Fertility Preservation in Adolescents and Young Adults With Cancer

2010 ◽  
Vol 28 (32) ◽  
pp. 4831-4841 ◽  
Author(s):  
Jennifer Levine ◽  
Andrea Canada ◽  
Catharyn J. Stern

Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.

2015 ◽  
Vol 04 (03) ◽  
pp. 134-139 ◽  
Author(s):  
Virender Suhag ◽  
B. S. Sunita ◽  
Arti Sarin ◽  
A. K. Singh ◽  
Dashottar S.

AbstractInfertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.


2015 ◽  
Vol 33 (22) ◽  
pp. 2424-2429 ◽  
Author(s):  
Kutluk Oktay ◽  
Volkan Turan ◽  
Giuliano Bedoschi ◽  
Fernanda S. Pacheco ◽  
Fred Moy

Purpose We have previously reported an approach to ovarian stimulation for the purpose of fertility preservation (FP) in women with breast cancer via embryo freezing with the concurrent use of letrozole. The aim of this study was to provide the pregnancy and FP outcomes when embryos generated with the same protocol are used. Patients and Methods In all, 131 women with stage ≤ 3 breast cancer underwent ovarian stimulation and received concurrent letrozole 5 mg per day before receiving adjuvant chemotherapy and cryopreserving embryos. Results Thirty-three of the 131 women underwent 40 attempts to transfer embryos to their own uterus (n = 18) or via the use of a gestational carrier (n = 22) at a mean age of 41.5 ± 4.3 years with a median 5.25 years after embryo cryopreservation. The overall live birth rate per embryo transfer was similar to the US national mean among infertile women of a similar age undergoing in vitro fertilization–embryo transfer (45.0 v 38.2; P = .2). Seven (38.8%) of the 18 pregnancies were twins with no higher-order pregnancies being encountered. No fetal anomalies or malformations were reported in 25 children after a mean follow-up of 40.4 ± 26.4 months. Seventeen of the 33 women attempting pregnancy had at least one child, translating into an FP rate of 51.5% per attempting woman. Conclusion Embryo cryopreservation after ovarian stimulation with the letrozole and follicle-stimulating hormone protocol preserves fertility in women with breast cancer and results in pregnancy rates comparable to those expected in a noncancer population undergoing in vitro fertilization.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9509-9509
Author(s):  
S. T. Vadaparampil ◽  
K. M. Lowrey ◽  
C. A. Miree ◽  
S. S. Eidson ◽  
J. B. Watson ◽  
...  

9509 Background: Studies suggest up to 90% of cancer patients in their reproductive years may be at risk of permanent infertility. Yet, few utilize fertility preservation (FP) technologies. One barrier identified by patients and providers is the lack of insurance coverage for FP services. The goal of this study was to examine codified state policies related to infertility and assess their implications for cancer patients at risk for infertility due to treatment. Methods: A keyword search string was developed to identify statutes and administrative regulations of insurance coverage for FP in effect as of July 1, 2008, for the 50 states and the District of Columbia. Laws addressing a more general population but pertaining to cancer patients (e.g., policies addressing in vitro fertilization), were compiled using Lexis-Nexis. Data were analyzed by reviewing the “plain meaning” of the text, legislative/administrative history, and annotated case law. Legal reasoning and common rules of statutory construction and legislative interpretation were used. Findings were recorded using qualitative and dichotomous, quantitative indicators. Quality assurance reviews of all data were conducted and findings were compared with secondary sources. Results: As of July 1, 2008, 15 states (29.4%) had laws relating to insurance coverage for infertility or in vitro fertilization (IVF) procedures. Nine states (17.6%) mandated some type of insurance coverage for infertility treatments, 5 of which defined infertility. One state (CA) mandated an offer of coverage for infertility, but did not define it. For laws concerning IVF, 7 states (13.7%) mandated coverage; 1 state (TX) mandated an offer of coverage; and 2 states (CA and IL) specifically excluded IVF from a mandatory offer of coverage. No state laws or regulations addressed insurance coverage for FP methods specific to cancer patients. Conclusions: There is a strong argument for policies that require coverage for infertility of cancer survivors and FP options prior to treatment similar to mandatory coverage requirements for other side effects experienced by cancer patients (e.g., lymphedema, alopecia). No significant financial relationships to disclose.


Genes ◽  
2021 ◽  
Vol 12 (5) ◽  
pp. 701
Author(s):  
Ovidiu Bîcă ◽  
Ioan Sârbu ◽  
Carmen Iulia Ciongradi

This article reviews the latest information about preserving reproductive potential that can offer enhanced prospects for future conception in the pediatric male population with cancer, whose fertility is threatened because of the gonadotoxic effects of chemotherapy and radiation. An estimated 400,000 children and adolescents aged 0–19 years will be diagnosed with cancer each year. Fertility is compromised in one-third of adult male survivors of childhood cancer. We present the latest approaches and techniques for fertility preservation, starting with fertility preservation counselling, a clinical practice guideline used around the world and finishing with recent advances in basic science and translational research. Improving strategies for the maturation of germ cells in vitro combined with new molecular techniques for gene editing could be the next scientific keystone to eradicate genetic diseases such as cancer related mutations in the offspring of cancer survivors.


2013 ◽  
Vol 100 (3) ◽  
pp. S409
Author(s):  
M.S. Christianson ◽  
L. Londra ◽  
S. Seifert ◽  
H. Wu ◽  
A.M. Khafagy ◽  
...  

