DOCSLIB.ORG

Reproductive Health Ovarian Damage During Chemotherapy In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Reproductive Health Ovarian Damage During Chemotherapy In Clinical Medicine Insights: Reproductive Health OPEN ACCESS Full open access to this and thousands of other papers at PErspEctiVE http://www.la-press.com. Ovarian Damage During Chemotherapy in Autoimmune Diseases: Broad Health Implications beyond Fertility Wendy Marder1, Senait Fisseha2, Martha A. Ganser1 and Emily C. Somers1–3 1Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA. 2Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, Michigan, USA. 3Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA. Corresponding author email: [email protected] Abstract: Women with autoimmune diseases such as lupus, scleroderma, and vasculitis receiving cyclophosphamide for severe disease manifestations risk primary ovarian insufficiency (POI) due to gonadotoxicity of this therapy. In addition to loss of reproductive poten- tial, POI is associated with increased risk of morbidity and mortality. Practitioners caring for women requiring gonadotoxic therapies should be familiar with long-term health implications of POI and strategies for ovarian preservation. Accumulating evidence supports the effectiveness of adjunctive gonadotropin releasing hormone analog (GnRH-a) for ovarian protection during gonadotoxic therapy in cancer and autoimmune populations. GnRH-a is less costly and invasive than assisted reproductive technologies used for achieve- ment of future pregnancies, but is not Food and Drug Administration approved for ovarian preservation. This review focuses on POI comorbidities and strategies for mitigation of related sequelae, which can accumulate over decades of hypoesteogenism. These issues are arguably more pronounced for women with chronic autoimmune diseases, in whom superimposed POI further heightens risks of car- diovascular disease and osteoporosis. Therefore, even if future pregnancy is not desired, ovarian protection during gonadotoxic therapy should be a major goal of disease management. Keywords: primary ovarian insufficiency, autoimmune diseases, cyclophosphamide, fertility preservation Clinical Medicine Insights: Reproductive Health 2012:6 9–18 doi: 10.4137/CMRH.S10415 This article is available from http://www.la-press.com. © the author(s), publisher and licensee Libertas Academica Ltd. This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited. Clinical Medicine Insights: Reproductive Health 2012:6 9 Marder et al Introduction least 1 month apart in the menopausal range.5 Unlike Severe manifestations of autoimmune diseases, such natural menopause, which occurs on average at age as systemic lupus erythematosus (SLE), systemic 50 years,12 50% of women with POI still have varia- sclerosis, and vasculitis, often require treatment tions in ovarian function, and 5%–10% conceive and with gonadotoxic immunosuppressive medications, deliver a child after receiving the diagnosis.5,13,14 particularly cyclophosphamide (CYC). While CYC While sequelae apply to all causes of POI (which is administration prolongs survival in these diseases, most frequently considered to be idiopathic, affecting it is associated with significant toxicity, including 1% of women under the age of 40 years),15,16 symptoms an unacceptably high incidence of primary ovarian are compounded in women with autoimmune diseases. insufficiency (POI) in female patients, with con- Both the underlying autoimmune/inflammatory pro- sequent irreversible amenorrhea and infertility.1–3 cesses and their treatments (eg, corticosteroids) are Beyond reproductive implications, POI is associated associated with many serious long-term consequences with broad and long lasting detrimental effects on of hypoestrogenism, most notably cardiovascular dis- general health, quality of life, and life expectancy.4–6 ease and loss of bone mineral density.17–21 These poten- With autoimmune diseases often affecting women tial long-term consequences of ovarian damage, beyond during their reproductive years,7 it is imperative that infertility, may be overlooked in women with autoim- the risks of prolonged hypoestrogenemia associated mune diseases requiring CYC (often on an urgent or with gonadotoxic therapies are adequately recog- semi-urgent basis), and particularly among patients nized when formulating treatment plans. These issues who may not be concerned with future childbearing. have been rigorously addressed in the field of oncol- ogy, as is evidenced by the development of practice Medications used in Autoimmune guidelines for fertility preservation in the cancer Diseases Associated with POI population.8 In comparison, rheumatologists have and Common Sequelae yet to develop