Fertility preservation in female cancer patients



Cancer is not rare in younger women of reproductive age therefore the preservation of fertility among them has become a significant concern due to aggressive cancer therapy they must undergo. Today different strategies for fertility preservation are available in patients at risk. However, many of these available techniques are still experimental and have limited clinical experience. Under ethical principle, better interdisciplinary cooperation between clinicians and patients, appropriate counseling and further research on cryopreservation and transplantation techniques may enhance their success to preserve fertility of young cancer victims. In this article, the existing and emerging fertility preserving strategies in young cancer female as well as their safety and ethical issues are discussed.

Key words

cancer transplantation cryopreservation fertility preservation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chang HJ, Shu CS. Fertility preservation for women with malignancies: current developments of cryopreservation. J Gynecol Oncol, 2008, 19: 99–107.CrossRefPubMedGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59: 225–249.CrossRefPubMedGoogle Scholar
  3. 3.
    Sonmezer M, Oktay K. Fertility preservation in female patients. Hum Reprod Update, 2004, 10: 251–266.CrossRefPubMedGoogle Scholar
  4. 4.
    Marhhom E, Cohen I. Fertility preservation options for women with malignancies. Obstet Gynecol Surv, 2007, 62: 58–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med, 2009, 360: 902–911.CrossRefPubMedGoogle Scholar
  6. 6.
    Oehninger S. Strategies for fertility preservation in female and male cancer survivors. J Soc Gynecol Investig, 2005, 12: 222–231.CrossRefPubMedGoogle Scholar
  7. 7.
    Seli E, Tangir J. Fertility preservation options for female patients with malignancies. Curr Opin Obstet Gynecol, 2005, 17: 299–308.CrossRefPubMedGoogle Scholar
  8. 8.
    Oktay K, Buyuk E, Davis O, et al. Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Hum Reprod, 2003, 18: 90–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Klijn JG, Beex LV, Mauriac L, et al. Combined treatment with buserelin and tamoxifen in premenopausal metastatic breast cancer: a randomized study. J Nat Cancer Inst, 2000, 92: 903–911.CrossRefPubMedGoogle Scholar
  10. 10.
    Pfister CU, Martoni A, Zamagni C, et al. Effect of age and single versus multiple dose pharmacokinetics of letrozole (Femara) in breast cancer patients. Biopharm Drug Dispos, 2001, 22: 191–197.CrossRefPubMedGoogle Scholar
  11. 11.
    Wallace WH, Anderson R, Baird D. Preservation of fertility in young women treated for cancer. Lancet Oncol, 2004, 5: 269–270.CrossRefPubMedGoogle Scholar
  12. 12.
    Practice committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproduction Technology. Ovarian tissue and oocyte cryopreservation. Fertil Steril, 2006, 86: S142–147.Google Scholar
  13. 13.
    Chen C. Pregnancy after human oocyte cryopreservation. Lancet, 1986, 1: 884–886.CrossRefPubMedGoogle Scholar
  14. 14.
    Ezcurra D, Rangnow J, Craig M, et al. The human oocyte preservation experience (HOPE) a phase IV, prospective, multicenter, observational oocyte cryopreservation registry. Reprod Biol Endocrinol, 2009, 7: 53.CrossRefPubMedGoogle Scholar
  15. 15.
    Porcu E, Fabbri R, Seracchioli R, et al. Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes. Fertil Steril, 1997, 68: 724–726.CrossRefPubMedGoogle Scholar
  16. 16.
    Katayama KP, Stehlik J, Kuwayama M. High survival rate of vitrified human oocytes results in clinical pregnancy. Fertil Steril, 2003, 80: 223–224.CrossRefPubMedGoogle Scholar
  17. 17.
    Yoon TK, Kim TJ, Park SE, et al. Live births after vitrification of oocytes in a stimulated in vitro fertilization-embryo transfer program. Fertil Steril, 2003, 79: 1323–1326.CrossRefPubMedGoogle Scholar
  18. 18.
    Borini A, Bonu MA, Coticchio G, et al. Pregnancies and births after oocyte cryopreservation. Fertil Steril, 2004, 82: 601–605.CrossRefPubMedGoogle Scholar
  19. 19.
    Porcu E. Oocyte freezing. Semin Reprod Med, 2001, 19: 221–230.CrossRefPubMedGoogle Scholar
  20. 20.
    Tucker M, Wright G, Morton P, et al. Preliminary experience with human oocyte cryopreservation using 1,2-propanediol and sucrose. Hum Reprod, 1996, 11: 1513–1515.PubMedGoogle Scholar
  21. 21.
    Gook DA, Schiewe MC, Osborn SM, et al. Intracytoplasmic sperm injection and embryo development of human oocytes cryopreserved using 1, 2-propanediol. Hum Reprod, 1995, 10: 2637–2641.PubMedGoogle Scholar
  22. 22.
    Fabbri R, Porcu E, Marsella T, et al. Human oocyte cryopreservation: new perspectives regarding oocyte survival. Hum Reprod, 2001, 16:411–416.CrossRefPubMedGoogle Scholar
  23. 23.
