title: Infertility in reproductive-age female cancer survivors.
abstract: Improved survival rates among reproductive-age females diagnosed with cancer have increased the focus on long-term quality of life, including maintenance of the ability to conceive biological children. Cancer-directed therapies such as high-dose alkylating agents and radiation to the pelvis, which deplete ovarian reserve, radiation to the brain, which affects the hypothalamic-pituitary-gonadal axis, and surgical resection of reproductive structures can decrease the likelihood of having biological children. Standard fertility preservation strategies such as embryo and oocyte cryopreservation before the onset of therapy offer the opportunity to conserve fertility, but they may not be feasible because of the urgency to start cancer therapy, financial limitations, and a lack of access to reproductive endocrinologists. Ovarian tissue freezing is considered experimental, with limited data related to pregnancies, but it minimizes treatment delay. Studies evaluating gonadotropin-releasing hormone analogues have had mixed results, although a recent randomized, prospective study in women with breast cancer demonstrated a protective effect. Fertility preservation programs are increasingly being developed within cancer programs. In this article, we describe risks to infertility and options for preservation, raise psychosocial and ethical issues, and propose elements for establishing an effective fertility preservation program.
authors: Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York.
authors: Jennifer M
authors: JM
authors: Levine
authors: Joanne Frankel
authors: JF
authors: Kelvin
authors: Gwendolyn P
authors: GP
authors: Quinn
authors: Clarisa R
authors: CR
authors: Gracia
mesh_terms: D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D005260:Female; D059247:Fertility Preservation / Q000191:economics / Q000379:methods* / Q000592:standards / Q000639:trends; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007246:Infertility / Q000191:economics / Q000209:etiology* / Q000517:prevention & control*; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D007248:Infertility, Male / Q000209:etiology / Q000517:prevention & control; D033183:Interdisciplinary Communication; D008297:Male; D008594:Menopause, Premature; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D054315:Oocyte Retrieval; D059351:Organ Sparing Treatments; D010053:Ovary / Q000187:drug effects / Q000528:radiation effects; D016730:Program Development; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D018570:Risk Assessment; D053625:Sperm Retrieval; D017741:Survivors / Q000706:statistics & numerical data*; D035501:Uncertainty
chemical_list: D018906:Antineoplastic Agents, Alkylating; D007987:Gonadotropin-Releasing Hormone
keywords: adolescent and young adult; cancer; fertility preservation; infertility