I am starting cancer treatment, but want to have a baby in the future. Can my fertility be preserved?
Each year, about 10,000 reproductive-aged women are diagnosed with cancer in Australia. Many of them will require chemotherapy. A good proportion of these women will also desire fertility upon completing cancer treatment. Most chemotherapeutic agents destroy follicles and lead to a significant reduction in ovarian reserve.
Those facing chemotherapy have multiple options to preserve fertility and hormone secretion. Assisted reproduction through embryo or oocyte vitrification may enable them to achieve a pregnancy using their own eggs (gametes). Egg donation also allows them to start a family, though not with their own eggs. Ovarian tissue freezing could provide them with a larger follicle pool upon successful transplantation and could restore the normal hormonal background. Medical or financial constraints, however, may prevent some women from using these options.
The use of medications such as gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy could reduce the effect of chemotherapy on ovarian reserve. 12 out of 14 meta-analyses done on this issue supported the use of GnRHa for prevention of premature ovarian failure. Of the nine evaluating pregnancy rates, however, only two favored its use.
Based on their findings, we support the use of GnRHa for ovarian function preservation in women undergoing chemotherapy.
The maintenance of ovarian function in reproductive-aged women is important for reproductive as well as hormonal reasons. Hypogonadism resulting from chemotherapy-induced ovarian damage affects bone, cardiovascular, and mental health and long-term quality of life.
Assisted reproductive technology may offer solutions for fertility preservation, but the effect is limited by the number of eggs or embryos freezed, and it is expensive. Experience is limited with ovarian cortex or whole ovary transplantation. Ideally, the loss of follicles should be prevented. The impact of chemotherapy depends on the patient's age, the agent used, duration of exposure, and baseline ovarian reserve.
GnRHa was proposed to reduce the toxic ovarian effects by inducing a hypogonadotropic (suppressed) stage. Inactive follicles are more resistant to damage. GnRHa reduces the ovarian blood flow and lowers the amount of drugs reaching the follicles. Reports have been controversial; but, according to recent reviews, most meta-analyses support a benefit for ovarian function preservation.
Original article published on 2 Dec 2016 on medscape.com