Abstract
Many premenopausal patients who develop breast cancer have not yet completed their
family planning, so measures of fertility protection to preserve their fertile potential
would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles
– irrespective of whether in a neoadjuvant or adjuvant setting – and this can sometimes
result in permanent infertility. Depending on which cytostatic agents are used and
on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified
as low, moderate or high. Options of fertility preservation include: a) cryopreservation
of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes
are retrieved by transvaginal follicle aspiration, after which they are cryopreserved,
either unfertilised or on completion of IVF or ICSI treatment. During b) cryopreservation
of ovarian tissue, about 50% of the ovarian cortex of one ovary is resected with the
aid of a laparoscopic procedure and cryopreserved. The application of c) GnRH agonists
as a medicinal therapy option is an attempt at endocrine ovarian suppression in order
to protect oocytes, granulosa cells and theca cells from the cytotoxic effect of chemotherapy.
Key words
breast cancer - fertility preservation - cryopreservation - oocytes - ovarian tissue
- GnRH agonist
