Quality of life of young cancer survivors has become a major issue. However, anticancer therapies can have a detrimental impact on fertility. It is now well-established that all patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available. Currently, oocyte or embryo banking after controlled ovarian hyperstimulation represents the most effective method for preserving female fertility. Over the past years innovative protocols of ovarian stimulation have been developed to enable cancer patients to undergo oocyte or embryo cryopreservation irrespective of the phase of the cycle or without exogenous follicle-stimulating hormone-related increase in serum estradiol levels. The present article reviews the different protocols of ovarian hyperstimulation for cancer patients, candidates for fertility preservation.KEYWORDS:
cancer; controlled ovarian hyperstimulation; embryo cryopreservation; fertility preservation; oocyte vitrificationCONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer, pois acredita que as terapias para tratamento do câncer têm um impacto negativo na fertilidade. Por isso, todos os pacientes devem ter acesso às informações sobre os métodos de preservação da fertilidade como vitrificação de óvulos (oócitos) ou embriões.
The use of oocyte cryopreservation via vitrification has increased lately, becoming a common strategy in many IVF centers. This review summarizes the current state of oocyte vitrification, by analyzing the most recent reports on its use in IVF as part of infertile treatment and its contribution to elective fertility preservation (EFP).RECENT FINDINGS:
Oocyte vitrification has become helpful for managing different clinical situations currently providing similar results to fresh oocytes. Owing to satisfactory results, oocyte vitrification is being offered to healthy women to extend their reproductive options (EFP). Although little is known about outcomes in this specific population, new evidence is starting to emerge. Currently, most women are motivated by age and lack of partner. Age is strongly related to the probability of having a child with better chances when they do EFP younger than 35. In contrast to the biological efficiency, the majority of studies show that EFP is more cost-effective at 37-38 years.SUMMARY:
Oocyte vitrification is an efficient tool which can be helpful in managing the IVF cycle. Fertility preservation providers should inform women about their specific probabilities according to their age at vitrification, making emphasis in the fact that egg freezing does not guarantee success, but increases the possibilities of having a biological child in the future.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer e incentiva o uso de óvulos (oócitos) vitrificados. Esta prática tem se tornado comum em muitos centros de reprodução humana com resultados semelhantes àqueles com óvulos frescos. As chances são maiores quando realizada antes dos 35 anos.
Since the first live birth from oocyte cryopreservation three decades ago, oocyte cryopreservation has become an important component of ART. Cryopreservation techniques have evolved, leading to higher success rates and the introduction of oocyte cryopreservation into IVF clinics worldwide. Concurrently, there has been an increase in patient demand, especially for so-called 'social egg freezing' that allows women to preserve their fertility in anticipation of age-related fertility decline. This review addresses a need to evaluate the current status of oocyte cryopreservation. It explores current techniques and success rates, clinical applications, the rise of elective oocyte cryopreservation, and future implications.METHODS:
A search was performed using Web of Science and PubMed databases for publications between January 1980 and December 2015. Keywords used included 'egg freezing', 'oocyte freezing', 'oocyte cryopreservation', 'oocyte vitrification', and 'fertility preservation'.RESULTS:
The success rate of oocyte cryopreservation has risen, and the increasing use of vitrification offers has improved outcomes, with IVF pregnancy rates now similar to those achieved with fresh oocytes. There are conflicting opinions about the comparative success rates of open and closed vitrification. Patients are accessing and receiving oocyte cryopreservation for a wide range of indications, and there has been a marked increase in patient numbers and oocyte cryopreservation cycles. Oocyte cryopreservation for circumventing age-related infertility is becoming more widely accepted.CONCLUSION:
Oocyte cryopreservation is an established component of ART, with vitrification now being the cryopreservation technique of choice. Increasing numbers of women undergo oocyte cryopreservation for both medical and social reasons. It is important to continue auditing outcomes and reporting long-term follow-up of children born from frozen-thawed oocytes.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer, pois desde o primeiro nascimento, há 30 anos, de um bebê a partir de óvulos congelados, as técnicas de vitrificação tem sido muitos usadas e as taxas de sucesso estão equiparadas ao uso de óvulos “a fresco”.
