Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update

2018 ◽  
Vol 36 (19) ◽  
pp. 1994-2001 ◽  
Author(s):  
Kutluk Oktay ◽  
Brittany E. Harvey ◽  
Ann H. Partridge ◽  
Gwendolyn P. Quinn ◽  
Joyce Reinecke ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Health Care Providers ◽  
Ovarian Tissue ◽  
Cochrane Library ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Care Providers ◽  
Additional Information ◽  
Patients With Cancer ◽  
Preservation Methods

Purpose To provide current recommendations about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from January 2013 to March 2017 was completed using PubMed and the Cochrane Library. An Update Panel reviewed the identified publications. Results There were 61 publications identified and reviewed. None of these publications prompted a significant change in the 2013 recommendations. Recommendations Health care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible. Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm, oocyte, and embryo cryopreservation are considered standard practice and are widely available. There is conflicting evidence to recommend gonadotrophin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation. The Panel recognizes that, when proven fertility preservation methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. GnRHa should not be used in place of proven fertility preservation methods. The panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future. Additional information is available at www.asco.org/survivorship-guidelines .

scholarly journals Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

ESMO Open ◽  
2020 ◽  
Vol 5 (Suppl 4) ◽  
pp. e000771 ◽  
Author(s):  
Marta Perachino ◽  
Claudia Massarotti ◽  
Maria Grazia Razeti ◽  
Francesca Parisi ◽  
Luca Arecco ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Health Care Providers ◽  
Cancer Care ◽  
Safety Data ◽  
Young Patients ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Care Providers ◽  
Patients With Cancer ◽  
Age Related

Survivorship is an area of paramount importance to be addressed as early as possible after cancer diagnosis by all health care providers. On this regard, cancer care in young patients often poses several age-related considerations among which fertility and pregnancy-related issues have a crucial role. According to the available guidelines on the topic, all patients with cancer diagnosed during their reproductive years should be provided a proper oncofertility counselling before starting anticancer treatments. This is an important step in order to inform patients about the potential treatment-induced gonadotoxicity and the available strategies for fertility preservation so that they can be referred as early as possible to fertility specialists if potentially interested in these options.In this manuscript, we aim to provide an up to date overview on the available efficacy and safety data with the main strategies for fertility preservation in male and female cancer patients in order to help optimising the oncofertility counselling performed by healthcare providers involved in cancer care and dealing with young patients. In male patients with cancer, sperm cryopreservation is the standard technique for fertility preservation. Oocyte/embryo cryopreservation, ovarian tissue cryopreservation and temporary ovarian suppression with luteinising hormone-releasing hormone agonists during chemotherapy are the main options in female patients with cancer.A multidisciplinary management building a strong network between fertility and oncology/haematology units is crucial to properly address fertility care in all young patients with cancer, at both diagnosis and during oncologic follow-up. Discussing fertility and pregnancy-related issues with young patients with cancer has to be considered mandatory nowadays keeping in mind that returning to a normal life (including the possibility to have a family and to live with as few side effects as possible) should be considered an important ambition in cancer care in the 21st century .

Fertility Preservation

2018 ◽  
Author(s):  
Chantae S Sullivan-Pyke ◽  
Clarisa Gracia
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Testicular Tissue ◽  
Mature Oocyte ◽  
Gonadotropin Releasing Hormone ◽  
Oocyte Cryopreservation ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Tissue Cryopreservation

Fertility preservation has becoming increasingly important for patients at risk for gonadal failure, including those needing treatment for cancer or autoimmune conditions, genetic conditions that predispose to gonadal insufficiency, and age-related fertility decline. Embryo cryopreservation and mature oocyte cryopreservation are the standards for fertility preservation in postpubertal women. Ovarian tissue cryopreservation and gonadotropin-releasing hormone agonist use for ovarian suppression are experimental methods that may be offered to patients for whom embryo and/or mature oocyte cryopreservation are not applicable. The cryopreservation of spermatozoa is the standard for fertility preservation in postpubertal males, but testicular tissue cryopreservation may be offered to prepubertal males.   This review contains 10 figures, 6 tables and 53 references Key words: controlled ovarian stimulation, embryo cryopreservation, gonadotropin-releasing hormone agonist, in vitro maturation, oocyte cryopreservation, ovarian tissue cryopreservation, sperm extraction, testicular tissue cryopreservation  

scholarly journals Developing an Indonesian fertility preservation questionnaire for health care providers treating patients with cancer: A preliminary pilot study

