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Archives of Gynecology and Obstetrics

, Volume 282, Issue 5, pp 547–551 | Cite as

Management of fertility preservation in young breast cancer patients in a large breast cancer centre

  • B. Lawrenz
  • E. Neunhoeffer
  • M. Henes
  • S. Lessmann-Bechle
  • B. Krämer
  • Tanja Fehm
Reproductive Medicine

Abstract

Purpose

The increase of breast cancer in young women under 40 years and the increasing age of women at the time of the birth of their first child underlines the importance to implement counselling for fertility-preserving strategies in the management of breast cancer care. We present the fertility-preserving procedures performed after routine counselling for primary breast cancer patients in a large certified breast cancer centre.

Materials and methods

Since November 2006, patients aged below 40 years with histologically confirmed breast cancer are routinely counselled on fertility-preserving possibilities before breast surgery and chemotherapy in the fertility centre of the University Women’s Hospital in Tuebingen. The recommendations are based on the treatment recommendations of the network FertiPROTEKT.

Results

During the last 40 months, 56 primary breast cancer patients were counselled. Forty-one of these patients were hormone receptor positive. Thirty-four patients (63%) underwent fertility-preserving strategies. The majority of the patients (n = 22) decided on ovarian tissue cryopreservation. GnRH protection was performed in 14 patients. In 12 patients an ovarian stimulation protocol was initiated to cryopreserve fertilized or unfertilized oocytes. A combination of different fertility-preserving methods was performed in 12 patients.

Conclusions

The preservation of ovarian function and fertility are of great importance to young breast cancer patients. Counselling on fertility-preserving strategies is therefore critical in these patients and should be routinely performed.

Keywords

Breast cancer chemotherapy Fertility Fertility-preserving methods Cryopreservation 

Abbreviations

CMF

Cyclophosphamide, methotrexate, fluorouracil

FEC

Fluorouracil, epirubicin, cyclophosphamide

FAC

Fluorouracil, adriamycin, cyclophosphamide

EC

Epirubicin, cyclophosphamide

AC

Adriamycin, cyclophosphamide

Notes

Acknowledgments

We are greatly indebted to Mrs. Elizabeth Kraemer for reviewing our manuscript.

Conflict of interest statement

We declare that we have no conflict of interest.

