Fertility Preservation for Young Women with Rectal Cancer—A Combined Approach from One Referral Center
ABSTRACT BackgroundUp to 6% of women with colorectal cancer are diagnosed in the reproductive age and are at risk for premature ovarian failure
and infertility due to pelvic irradiation and chemotherapy.
Study DesignBetween 1997 and 2007, six women with rectal carcinoma were referred to the McGill Reproductive Center (Montreal, Canada)
for fertility preservation. Following resection of their primary tumor, they were scheduled to undergo pelvic irradiation.
ResultsFive patients underwent laparoscopic ovarian lateral transposition before radiotherapy in order to relocate their ovaries
outside the radiation field. A concomitant ovarian wedge resection was performed for ovarian cryopreservation. In two of these
women, before dissecting the ovarian cortical tissue for cryopreservation, all visible follicles were aspirated. The sixth
patient who had had low anterior resection underwent hormonal ovarian stimulation followed by oocyte retrieval and embryo
ConclusionsFertility preservation in women with rectal cancer is feasible. This includes laparoscopic ovarian transposition and cryopreservation
of ovarian tissue, embryo, or oocyte.
- SourceAvailable from: Robert E Brannigan[Show abstract] [Hide abstract]
ABSTRACT: As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may 1 day want to have children. Yet, gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients' wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, using case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer.Cancer 01/2011; 117(1):4-10. · 5.20 Impact Factor
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ABSTRACT: Background. Advances in the diagnosis and treatment of malignancies in girls and young women had significantly increased survival rates, but due to surgical removal of ovaries, potentially sterilizing radiotherapy or chemotherapy, is often the result of this treatment premature ovarian failure, infertility and premature menopause. The degree of ovarian damage depends on gonadotoxicity of chemotherapeutic agent and radiation dose, while surgical removal of ovaries results in definitive loss of ovarian function. Recently, with the purpose of fertility preservation, on one side, less radical surgical procedures in early stages of cancer are performed and on the other side, advanc in laboratory techniques in in vitro fertilization, enables cryopreservation of own genetic material Conclusions. While cryopreservation of embryos and oocytes is already established and successful procedure, ovarian transplantation remains, despite reports of livebirths following the transplantation, still at experimental stage. The indication for fertility preservation should take into account type of cancer, prognosis of the disease, age (≤38 let), planned therapy, such as type of surgical procedure, gonadotoxicity of chemotherapeutic agens and irradiation dose, therefore cooperation of oncologists, reproductive gynecologists and embryologists is mandatory, because each indication must be carefully taken into consideration.Zdravniški vestnik 10/2011; 80:762-70. · 0.17 Impact Factor
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ABSTRACT: Fertility preservation (FP) was developed with the explicit purpose of helping young women and men overcome complications of infertility associated with cancer-related treatments. Currently, no databases in the USA follow cancer or noncancer patients who undergo FP. Hence, the number and demographics of women and men who seek these services, as well as the efficacy, benefits, risks, success rates and quality of care of FP are unknown. Two feasibility studies on young women seeking FP in southern California are discussed. In addition, barriers, funding, a needs assessment, and approaches to establishing and evaluating a database are presented. A FP database would provide oncologists, reproductive endocrinologists and other medical specialists with an invaluable resource for evidence-based decisions; a foundation of knowledge that could alleviate patients’ fears so that they can make informed decisions; public health surveillance; and research opportunities.Expert Review of Obstetrics & Gynecology 01/2014; 7(3).