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Review article: Biomedical intelligence

Vol. 142 No. 3940 (2012)

Fertility preservation in cancer patients

  • Dorothea Wunder
  • Lucien Perey
Cite this as:
Swiss Med Wkly. 2012;142:w13645


Due to constant progress in oncology, survival rates of patients (children and adults) with cancer are increasing. Consequently, the reproductive future of young cancer patients needs to be addressed carefully. Fertility preservation techniques are available and issues such as the time available for fertility treatments, patients’ age, presence of a partner and patients’ personal wishes have to be considered.

In Switzerland, a first therapeutic network (Réseau Romand de Cancer et Fertilité), was created in the French speaking part of Switzerland in 2006. Since 2010, a global Swiss network (FertiSave) has been created. The goal of these networks is to maximise the safety and efficacy of fertility preservation options offered to cancer patients without compromising their oncological prognosis. Patients’ needs have to be identified, the therapeutic options evaluated rapidly and the optimal treatment promptly implemented in these urgent situations.

This article reviews the fertility preservation options currently available and makes recommendations for different specific cancer situations, consistent with the latest scientific evidence and in general agreement with international recommendations.


  1. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. J Clin Oncol. 2006;24:2917–31.
  3. Besse D, Bellavia M, de Ziegler D, Wunder D. Fertility and cancer: psychological support in young women who contemplate emergency assisted reproductive technologies (ART) prior to chemo- and/or radiation-therapy. Swiss Med Wkly. 2010;140:w13075. doi: 10.4414/smw.2010.13075.
  4. Von Wolff M, Montag M, Dittrich R, Denschlag D, Nawroth F, Lawrenz B. Fertility preservation in women – a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network Fertiprotekt. Arch Gynecol Obstet. 2011;284:427–35.
  5. Hawkins MM. Pregnancy outcome and offspring after childhood cancer. BMJ. 1994;309:1034.
  6. Swiss Law of Assisted Reproductive Technologies:
  7. Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. Clin Oncol. 2008;26(16):2630–5.
  8. Rodriguez-Wallberg KA, Oktay K. Fertility preservation in women with breast cancer. Clin Obstet Gynecol. 2010;53(4):753–62.
  9. Cobo A, Bellver J, Domingo J, Pérez S, Crespo J, Pellicer A, Remohí J. New options in assisted reproduction technology: the cryotop method of oocyte vitrification. Reprod Biomed Online. 2008;17(1):68–72.
  10. Dolmans MM, Marinescu C, Saussoy P, Van Langendonckt A, Amorim C, Donnez J. Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe. Blood. 2010;116(16):2908–14.
  11. Sanchez-Serrano M, Crespo J, Mirabet V, Cobo AC, Escriba MJ, Simon C, Pellicer A. Twins born after transplantation of ovarian cortical tissue and oocyte vitrification. Fertil Steril. 2010;93:268.e11-e.13.
  12. Rosendahl M, Timmermans Wielinga V, Nedergaard L, Kristensen SG, Ernst E, Rasmussen PE, et al. Cryopreservation of ovarian tissue for fertility preservation: no evidence of malignant cell contamination in ovarian tissue from patients with breast cancer. Fertil Steril. 2011;95:2158–61.
  13. Rosendahl M, Andersen CY, Ernst E, Westergaard LG, Rasmussen PE, Loft A, Andersen AN. Ovarian function after removal of an entire ovary for cryopreservation of pieces of cortex prior to gonadotoxic treatment: a follow up study. Hum Reprod. 2008;23:2475–83.
  14. Kim SS, Klemp J, Fabian C. Breast cancer and fertility preservation. Fertil Steril. 2011;95:1535–43.
  15. Dittrich R, Lotz L, Keck G, Hoffmann I, Mueller A, Beckmann MW, van der Ven H, Montag M. Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation. Fertil Steril. 2012;97:387–90.
  16. Oktay K. Spontaneous conceptions and live birth after heterotopic ovarian transplantation: is there a germline stem cell connection? Hum Reprod. 2006;21:1345–8.
  17. Blumenfeld Z, Avivi I, Eckman A, Epelbaum R, Rowe JM, Dann EJ. Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma. Fertil Steril. 2008;89:166–73.
  18. Oktay K, Sönmezer M, Oktem O, Fox K, Emons G, Bang H. Absence of conclusive evidence for the safety and efficacy of gonadotropin-releasing hormone analogue treatment in protecting against chemotherapy-induced gonadal injury. Oncologist. 2007;12:1055–66.
