Techniques for fertility preservation in patients with breast cancer.
ABSTRACT To outline the risks of infertility from breast cancer treatment, and to illustrate current techniques in preserving fertility in breast-cancer patients who wish to become pregnant after treatment is concluded.
Breast cancer often affects women of reproductive age. Although treatment is effective, cytotoxic chemotherapy causes ovarian reserve depletion, whereas hormonal therapy necessitates a delay in pregnancy, resulting in infertility. Patients of reproductive age should be referred to fertility specialists to explore methods of fertility preservation upon diagnosis. The best established method of fertility preservation is embryo cryopreservation, although investigational techniques such as, oocyte and ovarian tissue cryopreservation, may hold potential. Embryo cryopreservation involves ovarian stimulation to retrieve oocytes in-vitro fertilization prior to freezing. Techniques for the cryopreservation of unfertilized oocytes are under investigation. Successful pregnancies have resulted in breast cancer patients after treatment, without obvious compromise in their risk of recurrence or death from breast cancer.
Ovarian stimulation with retrieval of ooctyes for in-vitro fertilization remains the best known option for fertility preservation in women with early stage breast cancer whose risk of fertility may be compromised by adjuvant chemotherapy.
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ABSTRACT: Gonadal function was assessed in 89 patients after chemotherapy for Hodgkin's disease (HD). Thirty-seven patients had received mechlorethamine, vinblastine, prednisolone, and procarbazine (MVPP) and 52 patients, a hybrid combination of chlorambucil, vinblastine, prednisolone, procarbazine, doxorubicin, vincristine, and etoposide (ChIVPP/EVA). Fifty men (MVPP, n = 21; ChIVPP/EVA, n = 29) with a median age of 26 years (range, 16 to 54) and 39 women (MVPP, n = 16; ChIVPP/EVA, n = 23) with a median age of 30 years (range, 15 to 47) were studied at a median of 30 months (range, 4 to 83) following chemotherapy. Semen analysis showed azoospermia in 35 of 37 men, and increased serum follicle-stimulating hormone (FSH) levels in this group confirmed severe germinal epithelial damage. Analysis of pretreatment semen in 28 men showed azoospermia in one, oligospermia in four (sperm count < 20 x 10(6)/mL), and a normal sperm count in the remaining 23. In the women, 26 of 34 (76%) with a regular menstrual cycle before commencing chemotherapy became amenorrheic following treatment. Menses returned in 10 women, who had a median age of 25 years (range, 21 to 34), and there were two pregnancies in this group. In the other 16, with a median age of 36 years (range, 27 to 47), amenorrhea persisted and premature ovarian failure was confirmed by increased serum gonadotrophins and reduced estradiol (E2) concentrations. Of the original eight women in whom menses were maintained following treatment, two subsequently developed amenorrhea and the clinical and biochemical features of an early menopause. In total, 18 of 34 women (53%) required hormone replacement therapy for chemotherapy-induced ovarian failure. There was no statistically significant difference in the frequency or severity of gonadal dysfunction between MVPP- and ChIVPP/EVA-treated patients. We conclude that both of these chemotherapy schedules cause substantial damage to gonadal function in both sexes.Journal of Clinical Oncology 01/1995; 13(1):134-9. · 18.04 Impact Factor
- New England Journal of Medicine 07/2000; 342(25):1919. · 51.66 Impact Factor
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ABSTRACT: To correlate ovarian pathology findings with the indications for surgery, age, initial breast cancer stage, prior therapy for breast cancer, and current status of disease. We reviewed the charts of women with breast cancer who underwent oophorectomy at a single institution during the period 1987-1993. Two hundred thirty women were identified. The indications for oophorectomy were divided into three groups: 1) incidental, with no ovarian symptoms; 2) therapeutic oophorectomy for treatment of metastatic breast cancer; and 3) patients with adnexal or pelvic mass. Ovarian pathology was classified as benign, metastasis from breast primary, or primary ovarian or tubal malignancy. Eighty-nine women underwent oophorectomy incidental to pelvic surgery; one patient had metastatic breast cancer present in the ovaries and three patients had a clinically unsuspected ovarian or tubal primary cancer. Twenty patients had bilateral oophorectomy as therapy for metastatic breast cancer, and five of 20 (25%) had metastatic breast cancer to the ovaries. One hundred twenty-one women with a preoperative diagnosis of adnexal or pelvic mass underwent oophorectomy (unilateral or bilateral). Sixty-one (50%) had a benign process. Sixty patients were found to have a malignant neoplasm, including 44 new ovarian or tubal primary cancers and 16 with metastatic mammary cancer. Patients who present with new findings of an adnexal or pelvic mass are more likely to have a new ovarian or tubal malignancy than metastatic breast cancer, by a ratio of 3:1. These patients require complete evaluation; one should not assume that the adnexal or pelvic mass represents metastatic disease from the breast primary cancer.Obstetrics and Gynecology 10/1994; 84(3):449-52. · 4.80 Impact Factor