Ovarian Protection During Chemo- and Radio-Therapy

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.