From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY and Institute for Fertility Preservation, Center for Human Reproduction, New York, NY
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Kutluk Oktay, MD, FACOG, Institute for Fertility Preservation, 21 E 69th Street, New York, NY 10021; e-mail: koktay{at}fertilitypreservation.org
Overview: Fertility preservation is a growing priority for young cancer survivors. Exposure to drugs and radiation can result in irreversible damage to fertility. The damage may not be limited to the ovarian function and, in the case of pelvic surgery or radiation, may affect a woman's ability to carry a pregnancy. Fertility preservation techniques are largely experimental; nevertheless, progress has been made within the past decade. The only established method of fertility preservation is embryo cryopreservation, but this option may not be possible for children or single women. Oocyte cryopreservation is an option for single women, although it has lower success rates compared with embryo freezing; however, the success rates are rising. Both embryo and oocyte freezing require ovarian stimulation for approximately 2 weeks from the onset of menstrual period, which may result in a delay in chemotherapy administration as well as exposure to high estrogen levels. In the case of estrogen-sensitive cancer, aromatase inhibitors are used concurrently with fertility drugs to reduce the estrogen exposure during fertility treatments. For prepubescent children as well as when there is insufficient time to undergo ovarian stimulation, ovarian tissue cryopreservation and transplantation can be the only experimental strategy. There is no pharmacologic method to preserve fertility, and benefit of ovarian suppression is unproven. However, because more established methods such as embryo and egg freezing require longer time to complete, it is vital that patients with cancer interested in fertility preservation are immediately referred to experts.
