Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 91

Most young cancer patients are cured or have long survival as a result of unprecedented advances in oncology in recent decades. For instance, 80% of patients with leukemia, the most common pediatric cancer, are expected to be cured. Thus, the concern is no longer only on saving lives, but also on ensuring improved quality of life. Given that fertility‐related psychological distress is prevalent and persistent in cancer patients and survivors [1], they should routinely be given the opportunity to speak with a fertility specialist and thoroughly explore all fertility preservation options available to them.

The most common cancer in women of reproductive age is breast cancer; other cancers of note in this age group are leukemia, lymphoma, melanoma, cervical and ovarian cancers. The type of cancer, its stage, biologic features and patient factors influence prognosis and treatment. Treatment may be one or a combination of surgery, chemotherapy, radiotherapy and hormonal treatment. Chemotherapy, particularly with alkylating agents such as cyclophosphamide, is highly toxic to the primordial follicles in the ovary. The extent of the effect of chemotherapy on ovarian reserve will depend on the drug(s) used, dosage, age and the baseline ovarian reserve of the patient. Radiotherapy, particularly if directed to the pelvis, can adversely affect ovarian reserve. A 2019 review of articles on the risks of cancer treatments to fertility demonstrated that pelvic radiation of 5–10 Gy causes 25–75% increase in the risk of infertility and >10 Gy causes >75% increase [2]. The exposure required to induce ovarian failure and infertility decreases with increasing age. Radiation as low as 1 Gy was found to be associated with increased risk of premature menopause [3].

There are two key aspects to fertility preservation:

1 Minimization of the effect of cancer treatment on fertility; and

2 Provision of effective options for storage of gametes, embryos or germinal (e.g. ovarian) tissues.