxphamide, vincristine, adriamycine, dexamethasone) and 70-100 % after hematopoietic stem cell transplant (HSCT), with pregnancy rates of 50 %, 43 % and less than 5 %, respectively [5][6][7].…”