Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 92
Management options
ОглавлениеManagement of cancer patients requiring fertility preservation is often complex; navigation through the complexities and uncertainties will require a multidisciplinary team approach and thorough counseling of the patient, and often the partner too. The following issues will need to be assessed by the fertility specialist:
1 History: including age, menstrual history, pregnancies and fertility wishes.
2 Cancer: type, location, stage, prognosis and proposed treatment.
3 Time available for fertility preservation.
4 Patient’s general condition and medical history.
5 Baseline ovarian reserve (anti‐Müllerian hormone and antral follicle count).
6 Fertility preservation funding.
The available fertility preservation options are given in Table 10.1.
Table 10.1 Fertility preservation options according to gender and age at cancer presentation.
| Group | Fertility preservation options | Comments |
|---|---|---|
| Prepubertal girls | Laparoscopic removal and cryopreservation of ovarian tissue for transplantation when fertility is required | Transplantation carries a theoretical risk of reintroduction of cancer cells IVM may become a viable option in the future Consenting issues in minors |
| Postpubertal girls | COS, and preservation of oocytes Ovarian tissue cryopreservation for transplantation when fertility is required. GnRH agonist co‐treatment during chemotherapy | COS introduces delay in cancer treatment |
| Women | COS, and preservation of oocytes or embryos. Ovarian tissue cryopreservation for transplantation when fertility is required. GnRH agonist co‐treatment during chemotherapy | Sperm required for the creation of embryos If the male withdraws consent in the future, the woman is unlikely to be able to use the embryos (see Chapter 108) |
| Prepubertal boys | No established procedures | Experimental: stem cell extraction and later repopulation of the testis |
| Postpubertal boys | Electro‐ejaculation or masturbatory ejaculation and sperm banking SSR and sperm banking | Consenting issues in minors |
| Men | Ejaculatory sperm banking SSR and sperm banking (see Chapter 91) |
COS, controlled ovarian stimulation; GnRH, gonadotropin releasing hormone; IVM, in vitro maturation; SSR, surgical sperm retrieval.
