Fertility preservation in female cancer patients: an emerging challenge for physicians

Abstract

Fertility preservation has become an issue of great importance in female cancer patients due
 to increasing survival rates and delayed childbearing. It is an emerging challenge for
 physicians, cause of several related issues (multidisciplinary approach, doctor-patient
 communication, ethical, religious and legal problems) and many unresolved questions.
 This review aims to update the latest literature data, summarizing the effects of cancer
 treatments on female fertility and the various options currently available to offer cancer
 patients the opportunity of future pregnancies.
 Many strategies exist for fertility preservation in young women and they should be assessed
 according to the patient’s age, type of cancer, partner status and time available. Some
 techniques are well established, others are still experimental. The established methods include
 embryo cryopreservation, transposition of ovaries prior to radiation therapy, radiation
 shielding of gonads and conservative surgical approaches. The experimental methods include
 oocyte cryopreservation, in vitro maturation of oocytes, ovarian tissue cryopreservation and
 transplantation, and ovarian suppression. Improvement of these techniques as well as better
 characterization of their success rates and risks, await further investigation. Oocytes donation
 and gestational surrogacy represent the last options.
 Thus, the care of these patients is challenging, complex and requires a multidisciplinary
 approach. A close collaboration between Oncologists, Specialists in Reproductive Medicine,
 Gynecologic Oncologists and Endocrinologists is crucial for always offering the best possible
 option.