Fertility preservation

Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer affects reproductive health and preservation options are growing, sparked in part by the increase in the survival rate of cancer patients.

Fertility preservation procedures are indicated when it's predicted that there will be exposure to a cause of infertility, mainly cancer treatment.

Chemotherapy and radiation treatments for cancer and other serious illnesses can affect reproductive health. The regimens that threaten ovarian and testicular function are mainly radiation therapy to the pelvic area and some types of chemotherapy. Chemotherapies with high risk include procarbazine and alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine. Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin. On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycinand dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluoruracil.

These regimens attack rapidly dividing cells in the body, including healthy cells like sperm and those belonging to the ovarian follicle (egg). Depending on the dose and duration of administration, these therapies can have varying effects on reproductive health. Surgery involving reproductive tissue affects reproductive function and fertility.

For many cancer patients, the decrease or loss of reproductive function is temporary; many men and women, however, do not regain fertility after cancer treatment. Patients undergoing serious radiation, chemotherapy, or surgery sometimes experience symptoms resembling menopause (in women) or andropause (in men), which indicate reproductive damage. In women, decreased estrogen levels as a result of ovarian deficiency lead to weakened bone, changes in temperature control, altered mood, and decreased sexual desire. Men with testicular insufficiency also experience similar symptoms.

A study indicated that fewer oocytes are recovered from cancer patients wanting to perform embryo preservation when compared with an age-matched control group, but the mean number of zygotes generated appears to be similar. The same study found that, of 65 patients referred to the program, 28% declined to undergo embryo, oocyte, or tissue cryopreservation. 9% were found not to be eligible for medical reasons. Of the remaining 41 patients, 85% chose to cryopreserve embryos, 10% chose to cryopreserve oocytes, and 5% chose to undergo ovarian tissue freezing. No serious clinical sequelae resulted from participation.

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