References

  1. 1.
    Krebs in Deutschland (2004) 4. überarbeitet, aktualisierte Ausgabe. Arbeitsgemeinschaft Bevölkerungsbezogener Krebsregister in Deutschland. SaarbrückenGoogle Scholar
  2. 2.
    Partridge AH, Ruddy KJ (2007) Fertility and adjuvant treatment in young women with breast cancer. Breast 16(2):175–181CrossRefGoogle Scholar
  3. 3.
    Von Wolff M, Thaler C, Frambach T, Zeeb C, Lawrenz B, Popovici R, Strowitzki T (2009) Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril 92(4):1360–1365CrossRefGoogle Scholar
  4. 4.
    Azim AA, Costantini-Ferrando M, Oktay K (2008) Safety of fertility preservation by ovarian stimulation with letrozol and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 26(16):2630–2635CrossRefPubMedGoogle Scholar
  5. 5.
    Walshe JM, Denduluri N, Swain S (2006) Amenorrhea in premenopausal women after adjuvant chemotherapy for breast cancer. J Clin Oncol 24(36):5769–5779CrossRefPubMedGoogle Scholar
  6. 6.
    Larsen EC, Müller J, Schmiegelow K (2003) Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab 88:5307–5314CrossRefPubMedGoogle Scholar
  7. 7.
    Badawy A, Elnashar A, El-Ashry M, Shahat M (2009) Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril 91:694–697CrossRefPubMedGoogle Scholar
  8. 8.
    Blumenfeld Z, von Wolff M (2008) GnRH-analogues and oral contraceptives for fertility-preservation in women during chemotherapy. Hum Reprod Update 14:543–553CrossRefPubMedGoogle Scholar
  9. 9.
    Emig R, Wallwiener D, Licht P (2003) Ovarschutz und Fertilitätserhalt vor und während der Chemotherapie. Geburtsh Frauenheilk 63:574–576CrossRefGoogle Scholar
  10. 10.
    Sonmezer M, Oktay K (2006) Fertility preservation in young women undergoing breast cancer therapy. Oncologist 11:422–434CrossRefPubMedGoogle Scholar
  11. 11.
    Ismail-Khan R, Minton S, Cox C, Sims I, Lacevic M et al (2008) Preservation of ovarian function in young women treated with neoadjuvant chemotherapy for breast cancer: a randomized trial using the GnRH agonist (triptorelin) during chemotherapy. J Clin Oncol 26(suppl):524 (abstract)Google Scholar
  12. 12.
    Gerber B (2009) ASCO Annual Meeting. ZORO: a prospective randomized multicenter study to prevent chemotherapy-induced ovarian failure with the GnRH-agonist goserelin in young hormone-insensitive breast cancer patients receiving anthracycline containing (neo-)adjuvant chemotherapy (GBG37) 526 (abstract)Google Scholar
  13. 13.
    Oktay K, Hourvitz A, Sahin G, Oktem O, Safro B, Cil A, Bang H (2006) Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy. J Clin Endocrinol Metab 91:3885–3890CrossRefPubMedGoogle Scholar
  14. 14.
    Oktay K, Karlikaya G (2000) Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 342:1919CrossRefPubMedGoogle Scholar
  15. 15.
    Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, Martinez-Madrid B, Van Langendonckt A (2006) Restoration of ovarian function after orthotopic (intraovarian and periovarian) transplantation of cryopreserved ovarian tissue in a woman treated by bone marrow transplantation for sickle cell anaemia: case report. Hum Reprod 21:183–188CrossRefPubMedGoogle Scholar
  16. 16.
    Schmidt KL, Andersen CY, Loft A, Byskov AG, Ernst E, Andersen AN (2005) Follow-up of ovarian function post-chemotherapy following ovarian cryopreservation and transplantation. Hum Reprod 20:3539–3546CrossRefPubMedGoogle Scholar
  17. 17.
    Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, Martinez-Madrid B, Van Langendonckt A (2004) Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 364:1405–1410CrossRefPubMedGoogle Scholar
  18. 18.
    Meirow D, Levron J, Eldar-Geva T, Hardan I, Fridman E, Zalel Y, Schiff E, Dor J (2005) Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 353:318–321CrossRefPubMedGoogle Scholar
  19. 19.
    Demeestere I, Simon P, Buxant F, Robin V, Fernandez SA, Centner J, Delbaere A, Englert Y (2006) Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation: case report. Hum Reprod 21:2010–2014CrossRefPubMedGoogle Scholar
  20. 20.
    Rosendahl M, Loft A, Byskov AG, Ziebe S, Schmidt KL, Andersen AN, Ottosen C, Andersen CY (2006) Biochemical pregnancy after fertilization of an oocyte aspirated from a heterotopic autotransplant of cryopreserved ovarian tissue: case report. Hum Reprod 21:2006–2009CrossRefPubMedGoogle Scholar
  21. 21.
    Silber SJ, Gosden RG (2007) Ovarian transplantation in a series of monozygotic twins discordant for ovarian failure. N Engl J Med 356:1382–1384CrossRefPubMedGoogle Scholar
  22. 22.
    Lee SJ, Schover L, Partridge AH, Patrizio P, Wallace W, Hegerty R et al (2006) American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24:2917–2931CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • B. Lawrenz
    • 1
  • E. Neunhoeffer
    • 1
  • M. Henes
    • 1
  • S. Lessmann-Bechle
    • 1
  • B. Krämer
    • 1
  • Tanja Fehm
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity of TuebingenTübingenGermany

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