Fertility preservation in the young cancer survivor is recognized as a key survivorship issue by the American Society of Clinical Oncology and the American Society of Reproductive Medicine. Thus, health-care providers should inform women about the effects of cancer therapy on fertility and should discuss the different fertility preservation options available. It is also recommended to refer women expeditiously to a fertility specialist in order to improve counseling. Women's age, diagnosis, presence of male partner, time available, and preferences regarding use of donor sperm influence the selection of the appropriate fertility preservation option. Embryo and oocyte cryopreservation are the standard techniques used while ovarian tissue cryopreservation is new, yet promising. Despite the importance of fertility preservation for cancer survivors' quality of life, there are still communication and financial barriers faced by women who wish to pursue fertility preservation.KEYWORDS:
cancer survivorship; counseling; cryopreservation; fertility preservation; fertility sparing surgeryCONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. A preservação da fertilidade em pacientes jovens com câncer por si só já é um fator de melhora na sobrevida por criar esperanças futuras no difícil momento do diagnóstico. A idade da mulher, o diagnóstico, a presença de um parceiro, o tempo para inicio do tratamento e o tipo de tratamento irão definir a melhor técnica de preservação.
Infertility 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.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. A radiação das gônadas (radioterapia) e alguns protocolos de quimioterapia levam a falência ovariana e menopausa precoce e no homem podem causar azoospermia temporária ou definitiva. Há muitas técnicas disponíveis para preservação, entre elas: preservação de sêmen, embriões e óvulos, preservação de tecido ovariano, maturação in vitro de folículos e transposição ovariana.KEYWORDS:
Fertility preservation; oncological management; young adults
Lancet Oncol. 2016 Jun;17(6):e240-e253..
Fertility preservation in young patients with cervical cancer is suitable only for patients with good prognostic factors and disease amenable to surgery without adjuvant therapy. Consequently, it is only offered to patients with early-stage disease (stage IB tumours <4 cm), negative nodes, and non-aggressive histological subtypes. To determine whether fertility preservation is suitable, the first step is pelvic-node dissection to establish nodal spread. Tumour size (≤2 cm vs >2 cm) and lymphovascular space invasion status are two main factors to determine the best fertility-sparing surgical technique. In this systematic Review, we assess six different techniques that are available to preserve fertility (Dargent's procedure, simple trachelectomy or cone resection, neoadjuvant chemotherapy with conservative surgery, and laparotomic, laparoscopic and robot-assisted abdominal radical trachelectomy). The choice between the six different fertility preservation techniques should be based on the experience of the team, discussion with the patient or couple, and, above all, objective oncological data to balance the best chance for cure with optimum fertility results for each procedure.
J Clin Oncol. 2016 May 20;34(15):1780-6.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. Em pacientes com câncer de colo do útero há diferentes maneiras de preservação da fertilidade dependendo do estagio da doença. Muitas vezes é possível a traquelectomia (retirada do colo do útero) simples ou conização com quimioterapia neoadjuvante, ou cirurgia laparoscópica, conservando-se a possibilidade de gestação futura.
A cancer and fertility program was established at a large cancer center to support clinicians in discussing treatment-related fertility risks and fertility preservation (FP) options with patients and in referring patients to reproductive specialists. The program provides resources, clinician education, and fertility clinical nurse specialist consultation. This study evaluated the program's impact on patient satisfaction with information received.PATIENTS AND METHODS:
Retrospective cross-sectional surveys assessed satisfaction before (cohort 1 [C1]) and after (cohort 2 [C2]) program initiation. Questionnaires were investigator-designed, gender-specific, and anonymous.RESULTS:
Most C1 (150 males, 271 females) and C2 (120 males, 320 females) respondents were 2 years postdiagnosis; the most frequently reported cancers were testicular, breast, and lymphoma. A significant difference in satisfaction with the amount of information received was seen between C1 and C2. For males, satisfaction with information on fertility risks was high in both cohorts but significantly greater in C2 for information on sperm banking (χ(2) = 9.3, P = .01) and finding a sperm bank (χ(2) = 13.3, P = .001). For females, satisfaction with information was significantly greater in C2 for information on fertility risks (χ(2) = 62.1, P < .001), FP options (χ(2) = 71.9, P < .001), help with decision making (χ(2) = 80.2, P < .001), and finding a reproductive endocrinologist (χ(2) = 60.5, P < .001). Among patients who received and read information materials, 96% of males and 99% of females found them helpful. Among C2 females, fertility clinical nurse specialist consultation was associated with significantly greater satisfaction with information on FP options (χ(2) = 11.2, P = .004), help with decision making (χ(2) = 10.4, P = .006), and finding a reproductive endocrinologist (χ(2) = 22.6, P < .001), with 10% reporting lack of knowledge as a reason for not pursuing FP.CONCLUSION:
Improvements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.
