Skip to main content
SpringerLink
Log in

Fertility-sparing options for cancer patients

  • Special Section: Cancer in Pregnancy
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Fertility preservation is becoming an integral part of cancer care among women of reproductive age. Despite advances in the treatment of pelvic malignancies, all the currently available treatment approaches, including radiotherapy, chemotherapy, and surgery, place women at high risk for future fertility impairment. With improved long-term survival rates associated with cancer, expanding the reproductive options available is of high priority. Several fertility preservation options are available today for women with gynecologic and non-gynecologic malignancies. Depending on the underlying oncological entity, these can include the following procedures whether alone or in combination: oocyte cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, ovarian transposition, and trachelectomy. The purpose of this review is to provide the most up-to-date information on the aforementioned fertility-preserving approaches and highlight the current challenges, drawbacks, and areas of research where more data are still very necessary to optimize outcomes in young female oncological patients desiring pregnancy in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Partridge, A.H., et al., Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol, 2004. 22(20): p. 4174-83.

    Article  PubMed  Google Scholar 

  2. Loren, A.W., et al., Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013. 31(19): p. 2500-10.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Practice Committee of the American Society for Reproductive Medicine. Electronic address, a.a.o., Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril, 2019. 112(6): p. 1022?1033.

  4. Chan, J.L., et al., Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv, 2017. 11(1): p. 58-63.

    Article  PubMed  Google Scholar 

  5. Ozcan, M.C., V. Snegovskikh, and G.D. Adamson, Oocyte and embryo cryopreservation before gonadotoxic treatments: Principles of safe ovarian stimulation, a systematic review. Womens Health (Lond), 2022. 18: p. 17455065221074886.

    CAS  PubMed  Google Scholar 

  6. Practice Committees of the American Society for Reproductive, M. and T. the Society for Assisted Reproductive, Mature oocyte cryopreservation: a guideline. Fertil Steril, 2013. 99(1): p. 37?43.

  7. Cobo, A., et al., Six years' experience in ovum donation using vitrified oocytes: report of cumulative outcomes, impact of storage time, and development of a predictive model for oocyte survival rate. Fertility and Sterility, 2015. 104(6): p. 1426-1434.e8.

    Article  PubMed  Google Scholar 

  8. Levi-Setti, P.E., et al., Appraisal of clinical complications after 23,827 oocyte retrievals in a large assisted reproductive technology program. Fertil Steril, 2018. 109(6): p. 1038-1043.e1.

    Article  PubMed  Google Scholar 

  9. Papanikolaou, E.G., et al., Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertility and Sterility, 2006. 85(1): p. 112-120.

    Article  CAS  PubMed  Google Scholar 

  10. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril, 2016. 106(7): p. 1634?1647.

  11. Rao, A., Potential imaging findings following assisted reproduction: complications and clinical implications. Emerg Radiol, 2018. 25(1): p. 73-86.

    Article  PubMed  Google Scholar 

  12. Khattak, H., et al., Fresh and cryopreserved ovarian tissue transplantation for preserving reproductive and endocrine function: a systematic review and individual patient data meta-analysis. Hum Reprod Update, 2022. 28(3): p. 400-416.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bastings, L., et al., Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review. Human Reproduction Update, 2013. 19(5): p. 483-506.

    Article  CAS  PubMed  Google Scholar 

  14. Dolmans, M.-M., T. Falcone, and P. Patrizio, Importance of patient selection to analyze in vitro fertilization outcome with transplanted cryopreserved ovarian tissue. Fertility and Sterility, 2020. 114(2): p. 279-280.

    Article  PubMed  Google Scholar 

  15. B, N.D., et al., A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis. Fertil Steril, 2022. 117(6): p. 1266?1276.