    Eroglu A, Toner M, Toth TL. Beneficial effect of microinjected trehalose on the cryosurvival of human oocytes. Fertil Steril, 2002, 77: 152–158.CrossRefPubMedGoogle Scholar
  24. 24.
    Chang CC, Shapiro DB, Bernal DP, et al. Human oocyte vitrification: in-vivo and in-vitro maturation outcomes. Reprod Biomed Online, 2008, 17: 684–688.CrossRefPubMedGoogle Scholar
  25. 25.
    Strassburger D, Friedler S, Raziel A, et al. The outcome of ICSI of immature MI oocytes and rescued in vitro matured MII oocytes. Hum Reprod, 2004, 19: 1587–1590.CrossRefPubMedGoogle Scholar
  26. 26.
    Otsuki J, Momma Y, Takahashi K, et al. Timed IVM followed by ICSI in a patient with immature ovarian oocytes. Reprod Biomed Online, 2006, 13: 101–103.CrossRefPubMedGoogle Scholar
  27. 27.
    Vanhoutte L, De Sutter P, Van der Elst J, et al. Clinical benefit of metaphase I oocytes. Reprod Biol Endocrinol, 2005, 3: 71.CrossRefPubMedGoogle Scholar
  28. 28.
    Donnez J, Martinez-Madrid B, Jadoul P, et al. Ovarian tissue cryopreservation and transplantation: a review. Hum Reprod Update, 2006, 12: 519–535.CrossRefPubMedGoogle Scholar
  29. 29.
    Gosden RG, Baird DT, Wade JC, et al. Restoration of fertility to oophorectomized sheep by ovarian autografts stored at -196 degrees C. Hum Repord, 1994, 9: 597–603.Google Scholar
  30. 30.
    Kim SS, Lee WS, Chung MK, et al. Long-term ovarian function and fertility after heterotopic autotransplantation of cryobanked human ovarian tissue: 8-year experience in cancer patients. Fertil Steril, 2009, 91: 2349–2354.CrossRefPubMedGoogle Scholar
  31. 31.
    Donnez J, Squifflet J, Dolmans MM. Frozen-thawed ovarian tissue retransplants. Semin Reprod Med, 2009, 27: 472–478.CrossRefPubMedGoogle Scholar
  32. 32.
    Oktay K, Newton H, Godsen RG. Transplantation of cryopreserved human ovarian tissue results in follicle growth initiation in SCID mice. Fertil Steril, 2000, 73: 599–603.CrossRefPubMedGoogle Scholar
  33. 33.
    Salle B, Demirci B, Franck M, et al. Normal pregnancies and live births after autograft of frozen-thawed hemi-ovaries into ewes. Fertil Steril, 2002, 77: 403–408.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee DM, Yeoman RR, Battaglia DE, et al. Live birth after ovarian tissue transplant. Nature, 2004, 428: 137–138.CrossRefPubMedGoogle Scholar
  35. 35.
    Oktay K, Buyuk E, Rosenwakes Z, et al. A technique for transplantation of ovarian cortical stripes to the forearm. Fertil Steril, 2003, 80:193–198.CrossRefPubMedGoogle Scholar
  36. 36.
    Kim SS, Battaglia DE, Soules MR. The future of human ovarian cryopreservation and transplantation: fertility and beyond. Fertil Steril, 2001, 75: 1049–1056.CrossRefPubMedGoogle Scholar
  37. 37.
    Meirow D, Levron J, Eldar-Geva T, et al. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med, 2005, 353: 318–321.CrossRefPubMedGoogle Scholar
  38. 38.
    Demeestere I, Simon P, Emiliani S, et al. Fertility preservation: successful transplantation of cryopreserved ovarian tissue in a young patient previously treated for Hodgkin’s disease. Oncologist, 2007, 12: 1437–1442.CrossRefPubMedGoogle Scholar
  39. 39.
    Andersen CY, Rosendahl M, Byskov AG, et al. Two successful pregnancies following autotransplantation of frozen/thawed ovarian tissue. Hum Reprod, 2008, 23: 2266–2272.CrossRefPubMedGoogle Scholar
  40. 40.
    Kim SS, Hwang IT, Lee HC. Heterotopic autotransplantation of cryobanked human ovarian tissue as a strategy to restore ovarian function. Fertil Steril, 2004, 82: 930–932.CrossRefPubMedGoogle Scholar
  41. 41.
    Donnez J, Dolmans MM, Demylle D, et al. Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet, 2004, 364: 1405–1410.CrossRefPubMedGoogle Scholar
  42. 42.
    Oktay K, Buyuk E, Veeck L, et al. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet, 2004, 363: 837–840.CrossRefPubMedGoogle Scholar
  43. 43.
    Radford JA, Lieberman BA, Brison DR, et al. Orthotopic reimplantation of cryopreserved ovarian cortical stripes after high-dose chemotherapy for Hodgkin’s lymphoma. Lancet, 2001, 357: 1172–1175.CrossRefPubMedGoogle Scholar
  44. 44.
