Female fertility preservation in cancer patients


Authors: M. Tomilová 1;  K. Frühaufová 2
Authors‘ workplace: Europe IVF International s. r. o., Praha 1;  Gynem IVF Centrum, Praha 2
Published in: Ceska Gynekol 2022; 87(5): 356-361
Category: Review Article
doi: 10.48095/cccg2022356

Overview

Fertility preservation in cancer patients or oncofertility is a relatively new trend in modern medicine. In patients with unfulfilled reproductive plans, the possibility of starting a family is one of the key parameters of quality of life after overcoming a cancer. Guidelines have existed since 2013 and in 2020 the European Society of Human Reproduction and Embryology has also published a guideline, but the main problem of their application in clinical practice is the lack of information for both patients and, unfortunately, professionals, as well as the high cost of treatment. From 2022, health insurance companies in the Czech Republic partially cover the expenses for fertility preservation treatment for cancer patients. The possibilities of oncofertility are based, on the one hand, on improving the results of oncological treatment, on the other hand, on the development of reproductive technologies. Thanks to progress in treatment, up to 80% of pediatric oncology patients survive into adulthood, but chemotherapy, especially highly effective alkylating agents, is associated with a high risk of impaired fertility. This article overviewed9 modern global trends of fertility preservation in women undergoing cancer treatment based on an analysis of the English-language literature over the past 5 years.

Keywords:

oncofertility – fertility preservation – oocyte cryopreservation – embryo cryopreservation – ovarian tissue cryopreservation – oocyte in vitro maturation – gonadotropin-releasing hormone agonists


Sources

1. Oktay K, Harvey BE, Partridge et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 2018; 36 (19): 1994–2001. doi: 10.1200/JCO.2018.78.1914.

2. Poorvu PD, Frazier AL, Feraco AM et al. Cancer treatment-related infertility: a critical review of the evidence. JNCI Cancer Spectr 2019; 3 (1): pkz008. doi: 10.1093/jncics/pkz008.

3. Chemaitilly W, Li Z, Krasin MJ et al. Premature ovarian insufficiency in childhood cancer survivors: a report from the St. Jude lifetime cohort. J Clin Endocrinol Metab 2017; 102 (7): 2242–2250. doi: 10.1210/jc.2016-3723.

4. Velez MP, Richardson H, Baxter NN et al. Risk of infertility in female adolescents and young adults with cancer: a population-based cohort study. Hum Reprod 2021; 36 (7): 1981–1988. doi: 10.1093/humrep/deab036.

5. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (3): 209–249. doi: 10.3322/caac.21660.

6. Krejčí D, Pehalová L, Talábová A et al. Současné epidemiologické trendy novotvarů v České republice. Ústav zdravotnických informací a statistiky ČR. 2021 [online]. Dostupné z: https: //www.uzis.cz/res/f/008352/novotvary2018.pdf.

7. Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30 (11): 1760–1775. doi: 10.1093/annonc/mdz284.

8. Michalczyk K, Cymbaluk-Płoska A. Fertility preservation and long-term monitoring of gona­dotoxicity in firls, adolescents and young adults undergoing cancer treatment. Cancers (Basel) 2021; 13 (2): 202. doi: 10.3390/cancers13020202.

9. European Society of Human Reproduction and Embryology. Female Fertility Preservation Guideline of the European Society of Human Reproduction and Embryology 2020 ESHRE Female Fertility Preservation Guideline Development Group. 2022 [online]. Available from: https: //www.eshre.eu/Guidelines-and-Legal/Guidelines/Female-fertility-preservation.

10. Cavagna F, Pontes A, Cavagna M et al. Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients. Curr Oncol 2018; 5 (6): e527–e532. doi: 10.3747/co.25.3889.

11. Vaiarelli A, Cimadomo D, Trabucco E et al. Double stimulation in the same ovarian cycle (DuoStim) to maximize the number of oocytes retrieved from poor prognosis patients: a multicenter experience and SWOT analysis. Front Endocrinol (Lausanne) 2018; 9: 317. doi: 10.3389/fendo.2018.00317.

12. Shim YJ, Seol A, Lee D et al. The serum estradiol/oocyte ratio in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins. Obstet Gynecol Sci 2018; 61 (2): 242–246. doi: 10.5468/ogs.2018.61.2.242.

13. Marklund A, Eloranta S, Wikander I et al. Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer-a prospective nationwide Swedish multicenter study. Hum Reprod 2020; 35 (4): 929–938. doi: 10.1093/humrep/deaa029.

14. Rodgers RJ, Reid GD, Koch J et al. The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer: a systematic review. Hum Reprod 2017; 32 (5): 1033–1045. doi: 10.1093/humrep/dex027.

15. Letourneau J, Juarez-Hernandez F, Wald K et al. Concomitant tamoxifen or letrozole for optimal oocyte yield during fertility preservation for breast cancer: the TAmoxifen or Letrozole in Estrogen Sensitive tumors (TALES) randomized clinical trial. J Assist Reprod Genet 2021; 38 (9): 2455–2463. doi: 10.1007/s10815-021-02273-3.

16. Ben-Haroush A, Wertheimer A, Klochendler E et al. Effect of letrozole added to gonadotropins in controlled ovarian stimulation protocols on the yield and maturity of retrieved oocytes. Gynecol Endocrinol 2019; 35 (4): 324–327. doi: 10.1080/09513590.2018.1534950.

17. Turan V, Bedoschi G, Emirdar V et al. Ovarian stimulation in patients with cancer: impact of letrozole and BRCA mutations on fertility preservation cycle outcomes. Reprod Sci 2018; 25 (1): 26–32. doi: 10.1177/1933719117728800.

18. Pereira N, Hancock K, Cordeiro CN et al. Comparison of ovarian stimulation response in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins to patients undergoing ovarian stimulation with gonadotropins alone for elective cryopreservation of oocytes†. Gynecol Endocrinol 2016; 32 (10): 823–826. doi: 10.1080/09513 590.2016.1177013.

19. Checa Vizcaíno MA, Corchado AR, Cuadri ME. The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women. Reprod Biomed Online 2012; 24 (6): 606–610. doi: 10.1016/j.rbmo.2012.02.020.

20. Halsázová N, Crha I, Huser M et al. Zachování fertility u žen s karcinomem prsu před gona­dotoxickou léčbou. Ceska Gynekol 2017; 82 (4): 287–292.

21. Oktay K, Türkçüoğlu I, Rodriguez-Wallberg KA. GnRH agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation. Reprod Biomed Online 2010; 20 (6): 783–788. doi: 10.1016/j.rbmo.2010.03.004.

22. Goldrat O, Gervy C, Englert Y et al. Progesterone levels in letrozole associated controlled ovarian stimulation for fertility preservation in breast cancer patients. Hum Reprod 2015; 30 (9): 2184–2189. doi: 10.1093/humrep/dev155.

23. Bastings L, Beerendonk CC, Westphal JR et al. Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review. Hum Reprod Update 2013; 19 (5): 483–506. doi: 10.1093/humupd/dmt020.

24. Gellert SE, Pors SE, Kristensen SG et al. Transplantation of frozen-thawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish cohort. J Assist Reprod Genet 2018; 99 (2): 561–570. doi: 10.1007/s10815-018-1144-2.

25. Mardešić T, Jelínková L, Melicharová L. Úspěšná transplantace ovariální tkáně u pacientky s ovariálním selháním po onkologické léčbě. Ceska Gynekol 2017; 82 (1): 38–41.

26. Hoekman EJ, Louwe LA, Rooijers M et al. Ovarian tissue cryopreservation: low usage rates and high live-birth rate after transplantation. Acta Obstet Gynecol Scand 2020; 99 (2): 213–221. doi: 10.1111/aogs.13735.

27. Poirot C, Brugieres L, Yakouben K et al. Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center. Acta Obstet Gynecol Scand 2019; 98 (5): 630–637. doi: 10.1111/aogs.13616.

28. Siristatidis CS, Maheshwari A, Vaidakis D et al. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. Cochrane Database Syst Rev 2018; 11 (11): CD006606. doi: 10.1002/14651858.CD006606.pub4.

29. Galvão A, Segers I, Smitz J et al. In vitro maturation (IVM) of oocytes in patients with resis­tant ovary syndrome and in patients with repeated deficient oocyte maturation. J Assist Reprod Genet 2018; 35 (12): 2161–2171. doi: 10.1007/s10815-018-1317-z.

30. De Vos M. In vitro maturation of oocytes in connection with ovarian tissue cryopreservation. Hum Reprod 2021; 36. doi: 10.1093/humrep/ deab127.046.

31. De Vos M, Grynberg M, Ho TM et al. Perspectives on the development and future of oocyte IVM in clinical practice. J Assist Reprod Genet 2021; 38 (6): 1264–1280. doi: 10.1007/s10815-021-02263-5.

