Strategies for Fertility Preservation in Young Patients with Cancer: A Comprehensive Approach

Abstract

As a result of treatment innovations, the survival rates of young people with cancer have increased substantially. The cancers most frequently diagnosed in adults aged 25-49 years include breast, colorectal and cervical cancer and malignant melanoma (Cancer Research UK, 2009). The 5-year survival rates of over 90 % for many malignancies are now reported in young people. But the diagnosis and treatment of cancer often poses a threat to fertility. Methods of fertility preservation are evolving quickly and awareness needs to grow in the medical community regarding these methods. Studies suggest that the ability to have biological children is of great importance to many people. The possible future effects of chemotherapy or radiotherapy on fertility should be discussed with all cancer patients who have reproductive potential. Moreover, fertility preservation should be considered for all young people undergoing potentially gonadotoxic treatment. This article covers the various methods of fertility preserving options in young men and women with respect to the various treatment modalities that they may be subjected to. Sperm banking is a simple and low cost intervention. Embryo cryopreservation is the only established method of female fertility preservation. Oocyte cryopreservation offers a useful option for women without a male partner. Emergency ovarian stimulation and cryopreservation of ovarian tissue (followed by tissue transplantation or in-vitro maturation of oocytes) are experimental techniques for women who require urgent cancer treatment. Large, well-controlled studies are also required to identify any unexpected long-term sequelae of cryopreservation of oocytes and ovarian tissue.

Preserving fertility in an unconscious patient with Goodpasture syndrome—medicolegal and ethical aspects

“…The chance of recovery of spermatogenesis may be affected by the chemotherapeutic regimen and baseline reproductive function of the patient. Notably, alkylating agents, including cyclophosphamide, seem to have the most profound reproductive effects [ 9 , 21 ]. Adequate sperm will return to the ejaculate sufficient for natural conception in some patients; however, these numbers are poorly defined and fertility preservation options are usually discussed with the patient prior to chemotherapeutic treatment [ 7 ].…”

“…Treatment of choice with plasmapheresis combined with prednisone and a cytostatic like cyclophosphamide [ 1 – 3 , 5 , 6 ] should be initiated as soon as possible. Knowing that treatments containing high doses of alkylating agents (such as cyclophosphamide) present the highest level of risk for gonadal impact (azoospermia with irreversible mutagenic effect on all stages of spermatogenesis), patients should be counseled on fertility preservation prior to treatment [ 7 – 9 ]. In males, the established method to secure fertility is cryopreservation of sperm, which can later be used for assisted reproduction techniques [ 8 ].…”

“…In males, the established method to secure fertility is cryopreservation of sperm, which can later be used for assisted reproduction techniques [ 8 ]. If patients are unable of producing a semen sample with ejaculation, the most common methods for sperm retrieval include fine-needle aspiration, testicular sperm extraction (TESE), and micro-TESE (microsurgical TESE using magnification) [ 9 ]. TESE involves an incision of the tunica albuginea and retrieval of seminiferous tubules (Figs.…”

Discussions about reproductive and sexual health among young adult survivors of cancer

“…Because management for these tumor sites can frequently involve removal of or modification to the reproductive anatomy, this may serve as strong motivation for patients and physicians to more openly discuss fertility implications. The perceived ease and lower costs of sperm banking when compared to egg retrieval and cryopreservation may further explain why testicular cancer patients were most likely to embark on fertility preservation . With advances in fertility preservation, however, the number of available options is increasing while the costs are decreasing, and thus should encourage discussions across all tumor groups.…”

Fertility Preservation Options for Cancer Patients

“…The frozen cortical tissue can be thawed when the patient is declared cancer free and transplanted onto the patient's ovary (orthotopic transplantation) or other sites (heterotopic transplantation), such as the forearm or the abdominal wall. Autologous orthotopic transplantation allows for the possibility of natural fertilization [20]. With heterotopic transplantation pregnancy can only be achieved by oocyte retrieval and in-vitro fertilization utilizing assisted reproductive technologies.…”