Oncofertility and fertility preservation
Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.
Alkylators, pelvic radiation, transplant conditioning and some targeted drugs cause infertility; ASCO (2006, updated 2018) recommends discussing fertility with every patient of reproductive age before treatment. Options: sperm banking (standard, cheap), oocyte or embryo cryopreservation (random-start stimulation within 2 weeks; letrozole protocols for ER+ breast cancer), ovarian tissue cryopreservation (no longer experimental per ASRM 2019; >200 live births; the only option for prepubertal girls), GnRH agonist during chemotherapy (reduces premature ovarian insufficiency in breast cancer, POEMS/PROMISE; not fertility-proven), ovarian transposition before pelvic radiation, testicular tissue banking (experimental), and uterine transplantation. Pregnancy after breast cancer is safe (POSITIVE trial 2023: interrupting endocrine therapy for pregnancy did not increase recurrence at 3 years). Access is limited by cost, time pressure and referral rates (<50% of eligible patients counselled).
How it works
Time-critical referral to reproductive specialists before gonadotoxic therapy, with the preservation method chosen by sex, age, pubertal status, cancer type, time available and hormone sensitivity.
- Established live-birth outcomes for sperm, oocyte, embryo and ovarian tissue
- Random-start protocols avoid treatment delay
- POSITIVE trial reassures about pregnancy after breast cancer
- Cost and insurance coverage (mandated in only some US states)
- Prepubertal boys have only experimental options
- Referral gaps, especially in men, adolescents and LMICs
Latest papers
topQuery for this technology: (TITLE:"Oncofertility and fertility preservation" OR ABSTRACT:"Oncofertility and fertility preservation") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Oncofertility and fertility preservation, not a curated reading list.
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