similar practice guidelines for fertility Alkylating agents preservation in rheumatic disease patients undergo- Alkylating agents such as CYC and chlorambucil are ing treatment with gonadotoxic chemotherapy. immunosuppressive medications used to treat severe In this broad overview, we aim to: (a) increase manifestations of autoimmune diseases, including awareness and understanding of potential health con- SLE, systemic sclerosis, and vasculitis, and they are sequences, beyond infertility, of gonadotoxic therapies used as part of chemotherapeutic regimens for both in young women; and (b) highlight potential strategies hematologic malignancies and solid tumors. Even as for mitigation of such risks and resulting comorbidi- potentially less toxic alternatives for CYC therapy ties, including methods for ovarian protection. become more widely applied (eg, mycophenolate mofetil),22,23 CYC is still indicated in patients with Triple Threat of Primary Ovarian organ-threatening manifestations of severe autoim- Insufficiency, Underlying Autoimmune mune disease. In humans, CYC-induced ovarian Disease, and Treatment Side Effects damage is generally regarded as cumulative and irre- Menopause before the age of 40 years is considered versible, due in part to the progressive reduction of to be premature.5 The term “primary ovarian insuf- a limited number of primordial follicles.1–3 Among ficiency,” rather than “primary ovarian failure” or female patients treated with CYC for rheumatic dis- “premature menopause,” is the currently preferred ease or malignancy, POI develops in 12% to 83%, term, as it is less stigmatizing and allows the condition depending on variables including patient age, mode to be viewed as a continuum of impaired ovarian func- of administration, and cumulative CYC dose, all of tion as opposed to a dichotomous state.9–11 POI has which are strong predictors of POI.2,3,24–27 CYC may become recognized as “a serious and incurable chronic also contribute directly to bone loss, even beyond its disease,” the diagnosis of which requires a woman to potential to induce a hypoestrongenic state.28,29 In ani- be less than 40 years old, have experienced amenor- mal models, CYC decreases the number of osteoclasts rhea for 4 months or more, and she has to have two and osteoblasts on bone surfaces, and exerts adverse serum follicle stimulating hormone levels obtained at effects on epiphyseal growth plates.30,31 10 Clinical Medicine Insights: Reproductive Health 2012:6 Primary ovarian insufficiency in autoimmune disease Glucocorticoids at an age greater than 50 years.4,46 Similarly, mortality Large cumulative doses of glucocorticoid therapy has been shown to be significantly higher in women (GC), either by intravenous bolus dosing or through who undergo oophorectomy before age 45 versus prolonged daily oral therapy, have been associated referent women.47 Recently, prospective data from with side effects including accelerated atherosclero- a large, homogenous population-based study evalu- sis and osteoporosis.20,21,32–35 Although glucocorticoid ating the risk of fracture and mortality associated therapy is a cornerstone of treatment for patients with with age at menopause revealed that at 34 years of autoimmune diseases, efforts are continually being follow-up, women undergoing menopause before age made to decrease cumulative exposure by maintain- 47 had increased risks of mortality, fragility fractures, ing patients on immunosuppressive “steroid-sparing” and osteoporosis at age 77.48 agents such as methotrexate, azathioprine, and myco- phenolate mofetil. At high intravenous doses (eg, Cardiovascular disease .250 mg), the most common immediate side effects POI of any cause may also be associated with increased of glucocorticoid therapy include elevation of dia- morbidity and mortality from cardiovascular disease stolic blood pressure, cardiac arrhythmia, hyperglyce- (CVD) due to premature loss of the protective effects mia, and flushing.36 Long-term, moderate daily doses of estrogen.45,46 Data from several large cohort studies of prednisone, defined as .7.5 mg to 30 mg a day confirm the presence of a heightened CVD risk among for more than 2–3 months are associated with a range women who had a bilateral oophorectomy before age of adverse outcomes, including myopathy, glaucoma, 40 compared to after age 45, and the effect of exog- cataracts, infections, avascular necrosis, weight gain, enous estrogen was not necessarily protective.49,50 and various mood disturbances including depression, The Mayo Clinic Cohort Study of Oophorectomy and anxiety, and even psychosis.37–39 Even at low daily Aging, which included over 2,000 cases of unilateral doses (less than 7.5 mg/day), side effects of gluco-
Load more

Recommended publications
  • The Role of Gonadotropin-Releasing Hormone Agonists
    Review Preserving fertility when choosing chemotherapy regimens -- the role of gonadotropin-releasing 1. Introduction 2. Methods for fertility hormone agonists preservation † Zeev Blumenfeld & Ayelet Evron † 3. GnRH analogues Technion -- Israel Institute of Technology, Department Obstetrics and Gynecology, Rappaport 4. Risks and benefits of the Faculty of Medicine, Reproductive Endocrinology, Rambam Health Care Campus, Haifa, Israel different fertility preservation Introduction: methods The late effects of cancer treatment have recently gained a worldwide ubiquitous interest among reproductive endocrinologists, oncolo- 5. Chemotherapeutic agents gists, and all health care providers. Despite many publications on this subject, 6. GnRHa controversy there are many equivocal issues necessitating summary. The case for and 7. Expert opinion -- suggested against using GnRH-agonist for fertility preservation is summarized with the policy and management rationale that preventing ovarian failure may be better than treating it. Areas covered: We searched Medline in the last 10 years using terms: ‘fertility preservation’, ‘female chemotherapy’, ‘Gonadotropin-releasing hormone (GnRH) analogues’, ‘GnRH agonists’ ‘gonadotoxicity’, and ‘cancer treatment’. We included mainly publications from the past 7 years, but did not exclude previous, commonly referenced publications. Here, we summarize the various methods available for fertility preservation and minimizing chemotherapy induced gonadotoxicity. Expert opinion: Until now, 20 studies (15 retrospective and 5 randomized controlled trial) have reported on 2038 patients treated with GnRH-a in parallel to chemotherapy, showing a significant decrease in premature ovar- For personal use only. ian failure (POF) rate in survivors versus 8 studies reporting on 509 patients, with negative results. Patients treated with GnRH-a in parallel to chemother- apy preserved their cyclic ovarian function in 91% of cases as compared to 41% of controls, with a pregnancy rate of 19 -- 71% in the treated patients.
    [Show full text]
  • Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity
    International Journal of Molecular Sciences Review Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity Hyun-Woong Cho, Sanghoon Lee * , Kyung-Jin Min , Jin Hwa Hong , Jae Yun Song, Jae Kwan Lee , Nak Woo Lee and Tak Kim Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea; [email protected] (H.-W.C.); [email protected] (K.-J.M.); [email protected] (J.H.H.); [email protected] (J.Y.S.); [email protected] (J.K.L.); [email protected] (N.W.L.); [email protected] (T.K.) * Correspondence: [email protected]; Tel.: +82-2-920-6773 Received: 9 October 2020; Accepted: 20 October 2020; Published: 21 October 2020 Abstract: Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility
    [Show full text]
  • Fertility Preservation in >1000 Patients
    Arch Gynecol Obstet (2011) 283:651–656 DOI 10.1007/s00404-010-1772-y REPRODUCTIVE MEDICINE Fertility preservation in >1,000 patients: patient’s characteristics, spectrum, efficacy and risks of applied preservation techniques Barbara Lawrenz • Julia Jauckus • Markus S. Kupka • Thomas Strowitzki • Michael von Wolff Received: 31 August 2010 / Accepted: 9 November 2010 / Published online: 1 December 2010 Ó Springer-Verlag 2010 Abstract of the breast cancer patients and 92.7% of the lymphoma Introduction Data on the characteristics of female patients were childless. patients counselled for fertility preservation and the effi- 1,080 patients received a single or combined therapy such cacy and risk of the applied procedures are still poor. We as GnRH agonists (n = 823), cryopreservation of ovarian therefore analysed the registry of a network of 70 infertility tissue (n = 500), ovarian stimulation (n = 221) and centers which are involved in fertility preservation in transposition of the ovaries (n = 24). Only one severe Germany, Switzerland and Austria, called FertiPROTEKT complication, requiring postponement of the chemother- (hhtp://www.fertiprotekt.eu). apy, was documented. In stimulated patients, 2,417 oocytes Materials and methods 1,280 counselled patients (15–40 (mean n = 11.6, SD ± 7.7) were received. Fertilisation years) were analysed regarding characteristics and different rate per received oocyte was 61.3%. fertility preservation treatments before cytotoxic therapy in Conclusions Fertility preservation programmes mainly 2007–2009. involve women without children, diagnosed with breast Results 34.8% of the counselled patients were diagnosed cancer or Hodgkin’s lymphoma. Fertility preservation with breast cancer, 30.5% with Hodgkin’s lymphoma, 25.4% techniques can be applied with low risk.