F1000Research ◽  
2019 ◽  
Vol 7 ◽  
pp. 1890
Author(s):  
Achmad Kemal Harzif ◽  
Raymond Surya ◽  
Mila Maidarti ◽  
Ana Mariana ◽  
Bara Tracy Lovita ◽  
...  
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Fertility Preservation ◽  
Health Care Providers ◽  
Expert Panel ◽  
World Health ◽  
Cognitive Interviewing ◽  
Care Providers ◽  
Patients With Cancer ◽  
Forward Translation

Background: Early detection and advanced treatment increases the five-year survival rate of patients with cancer. However, long-term cancer therapy, such as chemotherapy and radiotherapy, can have negative effects, such as infertility. This study aimed to develop a standardized Indonesian questionnaire, which would be used to assess the quality of health care providers’ knowledge, attitude, and practice regarding fertility preservation in patients with cancer. Methods: A pilot study was performed in January and February 2018 at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. An existing questionnaire was translated from English to Indonesian using forward translation, back translation, expert panel, pretesting, and cognitive interviewing. Ten subspecialists in the following departments made up an expert panel, who were involved in pretesting and cognitive interviewing: pediatric hematology-oncology, hematology-oncology/internal medicine, gynecologic oncology, gynecologic immune-endocrinology, radiology-oncology, and surgical oncology. Results: The questionnaire was successfully translated. The ten respondents stated that the maximum age for women’s fertility preservation is 40 years of age (60%), 45 years of age (30%), or had no maximum age (10%). Additionally, the respondents stated that the maximum age for men’s fertility preservation is 40 years of age (30%), 50 years of age (20%), or had no maximum age (50%). The respondents’ knowledge stated that > 50% of them were aware but do not know enough about fertility preservation. The respondents stated that more than 50% of them give feedback agreeing to fertility preservation, and they always give advice about fertility preservation to their patients. Conclusion: The translation of the questionnaire followed translation steps from the World Health Organization and was adjusted based on the expert panel’s comments concerning fertility preservation. This validated questionnaire tool in Indonesian can be used for research purposes and clinical evaluation of fertility preservation among health care providers in Indonesia.

scholarly journals Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Barbara Buonomo ◽  
Claudia Massarotti ◽  
Miriam Dellino ◽  
Paola Anserini ◽  
Alberta Ferrari ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Health Care Providers ◽  
Current Evidence ◽  
Main Body ◽  
Care Providers ◽  
Preimplantation Genetic Testing ◽  
Main Research ◽  
Patients With Cancer ◽  
Pathogenic Variants ◽  
Tailored Counseling

Abstract Background Healthy individuals and patients with cancer who are carriers of germline pathogenic variants in the BRCA1/2 genes face multiple reproductive challenges that require appropriate counseling and specific expertise. Main body On December 5th–7th, 2019, patient advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to “San Giuseppe Moscati” Hospital in Avellino (Italy) for a workshop on reproductive management of women with germline pathogenic variants in the BRCA1/2 genes. From the discussion regarding the current evidence and future prospective in the field, eight main research questions were formulated and eight recommendations were developed regarding fertility, fertility preservation, preimplantation genetic testing, and pregnancy in healthy carriers and patients with cancer. Conclusion Several misconceptions about the topic persist among health care providers and patients often resulting in a discontinuous and suboptimal management. With the aim to offer patient-tailored counseling about reproductive issues, both awareness of current evidences and research should be promoted.

scholarly journals Follicle Rescue From Prepubertal Ovaries After Recent Treatment With Cyclophosphamide—An Experimental Culture System Using Mice to Achieve Mature Oocytes for Fertility Preservation

