Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies

Abstract

Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.

Can a University Reproductive Medicine Centre Be Financed Under the Pre-Existing General Conditions in Germany?

“…At present, the cooperation between practices and university hospitals is not sufficient 13 . Clear concepts and networks would have to be created to ensure the successful continued existence of reproductive medicine in Germany 17 , 18 . In addition, the infrastructure of the university centres must be adequately remunerated.…”

“…Eine ausreichende Kooperation der Praxen und der Universitätskliniken besteht derzeit nicht 13 . Klare Konzepte und Netzwerke müssen geschaffen werden, um ein erfolgreiches Weiterbestehen der Reproduktionsmedizin in Deutschland zu sichern 17 , 18 . Des Weiteren muss die Infrastruktur der universitären Zentren adäquat entlohnt werden.…”

Técnicas de preservación de la fertilidad femenina y experiencia en la Clínica de Fertilización Asistida en el Centro Médico ABC

“…9 La posibilidad de maduración in vitro de oocitos del tejido ovárico criopreservado acompañado de inseminación in vitro o ICSI permite a este grupo particular de pacientes embarazarse sin tener que efectuar el trasplante de tejido ovárico. [49][50][51] Se han documentado 5,000 nacimientos con el uso de esta técnica. 39 Tabla 1: Clasificación de gonadotóxicos.…”

Genetic predictors of chemotherapy-related amenorrhea in women with breast cancer

“…tandard chemotherapies for breast cancer damage the ovaries, causing temporary or permanent loss of menses (chemotherapy-related amenorrhea [CRA]) in many young women. Long-term amenorrhea has been seen in more than one-half of premenopausal women treated with the use of chemotherapy for breast cancer (1)(2)(3). Premature loss of ovarian function can cause hot flashes, vaginal dryness (4), and bone thinning, and may contribute to other health risks (5).…”