Therapies for malignant and benign pathology may compromise female fertility. Chemotherapy including alkylating agents, radiation and surgery may cause ovarian failure and damage to the uterus.
Risk of damage from Cancer treatment
Effects of chemo-radiotherapy on ovarian function:
1) temporary ovarian failure
2) permanent ovarian failure
3) persistence/return of ovarian function after therapy but high risk of early menopause ie early to mid 30s
4) irreparable damage to the uterus
Options for fertility preservation and protection
Given the toxic effects of chemotherapy agents on the ovary, with the resultant risk of temporary and more permanent ovarian failure, the availability of options to preserve and protect fertility is of great importance to these young women and their families.
Options prior to commencing gonadotoxic treatment::
1) protection of ovaries with GnRh analogues
2) preservation of mature oocytes
3) preservation of embryos
4) preservation of ovarian tissue
Options for fertility after development of premature ovarian failure:
1) oocyte donation
2) embryo donation
3) adoption/permanent care
4) surrogacy if significant uterine damage
5) childlessness
Important messages
1) any young woman at risk of fertility compromise should have the opportunity for discussion with fertility specialist
2) prompt referral and discussion of options is of paramount importance
3) various options currently available may offer a genuine opportunity to preserve fertility