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DOI: 10.1055/s-0035-1558184
Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?
Fertilitätsprotektion von onkologischen Patientinnen: Wie sollten die Patientinnen beraten werden?Publikationsverlauf
received 21. Juli 2015
revised 22. August 2015
accepted 25. August 2015
Publikationsdatum:
21. Dezember 2015 (online)
Abstract
Protecting the fertility of patients with oncologic disease is becoming more and more important, as fulfilling the wish to have children is increasingly occurring at a later stage in life and long-term survival rates after cancer are continuing to improve. A number of fertility-preserving options exist. In addition to techniques which have been around for some time such as medical ovarian suppression, ovarian transposition, and organ-preserving surgery, there are other, more recent, innovative methods which have developed over the last few years such as cryopreservation of oocytes or ovarian tissue transplantation after completing cancer therapy. As every procedure has its specific advantages and disadvantages, informed patient consent is essential. The physicianʼs aim must be to select the optimal procedure for each patient. The extent of patientsʼ information about the options to preserve fertility in women with oncologic disease remains limited. One of the main reasons for this is that clinicians are not sure how to inform patients about existing procedures and methods. The aim of this review article is to provide help in clinical practice.
Zusammenfassung
Dem Fertilitätserhalt bei Krebserkrankungen kommt eine immer größere Bedeutung zu, da sich die Erfüllung des Kinderwunschs zunehmend in spätere Lebensphasen verschiebt und das Langzeitüberleben bei Krebs steigt. Es steht eine Vielzahl fertilitätsprotektiver Maßnahmen zur Verfügung. Neben den seit längerer Zeit praktizierten Verfahren der medikamentösen Ovarsuppression, der Transposition der Eierstöcke und der organerhaltenden Chirurgie haben sich in den letzten Jahren die innovativen Methoden Kryokonservierung von Eizellen und Eierstockgewebe mit der späteren Transplantation nach Therapieabschluss etabliert. Jedes Vorgehen hat seine spezifischen Vor- und Nachteile, über die ärztlicherseits aufgeklärt werden muss. Letztendlich geht es darum, für jede Patientin das optimale Verfahren auszuwählen. Immer noch ist die Aufklärungsrate bez. Fertilitätserhalt bei Frauen mit onkologischen Erkrankungen sehr gering. Als wesentlicher Grund hierfür gilt auch, dass bei den Behandelnden eine Unsicherheit darüber besteht, wie sie Patientinnen über Methoden aufklären sollen. Der hier vorgestellte Review-Artikel soll eine Unterstützung im klinischen Alltag bieten.
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References
- 1 Statistisches Bundesamt. Alter bei der Geburt des ersten Kinds in Deutschland.. Online: https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Bevoelkerung/Geburten/Tabellen/GeburtenMutterAlterBundeslaender.html last access: 30.04.2015
- 2 Menken J, Trussell J, Larsen U. Age and infertility. Science 1986; 233: 1389-1394
- 3 Mattle V, Behringer K, Engert A et al. Female fertility after cytotoxic therapy-protection of ovarian function during chemotherapy of malignant and non-malignant diseases. Eur J Haematol Suppl 2005; 66: 77-82
- 4 Anderson RA, Wallace WH, Baird DT. Ovarian cryopreservation for fertility preservation: indications and outcomes. Reproduction 2008; 136: 681-689
- 5 Lee MC, Gray J, Han HS et al. Fertility and reproductive considerations in premenopausal patients with breast cancer. Cancer Control 2010; 17: 162-172
- 6 Li A, Pasternak M, Duke C et al. The effect of practitioner education on fertility preservation awareness, perception and clinical practice. Obstet Gynecol 2015; 125: 8-9
- 7 Dnistrian AM, Schwartz MK, Fraccchia AA et al. Endocrine consequences of CMF adjuvant therapy in premenopausal and postmenopausal breast cancer patients. Cancer 1993; 51: 803-807