    [Show full text]
  • FERTILITY PRESERVATION OPTIONS for CANCER PATIENTS Justo Callejo Olmos,1 Laura Almeida Toledano2
    FERTILITY PRESERVATION OPTIONS FOR CANCER PATIENTS Justo Callejo Olmos,1 Laura Almeida Toledano2 1. Professor and Clinical Chief of Gynecology, Department of Obstetrics and Gynaecology, Hospital Sant Joan de Déu Barcelona, Spain 2. Physician, Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu Barcelona, Spain Disclosure: No potential conflicts of interest. Received: 04.09.13 Accepted: 21.11.13 Citation: EMJ Gyn Obs. 2013;1:23-29. ABSTRACT Survival rates for cancer patients have increased in the last few years due to improvements achieved in cancer therapies. But, these treatments produce some adverse effects. One significant effect in prepubertal and young women is premature ovarian failure which impacts on reproductive capacity. For this reason, fertility preservation techniques appear. For the last few years there has been research into new procedures that will allow women to preserve their reproductive function. Specialised groups have appeared who advise women on the best fertility preservation option, always with a personalised approach. Currently, established fertility preservation techniques are embryo cryopreservation and oocyte cryopreservation; these two procedures can be offered widely to these women. However, there are some limitations: they cannot be offered to prepubertal women, they require a time interval to carry out (not always possible in cancer treatments), and they provide a restricted number of embryos or oocytes. On account of this, some specialised centres offer other experimental techniques such as ovarian tissue cryopreservation, which can be useful in this group of patients. We also have to take into account other procedures such as in vitro maturation of follicles, oophoropexy or trachelectomy. Gonadotropin-releasing hormone agonists should not be offered to these women because there is no evidence of their usefulness.
    [Show full text]
  • Infertility Services (Policy OCA 3.725)
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Infertility Services Policy Number: OCA 3.725 Version Number: 17 Version Effective Date: 11/01/21 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan Well Sense Health Plan MassHealth ACO MassHealth MCO Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options +Note: Disclaimer and audit information is located at the end of this document. Policy Summary Infertility services are covered services only for Plan members who meet ALL of the following Plan criteria: 1. The member is a Massachusetts resident enrolled in a BMC HealthNet Plan product with coverage for infertility treatment (as specified in the member’s evidence of coverage or applicable benefit document available at www.bmchp.org); AND 2. The Plan’s medical criteria are met for coverage of infertility services, which are based on the member’s medical history, diagnostic testing, and medical evaluations (as specified in the Medical Policy Statement section and Limitations section of this policy); AND 3. The treating provider is a contracted network infertility services provider; AND Infertility Services + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan. 1 of 67 4. The member is in active infertility treatment. ALL prior authorization requests for covered infertility services require Plan Medical Director review and approval. It will be determined during the Plan’s prior authorization process if the service is considered medically necessary for the requested indication (with Medical Necessity or Medically Necessary defined in the Definitions section of this policy).