J Natl Compr Canc Netw. 2016 Mar;14(3):355-63.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. Os tipos de câncer mais frequentes na população jovem são os linfomas, câncer de testículo e câncer de mama. Ao serem questionados, 96% dos homens e 99% das mulheres respondem que gostariam de ser informados sobre técnicas de preservação da fertilidade antes do tratamento oncológico.
As treatment paradigms improve and young women live longer after a breast cancer diagnosis, there is an increasing need to define the fertility-related problems that premenopausal women with breast cancer face, and, more importantly, to find solutions. This article discusses what is known regarding fertility risks associated with standard breast cancer treatment regimens and limitations of that information. We outline established and emerging techniques for fertility preservation, including recent developments surrounding the controversial utility of gonadotropin-releasing hormone agonists through chemotherapy, and review available data on the safety of pregnancy in breast cancer survivors. We highlight opportunities for further investigation, and contextualize fertility-related concerns in the modern treatment landscape. Above all, we stress the importance of this topic in a patient-centered approach to breast cancer care for young women.
J Pediatr Adolesc Gynecol. 2015 Aug;28(4):e105-7. doi: 10.1016/j.jpag.2014.09.013. Epub 2014 Oct 2.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. Entre as mulheres com câncer de mama, a sobrevida tem sido cada vez maior. Pensando na melhora da qualidade de vida pós-tratamento, torna-se muito importante a preservação da fertilidade. Questiona-se sobre os riscos para doença com a estimulação ovariana e novos protocolos têm sido empregados.
What is the effect of different alkylating agents used without pelvic radiation to treat childhood cancer in girls on the ovarian reserve in survivors?SUMMARY ANSWER:
Ovarian reserve seems to be particularly reduced in survivors who received procarbazine (in most cases for Hodgkin lymphoma) or high-dose chemotherapy; procarbazine but not cyclophosphamide dose is associated with diminished ovarian reserve.WHAT IS KNOWN ALREADY:
A few studies have demonstrated diminished ovarian reserve in survivors after various combination therapies, but the individual role of each treatment is difficult to assess.STUDY DESIGN:
Prospective cross-sectional study, involving 105 survivors and 20 controls.PARTICIPANTS/MATERIALS, SETTING, METHODS:
One hundred and five survivors aged 17-40 years and 20 controls investigated on Days 2-5 of a menstrual cycle or Day 7 of an oral contraceptive pill-free interval.MAIN OUTCOME MEASURES:
ovarian surface area (OS), total number of antral follicles (AFC), serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and anti-Müllerian hormone (AMH).MAIN RESULTS AND THE ROLE OF CHANCE:
Survivors had a lower OS than controls: 3.5 versus 4.4 cm(2) per ovary (P = 0.0004), and lower AMH levels: 10.7 versus 22 pmol/l (P = 0.003). Ovarian markers (OS, AMH, AFC) were worse in patients who received high-dose compared with conventional-dose alkylating agents (P = 0.01 for OS, P = 0.002 for AMH, P < 0.0001 for AFC). Hodgkin lymphoma survivors seemed to have a greater reduction in ovarian reserve than survivors of leukaemia (P = 0.04 for AMH, P = 0.01 for AFC), sarcoma (P = 0.04 for AMH, P = 0.04 for AFC) and other lymphomas (P = 0.04 for AFC). A multiple linear regression analysis showed that procarbazine but not cyclophosphamide nor ifosfamide dose was associated with reduced OS (P = 0.0003), AFC (P = 0.0007), AMH (P < 0.0001) and higher FSH levels (P < 0.0001).LIMITATIONS, REASONS FOR CAUTION:
The small percentage of participating survivors (28%) from the total cohort does not allow conclusion on fertility issues because of possible response bias. The association between procarbazine and HL makes it impossible to dissociate their individual impacts on ovarian reserve. The number of controls is small, but ovarian volume and AMH levels in survivors were compared with published normal values and results were unchanged.WIDER IMPLICATIONS OF THE FINDINGS:
Early detection and follow-up of compromised ovarian function after cancer therapy should help physicians to counsel young survivors about their fertility window. However, longitudinal follow-up is required to determine the rate of progression from low ovarian reserve to premature ovarian failure.STUDY FUNDING/COMPETING INTERESTS:
La Ligue contre le Cancer (grant no., PRAYN7497). The authors have no competing interests to disclose.
© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: email@example.com.KEYWORDS:
AMH; chemotherapy; childhood cancer survivors; hodgkin lymphoma; ovarian reserve
Reprod Biomed Online. 2014 Dec;29(6):722-8. doi: 10.1016/j.rbmo.2014.09.002. Epub 2014 Sep 10.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. As drogas usadas na quimioterapia de pacientes com linfomas Hodkin, comprovadamente, estão associadas a maior queda na reserva ovariana. Nos casos de linfomas os efeitos são ainda maiores do que nos caso de leucemias e sarcomas.
