Oncofertility in Canada: Gonadal Protection and Fertility-Sparing Strategies

Abstract

Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: Here, we review the fertility preservation measures currently available. Medical and surgical strategies are both outlined. Results: Fertility-preserving strategies and gonadal protection have demonstrated variable success in a number of approaches. The value of hormone suppression is still in question for women. Progestins for endometrial cancer and alternative chemotherapies are other medical approaches. Gonadal shielding and protective surgical approaches have also been attempted. Conclusions: The techniques discussed here may be selectively considered and integrated into patient care in an attempt to preserve future fertility before initiating cancer treatment.

Fertility preservation in female cancer patients: An overview

“…There is also the concern of metastatic disease in the ovaries though it exists in a minority of patients (1%). [ 33 ] Since this procedure does not prevent ovarian damage by cytotoxic drugs, it should be avoided if the patient has to undergo both chemo and radiotherapy. Transvaginal oocyte recovery becomes difficult because of ovarian transposition, and transabdominal oocyte retrieval (OR) may be required for IVF.…”