Abstract
Cancer may be detected at any age and could affect children, and reproductive age women as well. In recent years, cancer treatment has become less destructive and more specific. As a result, survival rates and quality of life following successful treatment have continuously improved. Cancer treatment typically involves surgery, chemo- or radiation therapy, or the combinations of these. These interventions often adversely affect the function of the reproductive organs. Chemo- and radiation therapy are known to be gonadotoxic. Survivors of oncologic therapy are typically rendered infertile primarily due to the loss of ovarian function. There are, however, several medical, surgical, and assisted reproductive technology options that could be and should be offered to those diagnosed with cancer and wish to maintain their fertility. Embryo cryopreservation has been available for decades and has been successfully applied for fertility preservation in women diagnosed with cancer. Recent advances in cryobiology have increased the efficacy of not just embryo but even oocyte and ovarian tissue freezing–thawing. Oocyte vitrification just like embryo cryopreservation requires the use of stimulation but does not require the patient to be in a stable relationship or accept the use of donor sperm. Ovarian tissue cryopreservation does not require stimulation and, following successful transplantation, provides the patient with the most eggs but is currently still considered experimental. This paper summarizes the various fertility-sparing medical, surgical and assisted reproductive technology options. It reviews the current status of embryo, oocyte, and ovarian tissue cryopreservation and discusses their risks and benefits.
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References
Siegel R, Ma J, Zou Z, et al. Cancer Statistics, 2014. CA Cancer J Clin. 2014;64:9–29.
Barber HR. The effect of cancer and its therapy upon fertility. Int J Fertil. 1981;26:250–9.
Sankaranarayanan R, Gaffikin L, Jacob M et al. A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005;89:S4–12.
Plante M, Renaud MC, Hoskins IA, et al. Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature. Gynecol Oncol. 2005;98:3–10.
Ungar L, Palfalvi L, Hogg R, et al. Abdominal radical trachelectomy: a fertility-preserving option for women with early cervical cancer. BJOG. 2005;112:366–9.
Palfalvi L, Ungar L, Boyle DCM, et al. Announcement of healthy baby boy born following abdominal radical trachelectomy. Int J Gynecol Cancer. 2003;13:249.
Damewood MD, Grochow LB. Prospects for fertility after chemotherapy or radiation for neoplastic disease. Fertil Steril. 1986;45:443–59.
Bisharah M, Tulandi T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol. 2003;188:367–70.
Bidzinski M, Lemieszczuk B, Zielinski J. Evaluation of the hormonal function and features of the ultrasound picture of transposed ovary in cervical cancer patients after surgery and pelvic irradiation. Eur J Gynaecol Oncol. 1993;14Suppl:77–80.
Gershenson DM, Miller AM, Champion VL, et al. Gynecologic oncology group. Reproductive and sexual function after platinum-based chemotherapy in long-term ovarian germ cell tumor survivors: a gynecologic oncology group study. J Clin Oncol. 2007;25:2792–7.
Schilder JM, Thompson AM, DePriest PD, et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol. 2002;87:1–7.
Tinelli FG, Tinelli R, La Grotta F, et al. Pregnancy outcome and recurrence after conservative laparoscopic surgery for borderline ovarian tumors. Acta Obstet Gynecol Scand. 2007;86:81–7.
Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under the age 40. Obstet Gynecol. 1997;90:434–40.
Yamazawa K, Hirai M, Fujito A, et al. Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer. Hum Reprod. 2007;22:1953–8.
Koskas M, Uzan J, Luton D, et al. Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril. 2014;101:785–94.
Posada MN, Kolp L, Garcia JE. Fertility options for female cancer patients: facts and fiction. Fertil Steril. 2001;75:647–53.
Blumenfeld Z, Avivi I, Eckman A, et al. Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma. Fertil Steril. 2008;89:166–73.
Elgindy EA, El-Haieg DO, Khorshid OM, et al. Gonadotrophin suppression to prevent chemotherapy-induced ovarian damage. Obstet Gynecol. 2013;121:78–86.
Bedaiwy MA, Abou-Setta AM, Desai N, et al. Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis. Fertil Steril. 2011;95:906–14.
Loren AW, Mangu PB, Beck LN, et al. American sociaty of clinical oncology. Fertility preservation for patients with cancer: Americal society of clinical oncology practice guideline update. J Clin Oncol. 2013;31:2500–10.
Trounson A, Mohr L. Human pregnancy following cryopreservation, thawing and transfer of an eight-cell embryo. Nature. 1983;305:707–9.
Abdel Hafez FF, Desai N, Abou-Setta AM, et al. Slow freezing, vitrification and ultra-rapid freezing of human embryos: a systematic review and meta-analysis. Reprod Biomed Online. 2010;20:209–22.