- 8 Gonfloni S, Di Tella L, Caldarola S et al. Inhibition of the c-Abl-TAp63 pathway protects mouse oocytes from chemotherapy-induced death. Nat Med 2009; 15: 1179-1185
- 9 Critchley HO, Wallace WH. Impact of cancer treatment on uterine function. J Nat Can Inst 2005; 34: 64-68
- 10 Ben-Aharon I, Bar-Joseph H, Tzarfaty G et al. Doxorubicin-induced ovarian toxicity. Reprod Biol Endocrinol 2010; 4: 8-20
- 11 Hart R. Preservation of fertility in adults and children diagnosed with cancer. BMJ 2008; 337: a2045
- 12 Abusief ME, Missmer SA, Ginsburg ES et al. The effects of paclitaxel, dose density, and trastuzumab on treatment-related amenorrhea in premenopausal women with breast cancer. Cancer 2010; 116: 791-798
- 13 Parulekar WR, Day AG, Ottaway JA et al. National Cancer Institute of Canada Clinical Trials Group. Incidence and prognostic impact of amenorrhea during adjuvant therapy in high-risk premenopausal breast cancer: analysis of a National Cancer Institute of Canada Clinical Trials Group Study – NCIC CTG MA. J Clin Oncol 2005; 23: 6002-6008
- 14 van der Kaaij MA, Heutte N, Meijnders P et al. Premature ovarian failure and fertility in long-term survivors of Hodgkinʼs lymphoma: a European Organisation for Research and Treatment of Cancer Lymphoma Group and Groupe dʼEtude des Lymphomes de lʼAdulte Cohort Study. J Clin Oncol 2012; 30: 291-299
- 15 Elis A, Tevet A, Yerushalmi R et al. Fertility status among women treated for aggressive non-Hodgkinʼs lymphoma. Leuk Lymphoma 2006; 47: 623-627
- 16 Pérez-Fidalgo JA, Roselló S, García-Garré E et al. Incidence of chemotherapy-induced amenorrhea in hormone-sensitive breast cancer patients: the impact of addition of taxanes to anthracycline based regimens. Breast Cancer Res Treat 2010; 120: 245-251
- 17 Schultheis B, Nijmeijer BA, Yin H et al. Imatinib mesylate at therapeutic doses has no impact on folliculogenesis or spermatogenesis in a leukaemic mouse model. Leuk Res 2012; 36: 271-274
- 18 Witzel ID, Müller V, Harps E et al. Trastuzumab in pregnancy associated with poor fetal outcome. Ann Oncol 2008; 19: 191-192
- 19 Newman H, Finger PT, Chin KJ et al. Systemic bevacizumab (avastin) for exudative retinal detachment secondary to choroidal melanoma. Eur J Ophthalmol 2011; 21: 796-801
- 20 Genetech. U.S. BL125085, Supplement. Bevacizumab Genentech, Inc.; 2011
- 21 Park JY, Joo WD, Chang SJ et al. Long-term outcomes after fertility-sparing laparoscopic radical trachelectomy in young women with early-stage cervical cancer: an Asan Gynecologic Cancer Group (AGCG) study. J Surg Oncol 2014; 110: 252-257
- 22 Hauerberg L, Høgdall C, Loft A et al. Vaginal radical trachelectomy for early stage cervical cancer. Results of the Danish National Single Center Strategy. Gynecol Oncol 2015; 138: 304-310
- 23 Loizzi V, Selvaggi L, Leone L et al. Borderline epithelial tumors of the ovary: experience of 55 patients. Oncol Lett 2015; 9: 912-914
- 24 Alvarez RM, Vazquez-Vicente D. Fertility sparing treatment in borderline ovarian tumors. Ecancermedicalscience 2015; 9: 507
- 25 Zapardiel I, Diestro MD, Aletti G. Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol 2014; 40: 387-393
- 26 Lee SJ, Schover L, Partridge AH et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006; 24: 2917-2931
- 27 Edgar DH, Gook DA. A critical appraisal of cryopreservation (slow cooling versus vitrification) of human oocytes and embryos. Hum Reprod Update 2012; 18: 536-554
- 28 Morice P, Thiam-Ba R, Castaigne D et al. Fertility results after ovarian transposition for pelvic malignancies treated by external irradiation or brachytherapy. Hum Reprod 1998; 13: 660-663
- 29 Shou H, Chen Y, Chen Z et al. Laparoscopic ovarian transposition in young women with cervical squamous cell carcinoma treated by primary pelvic irradiation. Eur J Gynaecol Oncol 2015; 36: 25-29
- 30 Beck-Fruchter R, Weiss A, Shalec E. GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data. Hum Reprod Update 2008; 14: 553-561
