Advances in Fertility Preservation for Young Women With Cancer

Each year, over 30,000 women of reproductive age are diagnosed with cancer in the United States. Common cancers in young women include breast cancer, hematologic malignancies, gynecologic malignancies, sarcomas, brain tumors, and colorectal cancer.1 Given the current trend toward delayed childbearing in Western countries, many young women with cancer have not yet completed their families at the time of diagnosis.2,3 Unfortunately, young women with cancer often require treatment that can compromise future fertility. Chemotherapy is toxic to the ovaries and can result in loss of primordial follicle reserve and premature ovarian failure.4,5 The degree of gonadotoxicity associated with each chemotherapy regimen varies according to the drug class(es), duration/dose of chemotherapy, and patient age. DNA damage induced by alkylating agents results in primordial cell death in the ovary, leading to a particularly high risk of subsequent infertility. Chemotherapy accelerates the natural age-related decline in follicle reserve, thus the likelihood of treatment-related infertility is greater in women who receive chemotherapy later in their reproductive years.5 In the case of hormone receptor–positive breast cancer, additional risk of infertility beyond that induced by chemotherapy occurs due to the need to delay conception during the course of 5 to 10 years of adjuvant endocrine therapy.6,7 Additionally, in some situations, future fertility may be impacted by the direct effects on the reproductive organs of radiation and/or surgery in the abdomen or pelvis, although fertility-sparing procedures can be considered if appropriate.8-10 The impact of newer targeted therapies on female fertility is not well defined. Data suggest that trastuzumab does not increase the risk of infertility in female patients with breast cancer, and pregnancies have been reported in patients treated with imatinib; however, conception should be avoided during the course of targeted therapies.11,12 With recent improvements in cancer survival rates, long-term effects of cancer treatment, such as infertility, have become important clinical issues.1 The majority of young female cancer survivors report reproductive concerns and many desire children.13-17 To date, available data indicate that pregnancy after cancer treatment does not increase the risk of cancer recurrence, even in women with a history of hormone receptor–positive breast cancer.18,19 Yet, female cancer survivors achieve pregnancy at lower rates than unaffected women in the general population.20 Recent advances in reproductive health