Kuang Y, Hong Q, Chen Q, et al. Luteal-phase ovarian stimulation is feasible for producing competent oocytes in women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment, with optimal pregnancy outcomes in frozen-thawed embryo transfer cycles. Fertil Steril. 2014;101:105–11.
Cakmak H, Katz A, Cedars MI, et al. Effective method for emergency fertility preservation: random-start controlled ovarian stimulation. Fertil Steril. 2013;100:1673–80.
Oktay K, Buyuk E, Libertella M, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol. 2005;23:4347–53.
Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol. 2008;26:2630–5.
Chen C. Pregnancy after human oocyte cryopreservation. Lancet. 1986;1:884–6.
The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99:37–43.
Scaravelli G, Vigiliano V, Mayorga JM, et al. Analysis of oocyte cryopreservation in assisted reproduction: the Italian National Register data from 2005 to 2007. Reprod Biomed Online. 2010;21:496–500.
Smith GD, Serafini PC, Fioravanti J, et al. Prospective randomized comparison of huan oocyte cryopreservation with slow-freezing or vitrification. Fertil Steril. 2010;94:2088–95.
Almodin CG, Minguetti-Camara VC, Paixao CL, et al. Embryo development and gestation using fresh and vitrified oocytes. Hum Reprod. 2010;25:1192–8.
Rienzi L, Cobo A, Paffoni A, et al. Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study. Hum Reprod. 2012;27:1606–12.
Cobo A, Remohi J, Chang CC, et al. Oocyte cryopreservation for donor egg banking. Reprod Biomed Online. 2011;23:341–6.
Cobo A, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011;96:277–85.
Goldman KN, Noyes NL, Knopman JM, et al. Oocyte efficiency: does live birth rate differ when analyzing cryopreserved and fresh oocytes on a per-oocyte basis? Fertil Steril. 2013;100:712–7.
Di Pietro C, Vento M, Guglielmino MR, et al. Molecular profiling of human oocytes after vitrification strongly suggests that they are biologically comparable with freshly isolated gametes. Fertil Steril. 2010;94:2804–7.
Noyes N, Porcu E, Borini A. Over 900 oocyte cryopreservation babied born with no apparent increase in congenital anomalies. Reprod Biomed Online. 2009;18:769–76.
Levi Setti PE, Albani E, Morenghi E, et al. Comparative analysis of fetal and neonatal outcomes of pregnancies from fresh and cryopreserved/thawed oocytes in the same group of patients. Fertil Steril. 2013;100:396–401.
Chian RC, Uzelac PS, Nargund G. In vitro maturation of immature oocytes for fertility preservation. Fertil Steril. 2013;99:1173–81.
The Practice Committee of the American Society for Reproductive Medicine. Ovarian tissue cryopreservation: a committee opinion. Fertil Steril. 2014;101:1237–43.
Donnez J, Dolemans MM. Fertility preservation in women. Nat Rev Endocrinol. 2013;9:735–49.
Oktay K, Oktem O. Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience. Fertil Steril. 2010;93:762–8.
Oktay K, Economos K, Kan M, et al. Endocrine function and oocyte retrieval after autologous transplantation of ovarian cortical strips to the forearm. JAMA. 2001;286:1490–3.
Bedaiwy MA, Falcone T. Whole ovary transplantation. Clin Obstet Gynecol. 2010;53:797–803.
Donnez J, Dolmans MM, Pellicier A, et al. Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril. 2013;99:1503–13.
Salama M, Winkler K, Murach KF, et al. Female fertility loss and preservation: threats and opportunities. Ann Oncol. 2013;24:598–608.
Silber S, Kagawa N, Kuwayama M, et al. Duration of fertility after fresh and frozen ovary transplantation. Fertil Steril. 2010;94:2191–6.
Donnez J, Squifflet J, Pirard C, et al. Live birth after allografting of ovarian cortex between genetically non-identical sisters. Hum Reprod. 2011;26:1384–8.
Hilders CG, Baranski AG, Peters L, et al. Successful human ovarian autotransplantation to the upper arm. Cancer. 2004;101:2771–8.
Silber SJ, Grudzinskas G, Gosden RG. Successful pregnancy after microsurgical transplantation of an intact ovary. N Engl J Med. 2008;359:2617–8.
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Peter Kovacs declares that he has no conflict of interest.
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Kovacs, P. Fertility Preservation in Reproductive Age Women with Cancer. J Obstet Gynecol India 64, 381–387 (2014). https://doi.org/10.1007/s13224-014-0626-0
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DOI: https://doi.org/10.1007/s13224-014-0626-0