Mitigating the risk: The role of ovarian transposition and medical suppression

Abstract

While much of the focus within oncofertility is on fertility preservation options that are performed prior to initiation of cancer treatment, there are two fertility preservation measures that can be performed during treatment in an attempt to reduce the gonadotoxicity of radiation therapy and chemotherapy. For women who must undergo pelvic radiation therapy, ovarian transposition, also called oophoropexy, can be used to surgically reposition the ovaries away from the planned field of radiation. Medical suppression of the ovary with gonadotropin-releasing hormone (GnRH) agonists, given concurrent with chemotherapy, is thought to have a protective effect on the ovary and follicles, though the mechanisms and clinical efficacy of this approach remain unproven and controversial. This chapter describes each of these procedures and reviews the clinical data on their use in patients wishing to preserve their fertility.