Fertility Preservation Options for Cancer Patients

Justo Callejo Olmos,1 Laura Almeida Toledano2

1. Professor and Clinical Chief of Gynecology, Department of Obstetrics and Gynaecology, Hospital Sant Joan de Déu Barcelona, Spain
2. Physician, Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu Barcelona, Spain

Disclosure: No potential conflicts of interest.
Received: 04.09.13 Accepted: 21.11.13
Citation: EMJ Gyn Obs. 2013;1:23-29.

Abstract

Survival rates for cancer patients have increased in the last few years due to improvements achieved in cancer therapies. But, these treatments produce some adverse effects. One significant effect in prepubertal and young women is premature ovarian failure which impacts on reproductive capacity. For this reason, fertility preservation techniques appear. For the last few years there has been research into new procedures that will allow women to preserve their reproductive function. Specialised groups have appeared who advise women on the best fertility preservation option, always with a personalized approach. Currently, established fertility preservation techniques are embryo cryopreservation and oocyte cryopreservation; these two procedures can be offered widely to these women. However, there are some limitations: they cannot be offered to prepubertal women, they require a time interval to carry out (not always possible in cancer treatments), and they provide a restricted number of embryos or oocytes. On account of this, some specialised centres offer other experimental techniques such as ovarian tissue cryopreservation, which can be useful in this group of patients. We also have to take into account other procedures such as in vitro maturation of follicles, oophoropexy or trachelectomy. Gonadotropin-releasing hormone agonists should not be offered to these women because there is no evidence of their usefulness. We must not forget that we can recommend a combination of techniques in order to optimise their fertility options. More research is still needed to find an ideal procedure that will allow a considerable number of metaphase II oocytes to be obtained to ensure a pregnancy avoiding the problems that exist with current techniques.

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