Improvement in oncologic treatment has made the preservation of fertility of
young women surviving cancer a demanding issue. International guidelines
recommend reproductive counseling before surgery, chemotherapy or radiotherapy.
Information should deal with the different ways to preserve fertility, such as embryos,
oocytes or ovarian tissue cryopreservation, suppression of ovarian activity during
chemotherapy, or ovarian transposition/shielding during radiotherapy. Preservation of
fertility during chemotherapy depends on several factors such as ovarian reserve at the
moment of treatment, age, type of treatment, type of dose and posology of the drug
used. Data from the literature show that certain preservation of ovarian function can be
achieved by suppressing ovarian function with a GnRH analog (GnRHa) during
chemotherapy for breast cancer. However, there is no evidence that ovarian
preservation can be achieved by ovarian suppression during chemotherapy for
hematological neoplasms. In these cases, oocyte cryopreservation represents the only
available option. Ovarian damage after pelvic radiotherapy is related to age and the
dose of radiation delivered. Ovarian preservation can be achieved via the transposition
of the ovaries from the radiation field by a minimally-invasive surgical approach. Three
surgical techniques for ovarian transposition by laparoscopy were described with either
a lateral, a medial, or an anterior approach. In conclusion, nowadays it is possible to
allow reproduction in most young women surviving cancer by an individualized
approach that takes into consideration the type of malignancy, the type of treatment,
and the preventive measures that can be used in every single case.
Keywords: Alkylating agents, Anti-mullerian hormone, Breast cancer, Chemotherapy, Counseling, Cryopreservation, Fertility, Gonadotrophin-releasin- -hormone agonist, Hematological neoplasms, Hematological stem-cell transplant, Non-alkylating agents, Ovarian protection, Ovarian transposition, Ovarian shielding, Ovarian function, Pelvic radiation, Radiotherapy, Surgery, Total body irradiation, Young women.
