Fertility preservation options for female patients with malignancies.
OBJECTIVE
Preservation of fertility in female patients diagnosed with cancer has recently been an area of intensive investigation. This review summarizes available options and discusses recently published data concerning experimental methods. Specific strategies for fertility preservation in women with gynecologic malignancies are also presented.


RESULTS
Success with ovarian stimulation protocols using tamoxifen or aromatase inhibitors has recently been reported for women with breast cancer who attempt embryo cryopreservation prior to chemotherapy. The first embryo transfer using oocytes retrieved from cryopreserved ovarian tissue implanted at a heterotopic location, the first pregnancy following orthotopic transplantation of cryopreserved ovarian tissue, and increasing success with oocyte cryopreservation were also reported.


CONCLUSIONS
Fertility preservation in female patients with cancer has become an important health issue due to increasing survival rates and delayed childbearing especially in Western countries. Radical vaginal trachelectomy for cervical cancer, conservative surgery for ovarian tumors, and progestin treatment in endometrial cancers may be considered at early stages in order to preserve fertility. Embryo cryopreservation is an established technique that is available for fertility preservation, providing a delay in the initiation of chemotherapy or radiotherapy is acceptable, and a partner or donor sperm is available. Additional techniques that could be offered after counseling the patient about their experimental nature include oocyte cryopreservation, ovarian cryopreservation, and gonadotropin-releasing hormone agonist co-treatment with chemotherapy. Improvement of these techniques as well as better characterization of their success rates and risks await further investigation.
Seli
Emre
E
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA. emre.seli@yale.edu
Tangir
Jacob
J
D000970:Antineoplastic Agents; D015925:Cryopreservation; D004359:Drug Therapy, Combination; D004622:Embryo, Mammalian; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000628:therapy*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D009865:Oocytes; D010053:Ovary / Q000601:surgery
D000970:Antineoplastic Agents; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone