Preservation of Fertility in the Cancer Patient
Posted 3/17/2005 Tommaso Falcone , MD Treatment of malignancies in young women has improved significantly to the extent that patients are increasingly consulting physicians before undergoing cancer treatment to discuss what can be done to preserve their fertility. Proper counseling of these patients requires a detailed knowledge of the impact of the specific chemotherapeutic agent or radiotherapy dose on fertility. Some agents may have little or no impact and, therefore, no specific intervention is required other than counseling. Others, such as alkylating agents, have a profound effect. Several options are available to a young woman who is at high risk for damage to her ovaries by cancer treatment. The most commonly used drug for preservation of fertility in the cancer patient is a gonadotropin-releasing hormone agonist (GnRHa). The concept is to induce hypogonadism before starting chemotherapy, although the efficacy of the therapy is controversial. GnRHa is not used for protection from radiotherapy-induced damage but may be useful if chemotherapy is used with the radiotherapy, which is often the case. The other forms of treatment to preserve fertility require assisted reproductive technologies, such as oocyte or embryo freezing. These procedures require some time to stimulate the ovary to produce oocytes. This time may not be available. If there is no partner, oocytes can be cryopreserved, although the results are not as good as those achieved with embryo cryopreservation. Another option is to remove ovarian tissue, cryopreserve it, and then transplant it back into the patient when the therapy is complete and the patient is ready to have children. However, only 1 patient has had a successful pregnancy with this procedure, and it is still considered experimental. One of the oldest methods of preserving fertility is ovarian transposition, the subject of the case report by Farber and colleagues. It has been reported for decades with mixed results. The advantage of laparoscopic access is that it allows a quick recovery that permits initiation of radiotherapy sooner than laparotomy. The technique described by Farber and colleagues is that of transposition to the paracolic gutters, which has been previously achieved with laparotomy. Fortunately, the 5-fluorouracil used in this case does not carry a high risk of gonadal toxicity. The patient's menstrual cycle resumed normally with luteal phase progesterone compatible with ovulation. The proper time to measure FSH and estradiol to assess ovarian reserve is in the early part of the cycle, usually Day 3, and not in the luteal phase. Although the patient did not attempt pregnancy in this case, successful pregnancies have been reported with laparotomy and laparoscopy. The report by Farber and colleagues highlights one option among several that are available to women with malignancies who are seeking to preserve their fertility. Related Links Clinical Articles http://www.medscape.com/viewarticle/499240?src=mp ------------------------ Yahoo! Groups Sponsor --------------------~--> Dying to be thin? Anorexia. Narrated by Julianne Moore . http://us.click.yahoo.com/7visLB/gsnJAA/xGEGAA/8zSolB/TM --------------------------------------------------------------------~-> New! Sign up for local CML support group meetings in your local community at http://cml.meetup.com Apply for Commercial Real Estate loans online and submit your deal to dozens of hungry lenders in just minutes. Loan programs for all types of business and commercial real estate. Apply anytime at http://realestatezoo.com CML (Chronic Myelogenous Leukemia Support List) --------------------------------- Part Of CMLHope.Com An International Community Of CML Patients For more information: http://cmlhope.com Post Message: [email protected] Subscribe: [EMAIL PROTECTED] Unsubscribe: [EMAIL PROTECTED] Change To No Mail/Web: [EMAIL PROTECTED] Change To Digest: [EMAIL PROTECTED] Change To Email: [EMAIL PROTECTED] List Help: [EMAIL PROTECTED] CML Group Web Site http://groups.yahoo.com/group/CML Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/CML/ <*> To unsubscribe from this group, send an email to: [EMAIL PROTECTED] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
