New promising strategies in oncofertility

Abstract

Introduction Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments. Areas Covered Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies. Expert Commentary There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.

Winter is coming: the future of cryopreservation

“…Oocyte cryopreservation is technically more challenging than embryo cryopreservation due to oocyte high water content that makes it more prone to cryoinjury. Therefore, oocyte cryopreservation involves a higher risk of damage during the preservation process and results in lower overall pregnancy rates compared to embryo cryopreservation [ 198 ]. Some of the adverse effects of oocyte cryopreservation as summarised by Angarita et al [ 193 ] are hardening of the zona pellucida [ 199 ], egg’s meiotic spindle, cytoskeleton and cortical granular damage by ice crystals [ 200 ].…”

Ethical Issues in Gender-Affirming Care for Youth

“…Oocyte cryopreservation is substantially more expensive, costing ∼$10 000 for the collection and freezing of gametes and $800 per year for storage. 74 Fertility drugs are not included in this estimate. In New York, average costs for mastectomy total $49 149, and breast procedures other than mastectomy, such as breast augmentation, cost on average $50 886.…”

The Meaning and Importance of Genetic Relatedness: Fertility Preservation Decision Making Among Israeli Adolescent Cancer Survivors and Their Parents

“…Oncofertility research indicates that survivors of adolescent cancers have a strong desire to parent (2)(3)(4)(5). Implied more often than explicitly stated, this desire is to parent genetically-related children (6,7). With multiple options available today to become a parent (such as gamete donation, surrogacy, or adoption), how does the matter of genetic relatedness factor into cancer patients' fertility preservation (FP) decision making?…”