    [Show full text]
  • Recent Advances in Fertility Preservation and Counseling for Reproductive-Aged Women with Colorectal Cancer: a Systematic Review Lisa M
    CURRENT STATUS REVIEWS Recent Advances in Fertility Preservation and Counseling for Reproductive-Aged Women with Colorectal Cancer: A Systematic Review Lisa M. Shandley, M.D., M.Sc.• Laurie J. McKenzie, M.D. Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia BACKGROUND: The incidence of colorectal cancer RESULTS: There are limited data regarding the impact among reproductive-aged women is increasing. Concerns of colorectal surgery on fertility. The gonadotoxic effects regarding future fertility are secondary only to concerns of chemotherapy on reproductive capacity depend regarding survival and may significantly impact quality on age at the time of chemotherapy administration, of life among reproductive-aged female cancer survivors. cumulative chemotherapy, radiation dose, type of agent, Fertility preservation counseling reduces long-term regret and baseline fertility status. Chemotherapy-induced risks and dissatisfaction among cancer survivors. Health care for colorectal cancers are considered low to moderate, providers counseling patients with colorectal cancer must whereas pelvic radiation with a dose of 45 to 50 Gray understand the impact of cancer treatment on future induces premature menopause in greater than 90% of reproductive potential. patients. Ovarian transposition may reduce but not eliminate the damaging effect of radiation on the ovaries. OBJECTIVE: This review aims to examine the effects that Embryo and oocyte cryopreservation are considered colorectal cancer treatments have on female fertility and standard of care for women desiring fertility preservation, summarize existing and emerging options for fertility with oocyte cryopreservation no longer being considered preservation. experimental. Ovarian tissue cryopreservation remains DATA SOURCES: EMBASE, National Library of Medicine experimental but may be an option for select patients.
    [Show full text]
  • 1 Fertility Preservation Counselling and Treatment for Medical
    1 Fertility preservation counselling and treatment for medical reasons – data from a multinational network with >5000 women M von Wolff1,8, R Dittrich2,8, J Liebenthron3,8, F Nawroth4,8, A N Schüring5,8, T Bruckner6, A Germeyer7,8 1Women’s University Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Effingerstrasse 102, 3010 Berne, Switzerland 2Women’s University Hospital, Friedrich-Alexander University of Erlangen–Nuremberg, Universitätsstraße 21-23, 91054 Erlangen, Germany 3Women’s University Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Sigmund-Freud-Str. 25, 53127 Bonn, Germany 4Centre for Fertility, Prenatal Medicine, Endocrinology and Osteology, amedes, Mönckebergstraße 10 (Barkhofpassage), 20095 Hamburg, Germany 5 Women’s University Hospital, Infertility center, Albert-Schweitzer-Campus 1, Building D11, Münster, Germany | downloaded: 26.9.2021 6Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 105, 69120 Heidelberg, Germany 7Women’s University Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany 8 Representing the network FertiPROTEKT https://doi.org/10.7892/boris.77642 source: 2 To whom correspondence should be addressed: Prof. Michael von Wolff Women’s University Hospital Division of Gynaecological Endocrinology and Reproductive Medicine Effingerstrasse 102, 3010 Bern, Switzerland Tel: +41-31-632-1301 Fax: +41-31-63211305 e-mail: [email protected] 3 Abstract Fertility preservation techniques for medical reasons are increasingly offered in national networks. Its introduction and improvement require knowledge about characteristics of counselled patients and fertility preservation techniques performed. Therefore the FertiPROTEKT network registry was analysed over 7 years until 2013. In 39 (2007) to 85 (2013) university and non-university centers in Germany, Austria and Switzerland, 5159 women were counselled and 4060 women underwent fertility preservation therapies.
