Preservation of Fertility in Gynecological Malignancies

Abstract

Survival rate of reproductive aged women with gynecologic cancer has steadily been improving. As cancer therapy and cancers themselves may carry the risk of infertility and many of these young female cancer patients did not complete their family planning yet at the time of cancer diagnosis, fertility preservation has an emerging importance. Oncofertility is a rising concept requiring the contributions of both gynecologic oncology and reproductive medicine. All patients should be adequately informed at the time of diagnosis about the risk of infertility and the available methods for fertility preservation so they will have maximal chance to make an optimal decision without any significant impact and delay in oncologic outcome. The current treatment options for gynecologic malignancies include a wide variety of cytotoxic chemotherapy, different radiation treatments, multiple surgeries and anti-estrogen therapy, or any combination of these. Although these therapies can significantly reduce mortality, it can cause long-term toxicity, such as induction of an early menopause and fertility impairment even when the ovaries and the uterus left in place. At the present time, there are several potential options available including both standard and experimental assisted technologies. Embryo and sperm banking are the standard methods but many experts also count oocyte cryopreservation as a standard technique. Ovarian tissue harvesting, cryopreservation, and transplantation are safe but still believed as experimental as their utilization is still limited and their true value needs to be determined. Several pioneering procedures are being actively investigated, including uterus transplantation and in vitro follicle maturation, which may magnify the number of fertility preservation options for young cancer patients in the future. It is with great importance to start to discuss fertility preservation options even in the gynecologic oncologist's office and initiate the referral to fertility specialists immediately. The application of structured psychosocial supportive care also helps these patients through of this demanding time. In this chapter, the current data and concepts regarding fertility preservation of female patients with gynecological malignancies are reviewed.