Fertility options for female cancer patients: facts and fiction.
OBJECTIVE
To review the latest progress in the prevention of ovarian failure induced by chemo/radiotherapy, as well as the latest advances in culture technology and transplantation of frozen-thawed ovarian tissue.


METHODS
The English-language literature was searched with PubMed and related references.


CONCLUSIONS
The development of combination chemotherapy and radiotherapy has improved the long-term survival of young cancer patients who are then frequently faced with iatrogenic ovarian failure and its consequences. The use of prior and concomitant GnRH analogs with chemotherapy offers encouraging results in animal studies with regard to prevention of ovarian failure. Adequately controlled research projects are needed to define the utility of GnRHa cotreatment in women cancer patients exposed to prolonged chemotherapy. Ovarian tissue cryopreservation is the optimal procedure for follicle banking. Theoretic options include returning the banked tissue back to the original pedicle so that pregnancy could be achieved naturally. Alternatively, the tissue can be grafted to a heterotopic site, either as an autograft (i.e., rectus abdominis muscle sheath) or as a xenograft (i.e., immunodeficient mice). Follicles could also be grown in vitro. Until reliable ovarian culture technology becomes available, autologous transplantation offers the best prospect of using frozen-thawed ovarian tissue. A primary concern, however, is the issue of microscopic metastatic disease to the ovary and the possibility of tumor reimplantation. Areas of research should focus on optimizing the freeze/thaw procedure for ovarian tissue, minimizing the ischemia-reperfusion injury after transplantation, and detecting minimal residual disease in ovarian tissue grafts.
Posada
M N
MN
Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-1247, USA. natalia.posada@worldnet.att.net
Kolp
L
L
García
J E
JE
D000970:Antineoplastic Agents / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005298:Fertility / Q000187:drug effects / Q000528:radiation effects; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D016239:MEDLINE; D011878:Radiotherapy / Q000009:adverse effects; D012099:Reproductive Techniques; D017741:Survivors
D000970:Antineoplastic Agents