    Wolner-Hanseen P, Hägglund L, Ploman F, et al. Autotransplantation of cryopreserved ovarian tissue to the right forearm 4 (1/2) years after autologous stem cell transplantation. Acta Obstet Gynecol Scand, 2005, 84: 695–698.Google Scholar
  45. 45.
    Oktay K, Newton H, Mullan I, et al. Development of human primordial follicles to antral stages in SCID/hpg mice stimulated with follicle stimulating hormone. Hum Reprod, 1998, 13: 1133–1138.CrossRefPubMedGoogle Scholar
  46. 46.
    Gook DA, Osborn SM, Archer J, et al. Follicle development following cryopreservation of human ovarian tissue. Eur J Obstet Gynecol Reprod Biol, 2004, 113: S60–62.CrossRefPubMedGoogle Scholar
  47. 47.
    Lucifero D, Mertineit C, Clarke HJ, et al. Methylation dynamics of imprinted genes in mouse germ cells. Genomics, 2002, 79: 530–538.CrossRefPubMedGoogle Scholar
  48. 48.
    Abir R, Fisch B, Nitke S, et al. Morphological study of fully and partially isolated early human follicles. Fertil Steril, 2001, 75: 141–146.CrossRefPubMedGoogle Scholar
  49. 49.
    Laschke MW, Menger MD, Vollmar B. Ovariectomy improves neovascularization and microcirculation of freely transplanted ovarian follicles. J Endocrinol, 2002, 172: 535–544.CrossRefPubMedGoogle Scholar
  50. 50.
    Liu J, Van der Elst J, Van den Broecke R, et al. Early massive follicle loss and apoptosis in heterotopically grafted newborn mouse ovaries. Hum Reprod, 2002, 17: 605–611.CrossRefPubMedGoogle Scholar
  51. 51.
    Wang X, Chen H, Yin H, et al. Fertility after intact ovary transplantation. Nature, 2002, 415: 385.CrossRefPubMedGoogle Scholar
  52. 52.
    Bedaiwy MA, Jeremias E, Gurunluoglu R, et al. Restoration of ovarian function after autotransplantation of intact frozen-thawed sheep ovaries with microvascular anastomosis. Fertil Steril, 2003, 79:594–602.CrossRefPubMedGoogle Scholar
  53. 53.
    Martinez-Madrid B, Dolmans MM, Van Langendonckt A, et al. Freezethawing intact human ovary with its vascular pedicle with a passive cooling device. Fertil Steril, 2004, 82: 1390–1394.CrossRefPubMedGoogle Scholar
  54. 54.
    Bedaiwy MA, Hussein MR, Biscotti C, et al. Cryopreservation of intact human ovary with its vascular pedicle. Hum Reprod, 2006, 21: 3258–3269.CrossRefPubMedGoogle Scholar
  55. 55.
    Bedaiwy MA. Strategies for fertility preservation and gonadal protection during gonadotoxic chemotherapy and radiotherapy. Middle East Fertil Soc J, 2005, 10: 1–21.Google Scholar
  56. 56.
    Cancer and pregnancy. Methods for fertility preservation. Available: http://www.cancerinpregnancy.org/node/61, 24th May, 2010.
  57. 57.
    Morita Y, Tilly JL. Oocyte apoptosis: like sand through an hourglass. Dev Biol, 1999, 213: 1–17.CrossRefPubMedGoogle Scholar
  58. 58.
    Morita Y, Perez GI, Paris F, et al. Oocyte apoptosis is suppressed by disruption of the acid sphingomyelinase gene or by sphingosine-1-phosphate therapy. Nat Med, 2000, 6: 1109–1114.CrossRefPubMedGoogle Scholar
  59. 59.
    Paris F, Perez GI, Fuks Z, et al. Sphingosine-1-phosphate preserves fertility in irradiated female mice without propagating genomic damage in offspring. Nat Med, 2002, 8: 901–902.CrossRefPubMedGoogle Scholar
  60. 60.
    Shaw JM, Bowels J, Koopman P, et al. Fresh and cryopreserved ovarian tissue samples from donors with lymphoma transmit the cancer to graft recipients. Hum Reprod, 1996, 11: 1668–1673.PubMedGoogle Scholar
  61. 61.
    Meirow D, Hardan I, Dor J, et al. Searching for evidence of disease and malignant cell contamination in ovarian tissue stored from hematologic cancer patients. Hum Reprod, 2008, 23: 1007–1013.CrossRefPubMedGoogle Scholar
  62. 62.
    Liede A, Narod SA. Hereditary breast and ovarian cancer in Asia: Genetic epidemiology of BRCA1 and BRCA2. Hum Mutat, 2002, 20: 413–424.CrossRefPubMedGoogle Scholar
  63. 63.
    Dudzinski DM. Ethical issues in fertility preservation for adolescent cancer survivors: oocyte and ovarian tissue cryopreservation. J Pediatr Adolesc Gynecol, 2004, 17: 97–102.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina

Personalised recommendations