Published on March 1, 2014
Fertility preservation, from cancer to benign disease to social reasons: the challenge of the present decade Jacques Donnez, M.D., Ph.D. Infertility Research Unit, Socie te de Recherche pour l'Infertilite , Brussels, Belgium Received and accepted March 26, 2013. J.D. reports Board membership with PregLem and payment for lectures by Serono, MSD, Organon, and Ferring. Reprint requests: Jacques Donnez, M.D., Ph.D., Socie te de Recherche pour l'Infertilite (SRI), avenue Grandchamp, 143, - B1150 Brussels, Belgium (E-mail: email@example.com). Fertility and Sterility® Vol. 99, No. 6, May 2013 0015-0282/$36.00 Copyright ©2013 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2013.03.040
Predicting the likelihood of infertility following gonadotoxic treatments is extremely difﬁcult. • In the present issue, several hot topics in the ﬁeld of fertility preservation are discussed. (Fertil Steril 2013;99:1467–8. 2013 by American Society for Reproductive Medicine.)
• In de first review the impact of cancer therapy (radiotherapy and/or chemotherapy) on the female reproductive tract is discussed. • In the second review, time constraints, potential complica- tions, and limited opportunity for ovarian stimulation for fer- tility preservation (FP) or ovarian stimulation in women with cancer are reported. • Different strate- gies to increase the chances of future pregnancy are presented.
• Prevention of ovarian hyperstimulation syndrome (OHSS) in cancer patients is also a major issue discussed in the review, and use of gonadotropinreleasing hormone (GnRH) agonist is proposed to trigger ﬁnal oocyte maturation in women at risk of OHSS.
• In the review on oocyte vitriﬁcation, not only the results, but also the variables (age, oocyte quality, cryoprotectant type, and concentration, vitriﬁcation devices, team experi- ence) playing a key role towards ﬁnal outcome after oocyte vitriﬁcation are described. It may be concluded that vitriﬁca- tion is effective. Vitriﬁed oocytes retain their normal develop- mental potential, with survival rates of around 90% and pregnancy rates ranging from 60% to 75%.
• Many major scientiﬁc societies have changed their position in this regard and no longer consider oocyte vitriﬁcation as an experimental tool. Of course, oocyte vitriﬁcation implies the disadvantage of needing COS to harvest oocytes, which delays chemother- apy initiation.
• In the review on embryo cryopreservation, special con- siderations on ovarian stimulation for FP purposes are ana- lyzed. Embryo cryopreservation is an established and very successful method of FP when there is sufﬁcient time to perform ovarian stimulation
• Eleven patients became pregnant and six of them have al- ready delivered 12 healthy babies. • Although all pregnancies were obtained from tissue frozen according to the slow-freezing technique, vitriﬁcation re- sults in experimental models are looking increasingly promising. The quality of eggs obtained by IVF after trans- plantation is not optimal and there is no doubt that dysfunc- tional folliculogenesis occurs.
• The risk is also evaluated in case of breast cancer, cervical carcinoma, endometrial carcinoma, colorectal cancer and central nervous system tumors. This is of major interest to cli- nicians (oncologists, pediatricians, gynecologists) who need to counsel patients (and also parents when minors) in order to propose the most appropriate option for FP while analyzing associated risks.
• CONCLUSION – In this issue, fertility preservation in female cancer and non- cancer patients is extensively discussed. The time when the only goal was to cure the disease is long gone. Now, curing the disease, quality of life after cancer, and fertility preserva- tion are all important considerations.
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