32. Brown HM, Dunning KR, Sutton-McDowall M et al. Failure to launch: aberrant cumulus gene expression during oocyte in vitro maturation. Reproduction 2017; 153 (3): R109–R120. doi: 10.1530/REP-16-0426.

33. Practice Committees of the American Society for Reproductive Medicine, the Society of Reproductive Biologists and Technologists, and the Society for Assisted Reproductive Technology. In vitro maturation: a committee opinion. Fertil Steril 2021; 115 (2): 298–304. doi: 10.1016/j.fertnstert.2020.11.018.

34. Telfer EE, Andersen CY. In vitro growth and maturation of primordial follicles and immature oocytes. Fertil Steril 2021; 115 (5): 1116–1125. doi: 10.1016/j.fertnstert.2021.03.004.

35. Lambertini M, Horicks F, Del Mastro L. Ovarian protection with gonadotropin-releasing hormone agonists during chemotherapy in cancer patients: from bio­logical evidence to clinical application. Cancer Treat Rev 2019; 72: 65–77. doi: 10.1016/j.ctrv.2018.11.006.

36. Dolmans MM, Taylor HS, Rodriguez-Wallberg KA et al. Utility of gonadotropin-releasing hormone agonists for fertility preservation in women receiving chemotherapy: pros and cons. Fertil Steril 2020; 114 (4): 725–738. doi: 10.1016/ j.fertnstert.2020.08.011.

37. Abdel-Razeq H. Gonadotropin-releasing hormone agonists during chemotherapy for ovarian function and fertility preservation for patients with early-stage breast cancer. Cancer Manag Res 2019; 11: 4273–4282. doi: 10.2147/CMAR.S204069.

38. Scaruffi P, Stigliani S, Cardinali B et al. Gonadotropin releasing hormone agonists have an anti-apoptotic effect on cumulus cells. Int J Mol Sci 2019; 20 (23): 6045. doi: 10.3390/ijms20236 045.

39. Lambertini M, Ceppi M, Poggio F et al. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: a meta-analysis of randomized studies. Ann Oncol 2015; 26 (12): 2408–2419. doi: 10.1093/annonc/mdv 374.

40. Moore HC, Unger JM, Phillips KA et al. Final analysis of the prevention of early menopause study (POEMS) /SWOG Intergroup S0230. J Natl Cancer Inst 2019; 111 (2): 210–213. doi: 10.1093/jnci/djy185.

41. Valsamakis G, Valtetsiotis K, Charmandari E et al. GnRH analogues as a co-treatment to therapy in women of reproductive age with cancer and fertility preservation. Int J Mol Sci 2022; 23 (4): 2287. doi: 10.3390/ijms23042287.

42. Elgindy E, Sibai H, Abdelghani A et al. Protecting ovaries during chemotherapy through gonad suppression: a systematic review and meta-analysis. Obstet Gynecol 2015; 126 (1): 187–195. doi: 10.1097/AOG.0000000000000 905.

43. Demeestere I, Brice P, Peccatori FA et al. Gonadotropin-releasing hormone agonist for the prevention of chemotherapy-induced ovarian failure in patients with lymphoma: 1-year follow-up of a prospective randomized trial. J Clin Oncol 2013; 31 (7): 903–909. doi: 10.1200/JCO.2012.42.8185.

44. Rodriguez-Wallberg K, Turan V, Munster P et al. Can ovarian suppression with gonadotropin releasing hormone analogs (GnRHa) preserve fertility in cancer patients? Ann Onco 2016; 27 (2): 357. doi: 10.1093/annonc/mdv 554.

45. Hoekman EJ, Broeders EA, Louwe LA et al. Ovarian function after ovarian transposition and additional pelvic radiotherapy: a systematic review. Eur J Surg Oncol 2019; 45 (8): 1328–1340. doi: 10.1016/j.ejso.2019.02.017.

46. Jung W, Kim YH, Kim KS. Ovarian function preservation in patients with cervical cancer undergoing hysterectomy and ovarian transposition before pelvic radiotherapy. Technol Cancer Res Treat 2021; 20: 15330338211042140. doi: 10.1177/15330338211042140.

47. van der Kooi AL, Kelsey TW, van den Heuvel-Eibrink MM et al. Perinatal complications in female survivors of cancer: a systematic review and meta-analysis. Eur J Cancer 2019; 111: 126–137. doi: 10.1016/j.ejca.2019.01.104.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 5

2022 Issue 5

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account