Preserving fertility in patients undergoing treatment for breast cancer: current perspectives

Abstract

Invasive breast cancer (BC) is the most frequent cancer of young women. Considering the trend toward postponing childbearing until the later reproductive years, the number of childless women at diagnosis of BC will continue to increase. The American Society of Clinical Oncology and the American Society for Reproductive Medicine have recommended that the impact of cancer treatments on fertility should be addressed with all cancer patients of reproductive age and that options for fertility preservation, such as cryopreservation of embryos and oocytes, ovarian tissue, in vitro maturation of immature oocytes, and ovarian suppression with gonadotropin-releasing hormone analogs, should be discussed routinely. To optimally counsel patients on how to best weigh the risks and benefits of fertility preservation, both the health care provider and the patient must know about the options, their risks, and their likelihood of success. The aim of this review is to summarize current knowledge on fertility preservation options for young BC patients, surrogates of ovarian function, psychosocial aspects of infertility after cancer treatment, women’s attitudes towards childbearing after cancer treatment, and health care providers’ attitudes towards fertility preservation.

Challenges and Considerations in Optimizing Ovarian Stimulation Protocols in Oncofertility Patients

“…All chemotherapies have the potential to damage developing follicles; this can result in temporary amenorrhea. If the primordial follicle pool is not permanently damaged, menses will return, with the development of new follicles within 3–6 months after the last treatment ( 6 ). Studies indicate that alkylating agents are particularly gonadotoxic ( 7 ), with significantly diminished ovarian response demonstrated in those who received alkylating agents prior to oocyte retrieval ( 8 ).…”