Nonmalignant Diseases and Treatments Associated with Primary Ovarian Failure: An Expanded Role for Fertility Preservation

Abstract

Cancer treatments can be detrimental to fertility; recent literature has focused on the efforts of fertility preservation for this patient population. It should be recognized, however, that several nonmalignant medical conditions and therapeutic interventions could be similarly hazardous to fertility. Some of these nonmalignant diseases and their treatments that can adversely impact the reproductive axis are gastrointestinal diseases, rheumatologic disorders, nonmalignant hematologic conditions, neurologic disorders, renal disorders, gynecologic conditions, and metabolic diseases. Their negative effects on reproductive function are only now being appreciated and include impaired ovarian function, endocrine function, or sexual function and inability to carry a pregnancy to term. Complications and comorbidities associated with certain diseases may limit the success of established fertility preservation options. Recent advances in fertility preservation techniques may provide these patients with new options for childbearing. Here, we review several fertility-threatening conditions and treatments, describe current established and experimental fertility preservation options, and present three initiatives that may help minimize the adverse reproductive effects of these medical conditions and treatments by raising awareness of the issues and options: (1) increase awareness among practitioners about the reproductive consequences of specific diseases and treatments, (2) facilitate referral of patients to fertility-sparing or restorative programs, and (3) provide patient education about the risk of infertility at the time of diagnosis before initiation of treatment.

Size-specific follicle selection improves mouse oocyte reproductive outcomes

“…This issue has been at the forefront of reproductive research activities over the past 10 years and many new technologies have been developed to help these patients preserve their fertility (De Vos et al 2014). In addition to cancer, there are also non-malignant diseases and conditions, as well as their treatments, which can negatively affect reproductive function (Hirshfeld-Cytron et al 2011, Purcell & Moley 2011). In addition to fertility concerns, loss of endocrine support of hormonally responsive tissues can cause a cascade of medical and quality-of-life problems and must be addressed as part of the initial comprehensive plan of care for young women.…”

Fertility counseling and preservation: considerations for the pediatric endocrinologist

“…Individuals with TS most commonly have a 45,X karyotype, associated with hypoplastic ovaries and few oocytes, resulting in infertility (55). The oocyte damage occurs at variable rates ultimately ending with primary ovarian insufficiency (56).…”

“…The mechanisms are not well understood (55), and counseling should focus on early preservation options. Autoimmune ovarian insufficiency should also be considered in females with spontaneous POI with no clear explanation, and is thought to be the etiology in ~5% of cases (68).…”

“…Infiltrative conditions such as hemochromatosis can cause primary and secondary hypogonadism in males and females (55). Various infections can also lead to gonadal insufficiency; for example, mumps results in orchitis in select patients.…”

Ovarian tissue transport to expand access to fertility preservation: from animals to clinical practice

“…Chemotherapy and radiation therapy, although used successfully to treat a myriad of malignant and non-malignant conditions, can have the unintended long-term consequence of damaging reproductive function (De Vos, et al 2014, Hirshfeld-Cytron, et al 2011, Jeruss and Woodruff 2009, Lobo 2005, Meirow, et al 2005, Wallace, et al 2014, Woodruff 2010). In females, these treatments can negatively impact several aspects of the reproductive system, including the hypothalamic-pituitary-gonadal axis, the ovary, and the uterus (Duncan, et al 2014, Gracia and Woodruff 2012).…”