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.

Keywords: Cryopreservation of oocytes and ovarian tissue; Fertility preservation.

Fig. 1

Microscopic picture of primary follicle seen in ovarian cortical strips

Fig. 2

Laparoscopic lateral ovarian transposition [38]

Fig. 3

Strategies to preserve fertility in female cancer patients through freezing [85]

Fig. 4

Whole-ovary transplantation between monozygotic twins [82]. Panel a shows various structures in the ovarian vasculature that are key during transplantation of an ovary. In Panel b, the donor’s ovarian artery (0.5 mm in diameter) is prepared for transplantation. The donor’s ovarian artery and ovarian vein are then anastomosed to the recipient’s ovarian artery and vein, as show in Panels c and d, respectively. (Taken with kind permission from Dr. Sherman Silber [82]