Strategies for fertility preservation in female and male cancer survivors.
Improved survival rates and quality of life following modern cancer treatment have resulted in a growing number of patients requesting maintenance of reproductive capacity, both before and after completion of treatment. Several established options are currently available. In men, sperm banking should be offered as soon as the diagnosis of any malignant disease is established, irrespective of the expected cryosurvival rate. In such cases, conception can be achieved with frozen-thawed spermatozoa following either intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI). In women, depending on the type of cancer, the presence of an adequate ovarian reserve, and time to delay cancer treatment, in vitro fertilization (IVF) with embryo cryopreservation constitutes a valid alternative. On the other hand, cryopreservation of mature oocytes following IVF/ICSI offers some advantages, but it is still limited by its low success rate. Emerging and exciting techniques of germ cell/gonadal tissue cryopreservation (banking) followed by autotransplantation have been clinically explored, particularly in women. Novel cryotechnologies of ovarian and testicular tissue have proven efficacious and new transplantation strategies promise improved results. However, only one live birth following autotransplanted frozen-thawed ovarian tissue has been established and there are still no pregnancies reported from autotransplanted cryopreserved testicular tissue in the human. Efficiency and safety of these techniques needs to be demonstrated. Methods for gamete in vitro maturation also need further development. Gonadal tissue cryopreservation and transplantation should be considered experimental in humans for the present time until greater evidence regarding efficacy and safety is accrued.
Oehninger
Sergio
S
The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA. OehninSC@EVMS.edu
D015925:Cryopreservation; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy*; D008297:Male; D009369:Neoplasms / Q000628:therapy; D010053:Ovary / Q000637:transplantation; D011788:Quality of Life; D027724:Reproductive Techniques, Assisted; D013074:Sperm Banks; D017741:Survivors