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70 - Fertility Preservation in Female and Male Cancer Patients

from PART IV - ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION

Published online by Cambridge University Press:  04 August 2010

By
Mohamed A. Bedaiwy  and
Tommaso Falcone
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Female cancer patients between the ages of fifteen and forty-nine years are expected to not only survive their disease but also lead normal lives, mainly because of newer, more effective cancer therapies such as sterilizing chemotherapy and/or radiotherapy. Consequently, fertility preservation has become an important quality-of-life issue. Problems with fertility and obstetric disorders such as early pregnancy loss, premature labor, and low birth weight have all been described after cancer treatment (1).

Recent achievements in assisted reproductive technologies such as novel ovulation induction remedies, oocyte cryopreservation, and ovarian tissue cryopreservation and transplantation have further expanded the options for fertility preservation in women scheduled to receive chemotherapy and/or radiotherapy. However, most of the potential fertility preservation strategies do not have long-term follow-up data. The latest committee report of the American Society of Reproductive Medicine (ASRM) states that embryo cryopreservation is the only option for these patients with sufficient evidence of clinical utility. The remaining options, including orthotopic transplantation of cryopreserved ovarian tissue, are either experimental or without enough evidence to be proposed to patients at this stage.

We will review the recent evidence on the pathophysiology of chemotherapy/radiotherapy-induced gonadal toxicity and the recent data on the indications and the outcomes of techniques used for fertility preservation in female cancer patients.

BASIC OOCYTE BIOLOGY

In humans, primordial germ cells arrive in the gonadal ridge from the yolk sac endoderm by the seventh week of gestation. These germ cells become oogonia, which proliferate by mitosis before differentiating into primary oocytes.

Keywords

assisted reproductive technologieschemoprotectionchemotherapy-induced premature ovarian failurefertility preservationradiotherapy-induced premature ovarian failuresemen cryopreservationtesticular shieldingovariopexytesticular tissue cryopreservation
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 706 - 716
Publisher: Cambridge University Press
Print publication year: 2008

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