Prevention of ovarian damage and infertility in young female cancer patients awaiting chemotherapy—clinical approach and unsolved issues

Abstract

Great advances in the oncological therapy of childhood and adolescent cancer patients lead to an increase of young cancer survivors with a normal expectancy of life. The aggressive chemotherapy and/or radiation often compromises endocrine function with consecutive menopausal symptoms and sterility. Recently, new approaches were developed to preserve fertility with different methods to restore the ovarian function. The present review gives an overview of the current possibilities, which may be offered to these young cancer patients, as well as the chances of success and risks and the unsolved issues in special situations.

Fertility-Sparing Surgery in Early Epithelial Ovarian Cancer: A Viable Option?

“…Systemic and operative oncologic treatments consistently compromise the ovarian function, often resulting in infertility and premature menopause [26–28]. …”

“…Chemotherapeutic agents, which act cytotoxic by interrupting the normal cell cycle and inducing apoptosis do also negatively affect the highly endocrine-active ovarian tissue. Cisplatin and its analogues, that is, agents which play a highly significant role in the management of ovarian cancer, have been proven to present a risk factor for ovarian failure by an estimated odds ratio as high as 1.77 [28]. In order to decrease chemotherapy-induced gonadotoxicity on young women after FSS, hormonal protection is being recruited to force the ovarian tissue by pituitary downregulation to enter into a state of inactivity and so to make it less susceptible to cytotoxic agents.…”