Fertility preservation options for women with malignancies.
Cancer is not rare in younger women. There has been a remarkable improvement in the survival rates due to progress in cancer treatment. The necessary treatment for most of the common cancer types occurring in younger women implies either removal of the reproductive organs or cytotoxic treatment that could partially or definitively affect reproductive function. Early loss of ovarian function not only puts the patients at risk for menopause-related complications at a very young age, but is also associated with loss of fertility. Further, women in the western hemisphere have been delaying initiation of childbearing to later in life. The results of these changes have led to an increase in patients facing the risk of premature ovarian failure, and therefore seeking help in preserving their fertility. This increase in demand has resulted in a proliferation of techniques to preserve fertility. Indeed, the number of options is increasing; some are more established procedures, such as embryo cryopreservation, and some are still experimental, such as ovarian cryopreservation. Because of the variations in type and dose of chemotherapy, the type of cancer, the time available before onset of treatment, the patient's age and the partner status, each case is unique and requires a different strategy of fertility preservation.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to recall the potential early loss of ovarian function secondary to radiotherapy and/or chemotherapy for cancer at a young age; explain the increasing demands for fertility preservation; and summarize the limited number of proven, safe, and efficacious methods.
Marhhom
Enbal
E
Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar-Saba, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Cohen
Ilan
I
D000328:Adult; D000367:Age Factors; D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000453:epidemiology; D015925:Cryopreservation; D004622:Embryo, Mammalian; D016889:Endometrial Neoplasms / Q000601:surgery; D005260:Female; D005298:Fertility; D005833:Genital Neoplasms, Female / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D009865:Oocytes; D010050:Ovarian Function Tests; D010051:Ovarian Neoplasms / Q000601:surgery; D010053:Ovary / Q000187:drug effects / Q000528:radiation effects / Q000637:transplantation; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000517:prevention & control; D027724:Reproductive Techniques, Assisted; D014183:Transplantation, Heterologous; D016042:Transplantation, Heterotopic; D002583:Uterine Cervical Neoplasms / Q000601:surgery
D000970:Antineoplastic Agents