- 1. Fertility preservation, from cancer to benign disease to
social reasons: the challenge of the present decade Jacques Donnez,
M.D., Ph.D. Infertility Research Unit, Socie te de Recherche pour
l'Infertilite , Brussels, BelgiumReceived and accepted March 26,
2013. J.D. reports Board membership with PregLem and payment for
lectures by Serono, MSD, Organon, and Ferring. Reprint requests:
Jacques Donnez, M.D., Ph.D., Socie te de Recherche pour
l'Infertilite (SRI), avenue Grandchamp, 143, - B1150 Brussels,
Belgium (E-mail: [email protected]). Fertility and Sterility
Vol. 99, No. 6, May 2013 0015-0282/$36.00 Copyright 2013 American
Society for Reproductive Medicine, Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.fertnstert.2013.03.040
2. Predicting the likelihood of infertility following
gonadotoxic treatments is extremely difcult. In the present issue,
several hot topics in the eld of fertility preservation are
discussed. (Fertil Steril 2013;99:14678. 2013 by American Society
for Reproductive Medicine.) 3. In de first review the impact of
cancer therapy (radiotherapy and/or chemotherapy) on the female
reproductive tract is discussed. In the second review, time
constraints, potential complica- tions, and limited opportunity for
ovarian stimulation for fer- tility preservation (FP) or ovarian
stimulation in women with cancer are reported. Different strate-
gies to increase the chances of future pregnancy are presented. 4.
Prevention of ovarian hyperstimulation syndrome (OHSS) in cancer
patients is also a major issue discussed in the review, and use of
gonadotropinreleasing hormone (GnRH) agonist is proposed to trigger
nal oocyte maturation in women at risk of OHSS. 5. In the review on
oocyte vitrication, not only the results, but also the variables
(age, oocyte quality, cryoprotectant type, and concentration,
vitrication devices, team experi- ence) playing a key role towards
nal outcome after oocyte vitrication are described. It may be
concluded that vitrica- tion is effective. Vitried oocytes retain
their normal develop- mental potential, with survival rates of
around 90% and pregnancy rates ranging from 60% to 75%. 6. Many
major scientic societies have changed their position in this regard
and no longer consider oocyte vitrication as an experimental tool.
Of course, oocyte vitrication implies the disadvantage of needing
COS to harvest oocytes, which delays chemother- apy initiation. 7.
In the review on embryo cryopreservation, special con- siderations
on ovarian stimulation for FP purposes are ana- lyzed. Embryo
cryopreservation is an established and very successful method of FP
when there is sufcient time to perform ovarian stimulation 8.
Eleven patients became pregnant and six of them have al- ready
delivered 12 healthy babies. Although all pregnancies were obtained
from tissue frozen according to the slow-freezing technique,
vitrication re- sults in experimental models are looking
increasingly promising. The quality of eggs obtained by IVF after
trans- plantation is not optimal and there is no doubt that
dysfunc- tional folliculogenesis occurs. 9. The risk is also
evaluated in case of breast cancer, cervical carcinoma, endometrial
carcinoma, colorectal cancer and central nervous system tumors.
This is of major interest to cli- nicians (oncologists,
pediatricians, gynecologists) who need to counsel patients (and
also parents when minors) in order to propose the most appropriate
option for FP while analyzing associated risks. 10. CONCLUSION In
this issue, fertility preservation in female cancer and non- cancer
patients is extensively discussed. The time when the only goal was
to cure the disease is long gone. Now, curing the disease, quality
of life after cancer, and fertility preserva- tion are all
important considerations.