  16. Barcroft, J., N. Dayoub, and K.J. Thong, Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation. Journal of Assisted Reproduction and Genetics, 2013. 30(11): p. 1407-1413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Cohen, Y., et al., Decreased pregnancy and live birth rates after vitrification of in vitro matured oocytes. Journal of Assisted Reproduction and Genetics, 2018. 35(9): p. 1683-1689.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Karavani, G., et al., In vitro maturation rates in young premenarche patients. Fertility and Sterility, 2019. 112(2): p. 315-322.

    Article  PubMed  Google Scholar 

  19. In vitro maturation: a committee opinion. Fertil Steril, 2021. 115(2): p. 298-304.

    Article  Google Scholar 

  20. Letourneau, J.M., et al., Fertility preservation before breast cancer treatment appears unlikely to affect disease-free survival at a median follow-up of 43 months after fertility-preservation consultation. Cancer, 2020. 126(3): p. 487-495.

    Article  PubMed  Google Scholar 

  21. Marklund, A., et al., Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer-a prospective nationwide Swedish multicenter study. Hum Reprod, 2020. 35(4): p. 929-938.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Rodriguez-Wallberg, K.A., et al., Safety of fertility preservation in breast cancer patients in a register-based matched cohort study. Breast Cancer Res Treat, 2018. 167(3): p. 761-769.

    Article  PubMed  Google Scholar 

  23. Gay, C., et al., Ovarian Transposition Before Pelvic Radiation Therapy: Spatial Distribution and Dose Volume Analysis. Adv Radiat Oncol, 2022. 7(1): p. 100804.

    Article  PubMed  Google Scholar 

  24. Gubbala, K., et al., Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis. J Ovarian Res, 2014. 7: p. 69.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sella, T., S. Mironov, and H. Hricak, Imaging of transposed ovaries in patients with cervical carcinoma. AJR Am J Roentgenol, 2005. 184(5): p. 1602-10.

    Article  PubMed  Google Scholar 

  26. Buonomo, B., et al., Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review. Int J Gynecol Cancer, 2021. 31(3): p. 360-370.

    Article  PubMed  Google Scholar 

  27. Salih, S.M., et al., Diminished Utilization of in Vitro Fertilization Following Ovarian Transposition in Cervical Cancer Patients. J Reprod Med, 2015. 60(7-8): p. 345-53.

    PubMed  PubMed Central  Google Scholar 

  28. Hoekman, E.J., et al., Ovarian function after ovarian transposition and additional pelvic radiotherapy: A systematic review. Eur J Surg Oncol, 2019. 45(8): p. 1328-1340.

    Article  PubMed  Google Scholar 

  29. Barahmeh, S., et al., Ovarian transposition before pelvic irradiation: indications and functional outcome. J Obstet Gynaecol Res, 2013. 39(11): p. 1533-7.

    Article  PubMed  Google Scholar 

  30. Hwang, J.H., et al., Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy. Fertil Steril, 2012. 97(6): p. 1387?93 e1?2.

  31. Yin, L., et al., Ovarian transposition before radiotherapy in cervical cancer patients: functional outcome and the adequate dose constraint. Radiat Oncol, 2019. 14(1): p. 100.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Al-Badawi, I.A., et al., Laparoscopic ovarian transposition before pelvic irradiation: a Saudi tertiary center experience. Int J Gynecol Cancer, 2010. 20(6): p. 1082-6.

    Article  PubMed  Google Scholar 

  33. Laios, A., et al., Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis. BMC Womens Health, 2022. 22(1): p. 305.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hilal, L., et al., Factors Associated With Premature Ovarian Insufficiency in Young Women With Locally Advanced Rectal Cancer Treated With Pelvic Radiation Therapy. Adv Radiat Oncol, 2022. 7(1): p. 100801.

    Article  PubMed  Google Scholar 

  35. Marnitz, S., et al., Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment, helical tomotherapy and volumetric arc therapy for primary radiation - an intraindividual comparison. Radiat Oncol, 2015. 10: p. 91.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ghadjar, P., et al., Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation. Radiat Oncol, 2015. 10: p. 50.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Siegel, R.L., et al., Cancer statistics, 2022. CA Cancer J Clin, 2022. 72(1): p. 7-33.

