Preservation of Fertility in Patients with Cancer

English Version

The unique duality involved in confronting a life threatening diagnosis while simultaneously considering the deeply human desire to have a child presents a struggle both for patients with cancer and for clinicians. Yet with improved survival rates among young patients with cancer, recent benchto bedside translation of new techniques to preserve fertility, and increased awareness of choices for the preser vat ion of fertility, options for family planning are now being offered to patients who have received a diagnosis of cancer. Concerns about fertility are similar for men and women; however, their opportunities for intervention differ considerably. This review describes current and emerging options for the preservation of fertility in patients with cancer and provides a conceptual framework for managing concerns about fertility at the time of diagnosis.

The biomedical community faces four main challenges related to the preservation of fertility in people with cancer: the improvement of patient specific, life preserving treatments; the identification and reduction of the threat that cancer treatment poses to fertility; the expansion of safe and effective options for fertility treatment; and the creation of symptom-management plans for patients who lose endocrine function from the gonads as a consequence of cancer treatment. Current methods of fertility preservation include hormone stimulation in women and sperm banking in men. New methods for women, such as in vitro follicle maturation and techniques for tissue transplantation, are on the horizon. Decisions about the management of cancer can help to limit the side effects of treatment. Examples include reducing the radiation dosage and eliminating alkylating agents, etoposide, or bleomycin from chemotherapeutic regimens in children with low risk Hodgkin’s disease and using paclitaxel more selectively in patients with breast cancer. Such treatment modifications can help to preserve fertility without compromising cancer care. The goal is to provide and develop methods of fertility preservation that permit a range of options for patients that are linked to a multidisciplinary treatment plan until cancer treatments can be specifically targeted to cancer cells.

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