Obstetric outcome of first pregnancies achieved after vitrification and warming oocytes from women being treated for cancer was evaluated. Of a total of 493 women who consulted for fertility preservation, 357 had their oocytes cryopreserved after being diagnosed with cancer, and 11 returned after being cured for assisted reproduction treatments (eight had breast cancer, one Hodgkin lymphoma, one endometrial adenocarcinoma, and one thyroid cancer). The oocyte survival rate was 92.3%, the fertilization rate was 76.6%, and the mean number of embryos transferred was 1.8 ± 0.7. Beta-human chorionic gonadotropin was detected in seven out of the 11 embryo transfers carried out. Four ongoing pregnancies were achieved and delivered at term with normal fetal weight and no major or minor malformations. Women diagnosed with cancer who have their eggs cryopreserved before anti-cancer treatment have good assisted reproductive technology performance and good perinatal outcomes. Cryopreservation of oocytes seems to be a good alternative for fertility preservation in these women.
Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
J Hum Reprod Sci. 2014 Apr;7(2):111-8.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. O objetivo deste estudo foi analisar o prognóstico reprodutivo de pacientes após tratamento de câncer de mama, linfoma de Hodkin, câncer de tireoide e adenocarcinoma de endométrio. Foram analisadas 11 pacientes que retornaram após o tratamento. A taxa de sobrevivência dos óvulos (oócitos) foi de 92,3%, com 76,6% de taxa de fertilização e gestação positiva em 7 de 11 embriões transferidos.
Cancer survival has improved significantly and maintaining fertility is both a major concern and an important factor for the quality of life in cancer patients.AIMS:
To explore differences in oocyte stimulation for fertility preservation (FP) patients based on cancer diagnosis.SETTINGS AND DEIGN:
Between 2005 and 2011, 109 patients elected to pursue FP at a single institution.MATERIALS AND METHOD:
In vitro fertilization (IVF) outcome variables between four cancer diagnostic groups (breast, gynecologic, lymphoma/leukemia and other) and age-matched male factor or tubal factor infertility IVF control group were compared.STATISTICAL ANALYSIS:
ANOVA and Chi-square analyses were employed to compare variables between the groups that were normally distributed. Kruskal-Wallis with subsequent Mann-Whitney U-test were used for data that were not normally distributed.RESULTS:
Women with gynecologic malignancies were significantly older than the women in the other three groups, but tended to have a better ovarian response. Women with hematologic malignancies were most likely to have been exposed to chemotherapy and had the longest stimulations with a similar number of oocytes retrieved. The age-matched IVF controls had higher peak estradiol levels, number of oocytes obtained, and fertilization rates when compared to cancer patients with or without a history of prior chemotherapy.CONCLUSIONS:
Factors including age, type of cancer and chemotherapy exposure, can influence response to ovarian stimulation. Discussing these findings with patients presenting for FP may aid in setting realistic treatment expectations.
Iran J Reprod Med. 2014 Jun;12(6):377-82.CONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. Existem diferenças nos protocolos de estimulação e nas respostas para os tratamentos de fertilidade de acordo com os diferentes tipos de câncer. Mulheres com diagnóstico de câncer ginecológico tendem a ter mais idade, mas tem uma melhor resposta à estimulação quando comparadas com mulheres com neoplasias hematológicas.
Malignancies are not rare in girl and women during their reproductive years. Over the past three decades, the survival rate for cancer has been improving due to progress in cancer diagnosis and treatment. These patients frequently experience a variety of treatment, and disease-related side effects that diminish their quality of life during and after treatment; among these are loss of fertility and sexual dysfunction. There have been recent advances in the field of fertility preservation, which can allow many of these genital cancer survivors to have children in the future. This topic review discusses available options and specific strategies for fertility preservation in adolescent and young women with malignancies who wish to preserve their ability to become pregnant in the future.KEYWORDS:
Cervical cancer; Endometrial cancer; Fertility preservation; Leukemia; Malignancy; Ovarian cancerCONCLUSÃO
O IPGO criou o PROGRAMA OS FRUTOS DA VIDA, um tratamento gratuito para o congelamento de óvulos de pacientes com câncer. Até mesmo em crianças e mulheres jovens existem estratégias para tentativa de preservação da fertilidade e por isso o encaminhamento para um especialista e a discussão acerca das técnicas não pode ser negligenciados.
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