Fertility preservation in female cancer patients: An overview

Abstract

Fertility preservation is becoming increasingly important to improve the quality of life in cancer survivors. Despite guidelines suggesting that discussion of fertility preservation should be done prior to starting cancer therapies, there is a lack of implementation in this area. A number of techniques are available for fertility preservation, and they can be used individually or together in the same patient to maximize efficiency. Oocyte and embryo cryopreservation are now established techniques but have their limitations. Ovarian tissue cryopreservation though considered experimental at present, has a wider clinical application and the advantage of keeping the fertility window open for a longer time. Both chemotherapy and radiotherapy have a major impact on reproductive potential and fertility preservation procedures should be carried out prior to these treatments. The need for fertility preservation has to be weighed against morbidity and mortality associated with cancer. There is thus a need for a multidisciplinary collaboration between oncologists and reproductive specialists to improve awareness and availability.

Keywords: Cancer; counseling; cryopreservation; fertility preservation.

Figure 1

The risk of ovarian failure postchemotherapy is determined largely by the interaction of two factors: The type and amount of drug received and the age of the patient at treatment. Assessment of individual risk can be made using these factors; however, individual variation makes it advisable to consider fertility preservation measures even when treatment may fall into the low to moderate risk category. (Reprinted, with permission, from Meirow et al., 2010). *Vertical arrows represent the level of risk, with the greater number of arrows indicating greater risk; the horizontal arrow indicating negligible or unknown risk. **Dashed arrows represent the reduction in ovarian reserve that occurs following chemothereapy