Fertility preservation for young patients with cancer: Who is at risk and what can be offered?

Department of Child Life and Health, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
The Lancet Oncology (Impact Factor: 24.73). 05/2005; 6(4):209-18. DOI: 10.1016/S1470-2045(05)70092-9
Source: PubMed

ABSTRACT Estimates suggest that by 2010, one in 715 people in the UK will have survived cancer during childhood. With increasing numbers of children cured, attention has focused on their quality of life. We discuss the causes of impaired fertility after cancer treatment in young people, and outline which patients are at risk and how their gonadal function should be assessed. With the report of a livebirth after orthotopic transplantation of cryopreserved ovarian tissue and the continued development of intracytoplasmic sperm injection for men with poor sperm quality, we assess established and experimental strategies to protect or restore fertility, and discuss the ethical and legal issues that arise.

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Available from: Richard A Anderson, Feb 10, 2014
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    • "The function of different tissues and organs may be differently impaired by aggressive therapy. Gonads are particularly exposed to the deteriorating effects of certain chemotherapeutics and radiotherapy; on the other hand, when survivors reach adulthood, they wish to have their own biological children [1] [2] [3]. Fertility after anticancer therapy is a very important problem known by oncologists and endocrinologists as well as by cancer survivors themselves. "
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    ABSTRACT: We evaluated ovarian function by measuring the levels of anti-Müllerian hormone (AMH), estradiol, and gonadotropins in 83 young women treated for cancer during childhood and adolescence, and classified according to post-treatment gonadal toxicity versus 38 healthy females. Results. The mean AMH values were lower in the entire cohort independently of the risk group as compared to the control, whereas FSH was elevated only in the high risk group. The lowest AMH values were noted in patients after bone marrow transplantation (BMT) and those treated for Hodgkin lymphoma (HL). Nineteen patients (22.9%) had elevated FSH. They all had low AMH values. Lowered AMH values (but with normal FSH and LH) were observed in 43 patients (51.8%). There was no effect of age at the time of treatment (before puberty, during or after puberty) on AMH levels. Conclusion. Our results show the utility of AMH measurement as a sensitive marker of a reduced ovarian reserve in young cancer survivors. Patients after BMT and patients treated for HL, independently of age at treatment (prepuberty or puberty), are at the highest risk of gonadal damage and early menopause.
    International Journal of Endocrinology 12/2013; 2013:125080. DOI:10.1155/2013/125080 · 1.52 Impact Factor
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    • "There is a dearth of information on the efficacy of SSC transplantation in chemotherapy-treated large animals, probably due to the significant challenges associated with clinical management of animals treated systemically with highdose chemotherapies that cause severe hematopoietic deficits (Hermann et al., 2007). However, the importance of this experimental paradigm should not be overlooked because high-dose alkylating chemotherapies are used routinely for conditioning prior to hematopoietic stem cell (HSC) transplantation and are associated with high risk of infertility (Wallace et al., 2005; Lee et al., 2006; Mitchell et al., 2009; Green et al., 2010). The first large animal SSC transplants were performed in monkeys by Schlatt and colleagues (see Table S1), who described autologous transplants into irradiated monkey recipients in 2002 and again in 2011 (Schlatt et al., 2002; Jahnukainen et al., 2011). "
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    ABSTRACT: Spermatogonial stem cells (SSCs) maintain spermatogenesis throughout a man's life and may have application for treating some cases of male infertility, including those caused by chemotherapy before puberty. We performed autologous and allogeneic SSC transplantations into the testes of 18 adult and 5 prepubertal recipient macaques that were rendered infertile with alkylating chemotherapy. After autologous transplant, the donor genotype from lentivirus-marked SSCs was evident in the ejaculated sperm of 9/12 adult and 3/5 prepubertal recipients after they reached maturity. Allogeneic transplant led to donor-recipient chimerism in sperm from 2/6 adult recipients. Ejaculated sperm from one recipient transplanted with allogeneic donor SSCs were injected into 85 rhesus oocytes via intracytoplasmic sperm injection. Eighty-one oocytes were fertilized, producing embryos ranging from four-cell to blastocyst with donor paternal origin confirmed in 7/81 embryos. This demonstration of functional donor spermatogenesis following SSC transplantation in primates is an important milestone for informed clinical translation.
    Cell stem cell 11/2012; 11(5):715-26. DOI:10.1016/j.stem.2012.07.017 · 22.15 Impact Factor
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    • "However, the uterus of the patient did not grow to adult size, perhaps because the pelvis had received high doses of irradiation. It is well known that pelvic radiotherapy decreases uterine blood flow and reduces uterine volume and endometrial thickness [3] [4] [19]. "
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    ABSTRACT: Cancer treatments improve the survival rate of children and adolescents; however chemo- and radiotherapy result in gonadal damage leading to acute ovarian failure and sterility. Ovarian tissue cryopreservation allows long-term storage of primordial follicles and represents the only possibility of preserving the potential fertility in prepubertal girls. The aim of the present study is to describe our experience in ovarian tissue cryopreservation in 45 pediatric patients. The number of follicles per square millimeter of the overall section area and follicle quality were evaluated histologically. A strong negative correlation was found between age and follicular density in patients both prior to and after chemotherapy (P < 0.0001). Damage in follicular quality, that is, increased oocyte vacuolization and detachment of the oocyte from granulosa cells, was found after chemotherapy. Ovarian tissue cryopreservation, preferably performed before initiation of chemotherapy, should be offered to pediatric patients, including prepubertal girls, at risk of sterility.
    Obstetrics and Gynecology International 02/2012; 2012:910698. DOI:10.1155/2012/910698
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