    [Show full text]
  • Fertility Preservation in Women—A Practical Guide To
    Arch Gynecol Obstet (2011) 284:427–435 DOI 10.1007/s00404-011-1874-1 GYNECOLOGIC ONCOLOGY Fertility preservation in women—a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT Michael von Wolff • Markus Montag • Ralf Dittrich • Dominik Denschlag • Frank Nawroth • Barbara Lawrenz Received: 8 November 2010 / Accepted: 2 March 2011 / Published online: 24 March 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com Abstract individual use of fertility preservation methods for various Purpose Fertility preservation methods are playing an indications such as breast cancer, Hodgkin’s lymphoma increasing role in women up to the age of 40 years because and borderline ovarian tumours are given. of rising survival rates in those affected by cancer. How- Results Various options such as ovarian stimulation and ever, balanced practical recommendations concerning all cryopreservation of unfertilised or fertilised oocytes, relevant fertility preservation, to support doctors in coun- cryopreservation and transplantation of ovarian tissue, selling and treating patients, are still rare. GnRH-agonist administration and transposition of the Methods These recommendations were prepared by the ovaries can be offered. All the techniques can be performed network FertiPROTEKT (http://www.fertiprotect.eu), a alone or in combination within a maximum of 2 weeks collaboration of around 70 centres in Germany, Switzer- with low risk and different success rates. land and Austria. The recommendations were developed by Conclusions Fertility preservation in women has become specialists in reproductive medicine, reproductive biology an option with realistic chances to become pregnant after and oncology, which gave a comprehensive overview of all cytotoxic therapies.
    [Show full text]
  • Fertility Preservation and Infertility Treatments in Breast Cancer Patients. How to Stimulate and What Are
    Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Michael von W olff 1 FertilityDies ist derpreservation Titel der Präsentationand infertility treatments in breast cancer patients Prof. Michael von Wolff University Women`s Hospital Division of Gynecological Endocrinology and Reproductive Medicine 1 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern I (M.v.W.) have nothing to declare Michael von W olff 3 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Agenda • General remarks • Fertility preservation techniques • Infertility/pregnancy after Breast cancer Michael von W olff 4 2 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Agenda • General remarks • Fertility preservation techniques • Infertility/pregnancy after Breast cancer Michael von W olff 5 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Frequency of breast cancer counselings (>5.000 cases in FertiPROTEKT) Michael von W olff von Wolff et al., RBM online, 2015 6 3 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Michael von W olff Schüring….von Wolff, Arch Gynecol OBstet, in press 7 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Disease free survival Overall survival Good prognosis? 2010 Cancello et al., Ann Oncol Oncol Ann al., et Cancello Michael von W olff Schüring….von Wolff, Arch Gynecol OBstet, in press 8 4 Abteilung Gynäkologische Endokrinologie und Reproduktions me dizi n, Bern Risk of infertility
    [Show full text]
  • Emergency Fertility Preservation for Female Patients with Cancer: Clinical Perspectives
    ANTICANCER RESEARCH 35: 3117-3128 (2015) Review Emergency Fertility Preservation for Female Patients with Cancer: Clinical Perspectives MAHMOUD SALAMA and PETER MALLMANN Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany Abstract. To explore the new as well as the currently Almost one in 51 women will suffer from an invasive available options and strategies that can be used for cancer by the age of 39 years and hence will receive cancer emergency fertility preservation of female cancer patients, a treatment. The most common forms of invasive cancer in systematic literature review was performed for all full-text women are breast (29%), lung (13%), colorectal (8%), articles published in PubMed in English language in the past uterine and cervical (6%) cancer, thyroid carcinoma (6%), 15 years according to the Preferred Reporting Items for lymphoma (4%), melanoma (4%), leukemia (3%), kidney Systematic Reviews and Meta-Analyses (PRISMA) (3%) and pancreatic (3%) cancer (2). Cancer treatments such guidelines. Although under-utilized, several established, as chemotherapy and radiotherapy act through inhibition of experimental and debatable options exist and can be used DNA function and cell division, resulting in cytotoxicity and for emergency fertility preservation in females. Such options cell damage (6). After chemotherapy and radiotherapy, the include emergency ovarian stimulation, embryo freezing, egg probability of conception in female cancer survivors is freezing, ovarian tissue freezing and autotransplantation, in markedly diminished by 30-50%, with an increased risk of vitro maturation, and ovarian protection techniques. This delivering pre-term and of babies with low birth weight (7- article describes and evaluates in detail the advantages and 13).