- 31 Blumenfeld Z, von Wolff M. GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy. Hum Reprod Update 2008; 14: 543-552
- 32 Dittrich R, Maltaris T, Hoffmann I et al. Fertility preservation in cancer patients. Minerva Ginecol 2010; 62: 63-80
- 33 Loren AW, Mangu PB, Beck LN et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2013; 31: 2500-2510
- 34 Von Wolff M, Thaler CJ, Frambach T et al. Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril 2009; 92: 1360-1365
- 35 Whittingham DG. In-vitro fertilization, embryo transfer and storage. Br Med Bull 1979; 35: 105-111
- 36 Sanchez M, Novella-Maestre E, Teruel J et al. The Valencia Programme for Fertility Preservation. Clin Transl Oncol 2008; 10: 433-438
- 37 Herraiz S, Novella-Maestre E, Rodriguez B et al. Improving ovarian tissue cryopreservation for oncologic patients: slow freezing versus vitrification, effect of different procedures and devices. Fertil Steril 2014; 101: 775-784
- 38 Cobo A, Vajta G, Remohi J. Vitrification of human mature oocytes in clinical practice. Reprod Biomed Online 2009; 19: 4385
- 39 Smith GD, Serafini PC, Fioravanti J et al. Prospective randomized comparison of human oocyte cryopreservation with slow-rate freezing or vitrification. Fertil Steril 2010; 94: 2088-2095
- 40 Cobo A, Meseguer M, Remohi J et al. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod 2010; 25: 2239-2246
- 41 Donnez J, Dolmans MM, Demylle D et al. Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 2004; 364: 1405-1410
- 42 Oktay K, Karlikaya G. Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med 2000; 342: 1919
- 43 Krishnakumar S, Tambe P. Laparoscopic entry: a review of techniques, technologies and complications. J Gynecol Endosc Surg 2009; 1: 4-11
- 44 Donnez J, Dolmans MM, Pellicer A et al. Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 2013; 99: 1503-1513
- 45 Donnez J, Dolmans MM. Fertility preservation in women. Nat Rev Endocrinol 2013; 9: 735-749
- 46 Stern CJ, Gook D, Hale LG et al. Delivery of twins following heterotopic grafting of frozen-thawed ovarian tissue. Hum Reprod 2014; 29: 1828
- 47 Lawrenz B, Jauckus J, Kupka MS et al. Fertility preservation in > 1,000 patients: patientʼs characteristics, spectrum, efficacy and risks of applied preservation techniques. Arch Gynecol Obstet 2011; 283: 651-656
- 48 Corbett S, Shmorgun D, Claman P et al. Reproductive Endocrinology Infertility Committee. The prevention of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can 2014; 36: 1024-1036
- 49 Rosendahl M, Andersen MT, Ralfkiaer E et al. Evidence of residual disease in cryopreserved ovarian cortex from female patients with leukaemia. Fertil Steril 2010; 94: 2186-2190
- 50 Arav A, Gavish Z, Elami A et al. Ovarian function 6 years after cryopreservation and transplantation of whole sheep ovaries. Reprod Biomed Online 2010; 20: 48-52
- 51 Donnez J, Dolmans MM, Pellicer A et al. Fertility preservation for age-related fertility decline. Lancet 2015; 385: 506-507
- 52 Nekkebroeck J, Stoop D, Devroey P. O-036 A preliminary profile of women opting for oocyte cryopreservation for non-medical reasons. Hum Reprod 2010; 25: i15-i16
- 53 Stoop D, Maes E, Polyzos NP et al. Oocyte banking for anticipated gamete exhaustion (AGE) is a preventive intervention, neither social nor nonmedical. Reprod Biomed Online 2014; 28: 548-551
- 54 Rosendahl M, Greve T, Andersen CY. The safety of transplanting cryopreserved ovarian tissue in cancer patients: a review of the literature. J Assist Reprod Genet 2013; 30: 11-24
- 55 Lotz L, Montag M, Van der Ven H et al. Xenotransplantation of cryopreserved ovarian tissue from patients with ovarian tumors into SCID mice–no evidence of malignant cell contamination. Fertil Steril 2011; 95: 2612-2614
- 56 Rosendahl M, Andersen MT, Ralfkiaer E et al. Evidence of residual disease in cryopreserved ovarian cortex from female patients with leukemia. Fertil Steril 2010; 94: 2186-2190
- 57 Carcio HA ed. Management of the infertile Woman. Philadelphia: Lippincott; 1998