2021 ◽  
Vol 14 (4) ◽  
pp. e241417
Author(s):  
Tânia Ascensão ◽  
Maria Inês Marques ◽  
Helena Barros Leite

Ewing’s sarcoma is an aggressive tumour, common in paediatric age, in which treatment often implies a decrease in reproductive potential. We describe a case of a woman who had a lumbar Ewing’s Sarcoma in 1991, at the age of 8. She was submitted to extended tumourectomy, chemotherapy and local radiotherapy without preservation techniques. In adult life, and after two in vitro fertilization (IVF) reproductive cycles without success, she spontaneously conceived at the age of 32. After an uneventful pregnancy, she delivered a healthy child by caesarean section. This is a rare successful case of a spontaneous and uneventful pregnancy without previous preservation techniques. In the last 30 years, there has been significant development in this area, and currently, there are solutions for these patients, including in prepubertal age.


2018 ◽  
Vol 8 (1) ◽  
pp. 1 ◽  
Author(s):  
Konstantinos Sfakianoudis ◽  
Mara Simopoulou ◽  
Nikolaos Nitsos ◽  
Anna Rapani ◽  
Athanasios Pappas ◽  
...  

This report presents the case of a woman aged 40 who has experienced premature menopause from the age of 35. Having rejected oocyte donation, she opted for intraovarian injection of autologous platelet-rich plasma with the aim to rejuvenate the ovarian tissue and enable the employment of her own gametes through in-vitro fertilization. Six weeks following the autologous platelet-rich plasma treatment, a significant reduction in the patient’s follicle-stimulating hormone (FSH) levels were noted. A natural in-vitro fertilization cycle led to a biochemical pregnancy, resulting in a spontaneous abortion at the 5th week of pregnancy. This is the first report of a successful autologous platelet-rich plasma application leading to pregnancy in menopause. This report uniquely contributes to the medical knowledge and challenges current practice in the context of infertility. The efficiency and safety of this treatment with regard to the reproductive system merits further investigation.


2013 ◽  
Vol 62 (2) ◽  
Author(s):  
Vittoradolfo Tambone ◽  
Gaetano Piccinocchi ◽  
Massimiliano Andrea Vitali

Il medico di Medicina Generale, per la natura della sua professione, si trova spesso di fronte a problematiche etiche e bioetiche molto diverse, almeno in termini di applicazione, da quelle in cui si trovano i medici ospedalieri e che sembrano coinvolgere la Pratica Clinica nel suo complesso (tessuto sociale e familiare, la medicina del territorio). Tali dinamiche, a volte, rimangono ignorate e lontane anche dagli obiettivi didattici del sistema universitario italiano. L’obiettivo di questo studio pilota, è quello di raccogliere dati oggettivi sufficienti per poter organizzare un piano formativo specifico che colleghi il mondo universitario e la medicina del territorio. A tal fine è stato predisposto un questionario dall’analisi del quale emerge che i principali problemi etici percepiti dai medici di Medicina Generale sono la comunicazione di cattive notizie, i problemi familiari associati alle dipendenze (alcol, droghe, eccetera) ed il rapporto con i colleghi. Si può affermare, in base ai dati raccolti, che i problemi legati alla comunicazione (che in Letteratura rappresentano circa il 5% rispetto a quelli abitualmente considerati prioritari nel dibattito bioetico – quali aborto, fecondazione in vitro ed eutanasia) e quelli derivanti dalla difficoltà nel relazionarsi con i problemi accessori a quelli strettamente sanitari, come ad esempio i problemi familiari associati alle dipendenze, sono prioritari nella percezione degli intervistati. È emerso, inoltre, che il sentire la necessità di acquisire strumenti formativi in ambito etico è correlato all’esperienza della difficoltà ad interagire con questa tipologia di problematiche che non varia in funzione degli anni lavorativi trascorsi. Infine è emerso che le attività formative preferite (corsi residenziali, ECM e Master) sono quelle che permettono maggiore relazione formativa interpersonale sia con docenti (relazione verticale), sia con colleghi (relazione orizzontale). Tale tendenza suggerisce di dedicare maggiore attenzione alla formazione relazionale, probabilmente inserendo nella didattica formale moduli specifici di Psicologia Sociale e di Antropologia. ---------- The general practitioner, by nature of his profession, is often faced with many different ethical and bioethical issues from those with which other physicians who work in healthcare facilities are faced with. These problems seem to involve the whole social and family structure and primary healthcare, concerning aspects that are sometimes disregarded and distant even from the learning goals of the Italian university system. The aim of this pilot study is to collect objective data enough to organize a specific training plan that links university to general practice medicine. A questionnaire was therefore developed and submitted in an anonymous form to the participants of the 32nd National Congress of the Italian Society of General Medicine, held in Florence in November of 2011. The analysis of the questionnaires has shown that the main ethical problems perceived among general practitioners are communicating bad news, family problems associated with addictions (alcohol, drugs, etc.) and professional relationships with colleagues. According to the data collected, the following matters are most important for the respondents: problems related to communication (which in literature represent about 5% of the priorities usually considered the bioethical debate – such as abortion, in vitro fertilization and euthanasia) and those arising from the difficulty in incidental problems which are not strictly healthcare related, such as family problems associated with addictions. Furthermore feeling the need to acquire tools and training in ethics is related to experiencing the uneasiness with this kind of problem, and the fact that this uneasiness does not change with the years spent working, suggests that it is constantly present in this professional category. However, as many as 27% of respondents affirm they have not encountered ethical issues during their career. Finally it was found that the preferred learning types (residential courses, CME and post graduate diplomas) are those that allow greater interpersonal or educational relationship with teachers (vertical relationship) and with colleagues (horizontal relationship). This trend suggests to put greater emphasis on relational training possibly by introducing specific courses to Psychology and Social Anthropology in frontal teaching.


Sign in / Sign up

Export Citation Format

Share Document