Preservation of Fertility in Oncology Patients.

 

The decrease in fertility in women can be the result of several factors, one of them is the depletion of ovarian follicles, which, therefore, lead to a woman’s permanent inability to conceive. However, loss of female fertility may also be physiological, due to menopause, or pathological, due to gonadotoxicity, premature ovarian failure (POF) before age 40, bilateral oophorectomy, gonadal agenesis, and other genetic disorders.

Cancer treatments such as aggressive chemotherapy and radiation therapy have harmful gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women.

Every year worldwide, more than 6.6 million women are diagnosed with cancer, and about 10% of them are diagnosed during their reproductive age; Those who receive aggressive chemotherapy and radiation therapy can generally cause gonadotoxicity, premature ovarian failure, and subsequent loss of fertility in more than 80% of cases. In recent years, following the better prognosis for cancer patients, interest and attention have grown around fertility problems in these patients. International guidelines on preserving fertility in cancer patients recommend that doctors discuss with all patients of reproductive age (or their parents / guardians, if children) the risk of infertility from their cancer or its treatment.

Oncofertility counseling is recommended as early as possible and before cancer treatment to help patients make informed decisions about preserving fertility. Currently, however, stories are not routinely performed. In June 2017, a group of European oncofertility experts is estimated to have met to discuss current oncofertility needs for female cancer patients. This group of experts has produced a series of key recommendations to guide oncologists, hematologists, and other professionals involved with oncofertility issues and affected referrals for increased fertility preservation.

In order to preserve the fertility of young women (age <40) and girls with cancer, several established and experimental fertility preservation options can be offered in the emerging field of oncofertility.

Options included include cryopreservation of embryos or ovules. Experimental options include cryopreservation of ovarian tissue and subsequent autologous transplantation and / or in vitro maturation (IVM)

The in vitro maturation of the oocytes consists of performing a follicular puncture without having performed a previous ovarian stimulation. Thus we retrieve oocytes in immature stage that can later mature in vitro. This would allow us not to delay the start of cancer treatment and would be indicated in patients with contraindication to ovarian hormonal stimulation. A disadvantage is the low performance of the technique, since low fertilization and implantation rates are observed. The most widely used fertility preservation procedures are cryopreservation of embryos and oocytes. Cryopreservation is considered the ‘gold standard’, which involves preserving cells and tissues for prolonged periods of time at sub-zero temperatures using cryoprotectants to reduce cryogenic cell damage; in cancer patients it is performed using protocols with the use of drugs (letrozole, aromatase inhibitor) that prevent a significant elevation in estradiol levels during stimulation. However, these procedures require an available period of approximately 2 weeks before beginning any cancer treatment in order to perform oocyte stimulation and retrieval. Since the first live birth of oocyte cryopreservation three decades ago, oocyte cryopreservation has become an important component of Assisted Reproduction Techniques. Cryopreservation techniques have evolved, leading to higher success rates and the introduction of oocyte cryopreservation in IVF clinics worldwide.

 

 

 

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