    Article  PubMed  Google Scholar 

  38. NCCN. NCCN Guidelines for Patients, Cervical Cancer 2022. 2022 [cited 2022 November, 5]; Available from: https://www.nccn.org/patients/guidelines/content/PDF/cervical-patient-guideline.pdf.

  39. Theofanakis, C., et al., Fertility-Sparing Treatment for Young Patients with Early-Stage Cervical Cancer: A Dawn of a New Era. Front Surg, 2022. 9: p. 867993.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lakhman, Y., et al., Stage IB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology, 2013. 269(1): p. 149-58.

    Article  PubMed  Google Scholar 

  41. Rob, L., P. Skapa, and H. Robova, Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol, 2011. 12(2): p. 192-200.

    Article  PubMed  Google Scholar 

  42. Roman, L.D., Pregnancy after radical vaginal trachelectomy: maybe not such a risky undertaking after all. Gynecol Oncol, 2005. 98(1): p. 1-2.

    Article  PubMed  Google Scholar 

  43. Abu-Rustum, N.R. and Y. Sonoda, Fertility-sparing surgery in early-stage cervical cancer: indications and applications. J Natl Compr Canc Netw, 2010. 8(12): p. 1435-8.

    Article  PubMed  Google Scholar 

  44. Salvo, G., et al., Open vs minimally invasive radical trachelectomy in early-stage cervical cancer: International Radical Trachelectomy Assessment Study. Am J Obstet Gynecol, 2022. 226(1): p. 97 e1?97 e16.

  45. Bentivegna, E., et al., Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril, 2016. 106(5): p. 1195?1211 e5.

  46. Kasuga, Y., et al., Management of pregnancy after radical trachelectomy. Gynecol Oncol, 2021. 162(1): p. 220-225.

    Article  PubMed  Google Scholar 

  47. Kasuga, Y., et al., Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis. BJOG, 2017. 124(11): p. 1729-1735.

    Article  CAS  PubMed  Google Scholar 

  48. Kasuga, Y., K. Miyakoshi, and M. Tanaka, Ultrasound Findings of Varices at the Site of Uterovaginal Anastomosis in a Pregnant Woman After Radical Trachelectomy. J Ultrasound Med, 2019. 38(12): p. 3363-3364.

    Article  PubMed  Google Scholar 

  49. Kasuga, Y., et al., Pregnancy Outcomes After Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer: A 13-Year Experience in a Single Tertiary-Care Center. Int J Gynecol Cancer, 2016. 26(1): p. 163-8.

    Article  PubMed  Google Scholar 

  50. Practice Committee of the American Society for Reproductive, M. and a.a.o. Practice Committee of the Society for Assisted Reproductive Technology. Electronic address, Recommendations for practices using gestational carriers: a committee opinion. Fertil Steril, 2022. 118(1): p. 65?74.

  51. Ethics Committee of the American Society for Reproductive Medicine. Electronic address, a.a.o. and M. Ethics Committee of the American Society for Reproductive, Consideration of the gestational carrier: an Ethics Committee opinion. Fertil Steril, 2018. 110(6): p. 1017?1021.

  52. Murugappan, G., et al., Gestational carrier in assisted reproductive technology. Fertil Steril, 2018. 109(3): p. 420-428.

    Article  PubMed  Google Scholar 

  53. National Cancer Institutes SEER Database. [cited 2023 January 20, 2023]; Available from: https://seer.cancer.gov/statfacts/html/corp.html.

  54. Kohn, J.R., et al., Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers. J Minim Invasive Gynecol, 2021. 28(3): p. 392-402.

    Article  PubMed  Google Scholar 

  55. National Comprehensive Cancer Network. Uterine Neoplasms. Version 1.2023. [cited 2023 January 20]; Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1473.