    [Show full text]
  • Practical Recommendations for Fertility Preservation in Women by the Fertiprotekt Network
    Archives of Gynecology and Obstetrics (2018) 297:241–255 https://doi.org/10.1007/s00404-017-4594-3 GUIDELINES AND POSITION STATEMENTS Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part I: Indications for fertility preservation A. N. Schüring1 · T. Fehm2 · K. Behringer3 · M. Goeckenjan4 · P. Wimberger4 · M. Henes5 · J. Henes6 · M. F. Fey7 · M. von Wolf8 Received: 30 October 2017 / Accepted: 10 November 2017 / Published online: 24 November 2017 © The Author(s) 2017. This article is an open access publication Abstract Purpose Most guidelines about fertility preservation are predominantly focused on scientifc evidence, but are less practically orientated. Therefore, practically oriented recommendations are needed to support the clinician in daily practice. Methods A selective literature search was performed based on the clinical and scientifc experience of the authors, focussing on the most relevant diseases and gynaecological cancers. This article (Part I) provides information on topics that are essential for the fertility preservation indication, such as disease prognosis, disease therapy and its associated risks to fertility, recom- mending disease-specifc fertility preservation measures. Part II specifcally focusses on fertility preservation techniques. Results In breast cancer patients, fertility preservation such as ovarian tissue and oocyte cryopreservation is especially rec- ommended in low-stage cancer and in women < 35 years of age. In Hodgkin’s lymphoma, the indication is mainly based on the chemotherapy regime as some therapies have very low, others very high gonadotoxicity. In borderline ovarian tumours, preservation of fertility usually is achieved through fertility sparing surgery, ovarian stimulation may also be considered. In cervical cancer, endometrial cancer, rheumatic diseases and other malignancies such as Ewing sarcoma, colorectal carcinoma, non-Hodgkin lymphoma, leukaemia etc., several other factors must be considered to enable an individual, stage-dependent decision.
    [Show full text]
  • Fertility Preservation in Breast Cancer Patients Under Special Consideration of Ovarian Stimulation for Fertility Purposes
    Invited Commentary Open Access DOI: 10.19187/abc.202073149-154 Fertility Preservation in Breast Cancer Patients Under Special Consideration of Ovarian Stimulation for Fertility Purposes Sebastian Findeklee*a,b, Sebastian Grewec, Klaus Diedrichd a Kinderwunschzentrum Niederrhein, Madrider Straße 6; D-41069 Mönchengladbach, Germany b Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, D-66421 Homburg, Germany b Fertility Center Dr. Sebastian Grewe and Dr. Olaf Drost - Bremer Zentrum für Fortpflanzungsmedizin (BZF), Bremen, Germany d Schleswig-Holstein University Medical Center, Lübeck, Germany Importance of fertility preserving methods B. Epidemiologic aspects of breast cancer A. Socio-demographic changes in society Breast cancer is the most common malignancy in In the industrialized countries, two developments women around the world with 1.6 million new breast have been observed over the last few decades that cancer patients being identified each year 6 have shifted the focus of research and reproductive worldwide. Overall, 4-6 % of the women diagnosed medicine to maintaining fertility. With regard to are under the age of 40, and about one out of five 7 social life, there is a trend of postponing the women possesses a premenopausal hormonal status . realization of the desire to have children to an ever Advancement in the adjuvant systemic and later phase of life or a childbirth does not take place locoregional therapy has resulted in a significantly at all due to existing biological limits. In Germany, improved forecast. for example, between 1993 and 2013, the age of The function of the ovaries can be damaged by women at the birth of their first child rose from the therapy resulting in a loss of germ cells and later around 25 to 29.3 years.1 It is well-known for a long on in infertility.
    [Show full text]