Oncofertility and preservation of reproductive capacity in children and young adults

Abstract

With increasing numbers of survivors from cancer at a young age, the issue of fertility preservation has assumed greater importance. This review describes normal ovarian and testicular function and summarizes what is known about the effect of chemotherapy and radiotherapy on the gonads and uterus. All young patients with cancer or leukemia should have their fertility prognosis discussed before the initiation of treatment. Sperm and embryo cryopreservation should be considered standard practice and be widely available for those at significant risk of infertility. For prepubertal girls, ovarian tissue cryopreservation should be considered if the risk of premature menopause is high, but for the prepubertal boy there are no established techniques in current practice. Cancer 2011;117(10 suppl):2301–10. © 2011 American Cancer Society.

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…16,52,[101][102][103][104][105] The ASCO Clinical Practice Guidelines recommend that providers discuss the options for fertility preservation with all new patients with cancer at diagnosis. 106 Nevertheless, fertility preservation is currently one of the most underprescribed and least implemented services in AYA patients with cancer.…”

“…106 Nevertheless, fertility preservation is currently one of the most underprescribed and least implemented services in AYA patients with cancer. 52,101,107 A study that reviewed 231 records of AYA patients with leukemia/lymphoma, sarcoma, or breast or testicular cancers showed that infertility risk was discussed 26% of the time and fertility preservation options were discussed 24% of the time. 108 However, it is possible that more discussions about infertility occurred without having been documented.…”

“…112 Embryo cryopreservation after IVF has been highly successful in women younger than 40 years of age. 52,101 However, this method requires a male partner or sperm donor who is available with short notice. In one study that assessed pregnancy outcomes following embryo cryopreservation, letrozole was used in combination with follicle-stimulating hormone to protect patients with breast cancer against the harmful effects of increased estrogen.…”

Dexrazoxane exacerbates doxorubicin-induced testicular toxicity

“…The Childhood Cancer Survivor Study indicated that male survivors were substantially less likely to attain a pregnancy (hazard ratio 0.56, 95% CI 0.49-0.63) compared to their siblings (Green et al 2010). Nevertheless, although male infertility is one of the major lateterm concerns of anti-cancer treatments during childhood and adolescence (Brougham et al 2003, Wallace 2011, the mechanism of chemotherapy-induced testicular toxicity remains to be elucidated. Studies have demonstrated that several classes of chemotherapy alter spermatogenesis in the pre-pubertal and early pubertal testis (Masala et al 1997, Thomson et al 2002, Longhi et al 2003.…”

Embryo transfer following in vitro maturation and cryopreservation of oocytes recovered from antral follicles during conservative surgery for ovarian cancer

“…This has generated new expectations especially for women of adolescent and reproductive age for whom an increased hope of recovery from disease implies a prospect of parenthood [2]. Unfortunately, radioand chemotherapies have major effects on ovarian function, often leading to premature ovarian failure.…”