open access: Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 953937, 11 pages
doi:10.1155/2012/953937 Review Article Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

• Abstract
• Introduction
• Methods and Materials
• Results and Discussion
• Options for Fertility Preservation
• Additional Considerations
• Pregnancy after Cancer

Conclusions 

Given the relatively high incidence of cancer in reproductive age women and improvements in 5-year survival, an increasing number of women are presenting for discussion of fertility preservation and pregnancy after cancer treatment. The ASCO published recommendations in 2006 on fertility preservation in cancer patients. These guidelines state that oncologists should address the possibility of infertility with cancer patients and be prepared to discuss possible fertility preservation options or refer the patient to a reproductive specialist. Part of the difficulty in counseling patients regarding the risk of infertility and/or subsequent pregnancy complications is that the risks are dependent on several factors. These risks include the dose and duration of treatment, other risk factors for infertility, the age of the patient, and the patient’s baseline ovarian reserve at the time of initiation of treatment.
Advancements in ovarian reserve testing may help counsel patients about the impact of their cancer treatments on fertility and chances for future pregnancy. Fertility preservation is a rapidly evolving field that includes medical and surgical treatments to decrease the impact of cancer treatments on future fertility. Ongoing trials will address the effectiveness of GnRH agonists in protecting ovarian reserve. Several technologies exist to help preserve future fertility including embryo cryopreservation, oocyte, and ovarian tissue cryopreservation. Embryo cryopreservation is currently the only recommended method of gamete preservation, but recent advances in oocyte vitrification may increase the utility of this treatment for cancer patients. Additionally, PGD may decrease the risk of disease transmission of hereditary cancer syndromes. The risk to the patient of IVF may also be decreased with recent advances in IVF stimulation protocols. There may be an increased risk of preterm birth and associated neonatal complications for female cancer survivors, but the outcomes of the majority of pregnancies appear similar to noncancer patients. It is not clear whether the increased risks in pregnancy are related to the malignancy itself or the result of treatments such as radiation or chemotherapy. Also, the risk of disease recurrence will depend on several factors, but for most cancers the risk of recurrence is not increased secondary to pregnancy. Overall, pregnancy appears safe for most patients after cancer treatment but will depend on individual patient characteristics.