Dr. Nicole Noyes

Oocyte cryopreservation as a fertility preservation measure for cancer patients.

Reprod Biomed Online. 2011 Sep;23(3):323-33

Authors: Noyes N, Knopman JM, Melzer K, Fino ME, Friedman B, Westphal LM

Abstract
Advances in cancer treatment have allowed women to live longer, fuller lives. However, gonadotoxic therapies used to effect cancer 'cures' often significantly impair a woman's reproductive potential. Thus, in accordance with improved survival rates, there is an increase in demand for fertility preservation. Initially, fertility preservation was limited to embryo cryopreservation; therefore, the number of patients enrolling was relatively low. Recently, substantial improvements have increased available options, specifically oocyte cryopreservation, thereby expanding and altering the make-up of the patient population undergoing treatment for fertility preservation. Patient diversity requires the treating physician(s) to be cognizant of issues specific to cancer type and stage. Furthermore, patients often have comorbidities which must be attended to and addressed. Although not all patients will be candidates for, or will elect to pursue, fertility preservation, all should receive counselling regarding their options. This practice will ensure that the reproductive rights of those patients facing impending sterility are maintained. Here, fertility preservation protocols, practices and special considerations, categorized by most frequently encountered cancer types, are reviewed to guide reproductive endocrinologists in the management of fertility preservation in such patients. The formation of a multidisciplinary patient-structured team will ensure a successful, yet safe, fertility-preservation outcome. Advances in cancer treatment have allowed women to live longer, fuller lives. However, therapies used to treat cancer often significantly impair a woman's future ability to have children by damaging her eggs or removing key reproductive organs. Given that women are now often living well beyond their cancer diagnosis and treatment, there is an increased interest in preserving reproductive potential. Thus, the field of fertility preservation has been developed and continues to grow. Initially, fertility preservation was limited to freezing embryos formed by combining an egg with spermatozoa. One drawback of this approach is that it requires both female and male contributions. Recently, substantial improvements have expanded the available options, including freezing unfertilized eggs, affording female patients fertility preservation without a requisite male partner or donor. Cancer patients vary widely, requiring the treating physician(s) to be cognizant of issues specific to individual cancer types and extent of disease. Furthermore, cancer patients often have co-existing medical conditions which must be attended to and addressed. Although not all patients will be candidates for, or elect to pursue, fertility preservation, all should receive counselling regarding their options. This will ensure that the reproductive rights of cancer patients facing impending sterility are maintained. Here, we review fertility preservation protocols, practices and special considerations, categorized by the most commonly encountered cancer types, to guide physicians in the management of fertility preservation in such patients. We advocate the formation of a multidisciplinary patient-structured team to ensure a successful and safe fertility-preservation outcome.

PMID: 21570353 [PubMed - indexed for MEDLINE]