  56. Gunderson, C.C., et al., Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol, 2012. 125(2): p. 477-82.

    Article  CAS  PubMed  Google Scholar 

  57. Baker, J., et al., Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature. Gynecol Oncol, 2012. 125(1): p. 263-70.

    Article  CAS  PubMed  Google Scholar 

  58. Qin, Y., et al., Oral Progestin Treatment for Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis. Int J Gynecol Cancer, 2016. 26(6): p. 1081-91.

    Article  PubMed  Google Scholar 

  59. Schindler, A.E., et al., Classification and pharmacology of progestins. Maturitas, 2008. 61(1-2): p. 171-80.

    Article  PubMed  Google Scholar 

  60. Park, J.Y., Hysteroscopy in fertility-sparing management for early endometrial cancer: a double-edged sword. J Gynecol Oncol, 2017. 28(1): p. e16.

    Article  PubMed  Google Scholar 

  61. Lin, M.Y., et al., Role of imaging in the routine management of endometrial cancer. Int J Gynaecol Obstet, 2018. 143 Suppl 2(Suppl 2): p. 109?117.

  62. Arend, R.C., et al., Identifying a molecular profile to predict the risk of recurrence in high-intermediate risk endometrial cancer. Cancer Med, 2021. 10(22): p. 8238-8250.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Arend, R.C., et al., Endometrial cancer: Molecular markers and management of advanced stage disease. Gynecol Oncol, 2018. 150(3): p. 569-580.

    Article  CAS  PubMed  Google Scholar 

  64. Gallos, I.D., et al., Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol, 2012. 207(4): p. 266 e1?12.

  65. Gotlieb, W.H., et al., Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome. Cancer, 1998. 82(1): p. 141-6.

    Article  CAS  PubMed  Google Scholar 

  66. NCCN. National Comprehensive Cancer Network. Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer. 2023 [cited 2023 January 20]; Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1453.

  67. Tangir, J., et al., Reproductive function after conservative surgery and chemotherapy for malignant germ cell tumors of the ovary. Obstet Gynecol, 2003. 101(2): p. 251-7.

    PubMed  Google Scholar 

  68. Stewart, E.A., et al., Epidemiology of uterine fibroids: a systematic review. BJOG, 2017. 124(10): p. 1501-1512.

    Article  CAS  PubMed  Google Scholar 

  69. Baird, D.D., et al., High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol, 2003. 188(1): p. 100-7.

    Article  PubMed  Google Scholar 

  70. Donnez, J. and M.M. Dolmans, Uterine fibroid management: from the present to the future. Hum Reprod Update, 2016. 22(6): p. 665-686.

    Article  PubMed  PubMed Central  Google Scholar 

  71. American College of, O. and P. Gynecologists' Committee on Gynecologic, Uterine Morcellation for Presumed Leiomyomas: ACOG Committee Opinion, Number 822. Obstet Gynecol, 2021. 137(3): p. e63-e74.

  72. DeMulder, D. and S.M. Ascher, Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol, 2018. 211(6): p. 1405-1415.

    Article  PubMed  Google Scholar 

  73. Spielmann, A.L., et al., Comparison of MRI and sonography in the preliminary evaluation for fibroid embolization. AJR Am J Roentgenol, 2006. 187(6): p. 1499-504.

    Article  PubMed  Google Scholar 

  74. Hindman, N., et al., MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma: A Consensus Statement. Radiology, 2022: p. 211658.

  75. Lakhman, Y., et al., Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis. Eur Radiol, 2017. 27(7): p. 2903-2915.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA

    Snigdha Alur-Gupta

  2. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hila Fruchtman & Viktoriya Paroder

Authors
  1. Snigdha Alur-Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hila Fruchtman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viktoriya Paroder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Viktoriya Paroder.

Ethics declarations

Declarations

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alur-Gupta, S., Fruchtman, H. & Paroder, V. Fertility-sparing options for cancer patients. Abdom Radiol 48, 1618–1628 (2023). https://doi.org/10.1007/s00261-023-03839-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03839-8

Keywords

Search

Navigation