2021 ◽  
Vol 11 ◽  
Author(s):  
Xia Hao ◽  
Amandine Anastácio ◽  
Laia Viñals-Ribé ◽  
Ana Santamaria Lacuesta ◽  
Christina Diakaki ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Ovarian Tissue Cryopreservation ◽  
Ovarian Tissue Transplantation ◽  
Oocyte Competence ◽  
Patients With Cancer ◽  
Tissue Cryopreservation ◽  
Selection Of

Ovarian tissue cryopreservation is the only feasible method for fertility preservation in prepubertal girls that will undergo gonadotoxic chemotherapy. To date, the only clinical use of cryopreserved tissue is by a later tissue retransplantation to the patient. Clinical challenges in fertility preservation of very young patients with cancer include time constraints that do not allow to retrieve the tissue for cryopreservation before starting chemotherapy and the preclusion of future ovarian tissue transplantation due to the risk of reintroduction of malignant cells in patients with systemic diseases. To overcome these two challenges, we investigated using an experimental model the feasibility of retrieving secondary follicles from ovaries of prepubertal mice after cyclophosphamide (CPA) treatment in increasing doses of 50, 75, and 100 mg/kg. The follicles were thereafter cultured and matured in vitro. The main outcomes included the efficiency of the method in terms of obtained matured oocytes and the safety of these potentially fertility preservative procedures in terms of analyses of oocyte competence regarding normality of the spindle and chromosome configurations. Our findings demonstrated that it was feasible to isolate and culture secondary follicles and to obtain mature oocytes from prepubertal mice ovaries recently treated with CPA. The efficiency of this method was highly demonstrated in the 100 mg/kg CPA group, with near 90% follicle survival rate after 12 days’ culture, similarly to control. Around 80% of the follicles met the criteria to put into maturation, and more than 40% of them achieved metaphase II, with normal spindle and chromosome configurations observed. Suboptimal results were obtained in the 50 and 75 mg/kg CPA groups. These paradoxical findings towards CPA dose might probably reflect a more difficult selection of damaged growing follicles from ovaries recently treated with lower doses of CPA and a hampered ability to identify and discard those with reduced viability for the culture.

scholarly journals Should you be putting all your eggs into one basket? A look into the current state and future of ovarian tissue cryopreservation.

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Shakina Rauff ◽  
Zaraq Khan ◽  
Claus Yding Andersen
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Mature Oocyte ◽  
Reproductive Capacity ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Social Motives ◽  
Current State ◽  
Medical Indications ◽  
Tissue Cryopreservation

 Ovarian tissue cryopreservation has its primary goal in fertility preservation for women diagnosed with a malignancy and who may be rendered infertile because of the potential gonadotoxic chemotherapy and/or radiotherapy involved in treating their disease. Unlike the standard and endorsed methods of fertility preservation like mature oocyte and embryo cryopreservation, ovarian tissue freezing not only conserves the reproductive capacity of the woman but additionally, maintains the steroidogenic competence of the ovary due to the fact that the frozen cortex contains numerous ovarian follicles – the functional unit of the ovary. Not every follicle is fated to aid procreation. In fact more than 99% are destined to end up in atresia, which may be viewed as an enormous waste of inherent resources. In light of this, there have been propositions to expand the scope of ovarian tissue cryopreservation and transplantation beyond its traditional purpose of fertility preservation for medical indications. Some of these ideas include utilizing cryopreserved ovarian tissue for induction of puberty, delaying the menopause and fertility preservation for social motives. Needless to say, these novel ideas will evoke questions, controversy and a plethora of criticism about the safety, superiority, cost-effectiveness, implications and necessity of these different utilities. In this article, we aim to explore some of the issues that shroud these new indications and discuss the advantages for and diatribe against these evolving suggestions.

Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children's Oncology Group

2021 ◽  
Author(s):  
Natasha N. Frederick ◽  
James L. Klosky ◽  
Lillian R. Meacham ◽  
Gwendolyn P. Quinn ◽  
Joanne Frankel Kelvin ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Testicular Tissue ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Oncology Group ◽  
Modifiable Factors ◽  
Pediatric Cancer Patients ◽  
Tissue Cryopreservation

PURPOSE Fertility preservation (FP) services are part of comprehensive care for those newly diagnosed with cancer. The capacity to offer these services to children and adolescents with cancer is unknown. METHODS A cross-sectional survey was sent to 220 Children's Oncology Group member institutions regarding institutional characteristics, structure and organization of FP services, and barriers to FP. Standard descriptive statistics were computed for all variables. The association between site-specific factors and selected outcomes was examined using multivariable logistic regression. RESULTS One hundred forty-four programs (65.5%) returned surveys. Fifty-three (36.8%) reported a designated FP individual or team. Sperm banking was offered at 135 (97.8%) institutions, and testicular tissue cryopreservation at 37 (27.0%). Oocyte and embryo cryopreservation were offered at 91 (67.9%) and 62 (46.6%) institutions, respectively; ovarian tissue cryopreservation was offered at 64 (47.8%) institutions. The presence of dedicated FP personnel was independently associated with the ability to offer oocyte or embryo cryopreservation (odds ratio [OR], 4.7; 95% CI, 1.7 to 13.5), ovarian tissue cryopreservation (OR, 2.7; 95% CI, 1.2 to 6.0), and testicular tissue cryopreservation (OR, 3.3; 95% CI, 1.4 to 97.8). Only 26 (18.1%) participating institutions offered all current nonexperimental FP interventions. Barriers included cost (70.9%), inadequate knowledge or training (60.7%), difficulty characterizing fertility risk (50.4%), inadequate staffing (45.5%), and logistics with reproductive specialties (38%-39%). CONCLUSION This study provides the most comprehensive view of the current landscape of FP infrastructure for children and adolescents with cancer and demonstrates that existing infrastructure is inadequate to offer comprehensive services to patients. We discuss modifiable factors to improve patient access to FP.

scholarly journals Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

2013 ◽  
Vol 31 (19) ◽  
pp. 2500-2510 ◽  
Author(s):  
Alison W. Loren ◽  
Pamela B. Mangu ◽  
Lindsay Nohr Beck ◽  
Lawrence Brennan ◽  
Anthony J. Magdalinski ◽  
...  
Keyword(s):  
Health Care ◽  
Fertility Preservation ◽  
Clinical Oncology ◽  
Health Care Providers ◽  
Randomized Clinical Trials ◽  
Case Series ◽  
Cochrane Collaboration ◽  
Embryo Cryopreservation ◽  
Care Providers ◽  
American Society

Purpose To update guidance for health care providers about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. Results There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. Recommendations As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.

scholarly journals Female fertility preservation: past, present and future

Reproduction ◽  
2018 ◽  
Vol 156 (1) ◽  
pp. F11-F27 ◽  
Author(s):  
Benjamin Fisch ◽  
Ronit Abir
Keyword(s):  
Cancer Therapy ◽  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Reproductive Technologies ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Primordial Follicles ◽  
Anti Cancer

Anti-cancer therapy, particularly chemotherapy, damages ovarian follicles and promotes ovarian failure. The only pharmacological means for protecting the ovaries from chemotherapy-induced injury is gonadotrophin-releasing hormone agonist, but its efficiency remains controversial; ovarian transposition is used to shield the ovary from radiation when indicated. Until the late 1990s, the only option for fertility preservation and restoration in women with cancer was embryo cryopreservation. The development of other assisted reproductive technologies such as mature oocyte cryopreservation andin vitromaturation of oocytes has contributed to fertility preservation. Treatment regimens to obtain mature oocytes/embryos have been modified to overcome various limitations of conventional ovarian stimulation protocols. In the last decades, several centres have begun cryopreserving ovarian samples containing primordial follicles from young patients before anti-cancer therapy. The first live birth following implantation of cryopreserved-thawed ovarian tissue was reported in 2004; since then, the number has risen to more than 130. Nowadays, ovarian tissue cryopreservation can be combined within vitromaturation and vitrification of oocytes. The use of cryopreserved oocytes eliminates the risk posed by ovarian implantation of reseeding the cancer. Novel methods for enhancing follicular survival after implantation are presently being studied. In addition, researchers are currently investigating agents for ovarian protection. It is expected that the risk of reimplantation of malignant cells with ovarian grafts will be overcome with the putative development of an artificial ovary and an efficient follicle class- and species-dependentin vitrosystem for culturing primordial follicles.

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