  19. Oktay K, Briggs D, Gosden RG. Ontogeny of follicle-stimulating hormone receptor gene expression in isolated human ovarian follicles. J Clin Endocrinol Metab. 1997;82:3748–51.
  20. Oktay K, Sönmezer M. Gonadotropin-releasing hormone analogs in fertility preservation: lack of biological basis? Nat Clin Pract Endocrinol Metab. 2008;4(9):488–9.
  21. Waxman JH, Ahmed R, Smith D, Wrigley PF, Gregory W, Shalet S, et al. Failure to preserve fertility in patients with Hodgkin’s disease. Cancer Chemother Pharmacol. 1987;19:159–62.
  22. Ismail-Khan R, Minton S, Cox C. Preservation of ovarian function in young women treated with neoadjuvant chemotherapy for breast cancer: A randomized trial using the GnRH agonist (triptorelin) during chemotherapy. J Clin Oncol. 2008;26:12(abstr 524).
  23. Badawy A, Elnashar A, El-Ashry M, Shahat M. Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril. 2009;91(3):694–7.
  24. Sverrisdottir A, Nystedt M, Johansson H, Fornander T. Adjuvant goserelin and ovarian preservation in chemotherapy treated patients with early breast cancer: results from a randomized trial. Breast Cancer Res Treat. 2009;117(3):561–7.
  25. Bedaiwy MA, Abou-Setta AM, Desai N, Hurd W, Starks D, El-Nashar SA, et al. Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis. Fertil Steril. 2011;95:906–14.
  26. Kim SS, Lee JR, Jee BC, Suh CS, Kim SH, Ting A, et al. Use of hormonal protection for chemotherapy-induced gonadotoxicity. Clin Obstet Gynecol. 2010;53:740–52.
  27. Kim SS, Klemp J, Fabian C. Breast cancer and fertility preservation. Fertil Steril. 2011;95:1535–43.
  28. Bloemers MC, Portelance L, Legler C, Renaud MC, Tan SL. Preservation of ovarian function by ovarian transposition prior to concurrent chemotherapy and pelvic radiation for cervical cancer. A case report and review of the literature. Eur J Gynecol Oncol. 2010;31:194–7.
  29. Bishara M, Tlandi T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol. 2003;188:367–70.
  30. Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys. 2009;73:1304–12.
  31. Brougham MFH, Wallace WHB. Subfertility in children and young people treated for solid and haematological malignancies. Br J Haematol. 2005;131:143–55.
  32. Dursun P, Ayhan A, Yanik FB, Kuşçu E. Ovarian transposition for the preservation of ovarian function in young patients with cervical carcinoma. Eur J Gynaecol Oncol. 2009;30:13–5.
  33. Huober-Zeeb C, Lawrenz B, Popovici RM, Strowitzki T, Germeyer A, Stute P, et al. Improving fertility preservation in cancer: Ovarian tissue cryobanking followed by ovarian stimulation can be efficiently and safely combined. Fertil Steril. 2011;95(1):342–4.
  34. Broer SL, Dólleman M, Opmeer BC, Fauser BC, Mol BW, Broekmans FJ. AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis. Hum Reprod Update. 2011;17:46–54.
  35. Lie Fong S, Lugtenburg PJ, Schipper I, Themmen AP, de Jong FH, Sooneveld P, et al. Anti-müllerian hormone as a marker of ovarian function in women after chemotherapy and radiotherapy for haematological malignancies. Hum Reprod. 2008:23(3):674–8.
  36. Azem F, Samara N, Cohen T, Ben-Yosef D, Almog B, Lessing JB, et al. Assessment of ovarian reserve following ovarian tissue banking and/or GnRH-a co-treatment prior to chemotherapy in patients with Hodgkin’s disease. J Assist Reprod Genet. 2008;25:535–8.
  37. De la Haba-Rodríguez J, Calderay M. Impact of breast cancer treatment on fertility. Breast Cancer Res Treat. 2010;123:59–63.
  38. Ganz PA, Land SR, Geyer CE Jr, Cecchini RS, Costantino JP, Pajon ER, et al. Menstrual history and quality-of-life outcomes in women with node-positive breast cancer treated with adjuvant therapy on the NSABP B-30 trial. J Clin Oncol. 2011;29:1110–6.
  39. Morice P. Borderline tumours of the ovary and fertility. Eur J Cancer. 2006;42(2):149–58.
  40. Fortin A, Morice P, Thoury A, Camatte S, Dhainaut C, Madelenat P. Impact of infertility drugs after treatment of borderline ovarian tumors: results of a retrospective multicenter study. Fertil Steril. 2007;87(3):591–6.
  41. Uzan C, Kane A, Rey A, Gouy S, Duvillard P, Morice P. Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary. Ann Oncol. 2010;21(1):55–60.
  42. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. 1992;136(10):1184–203.
  43. Brinton L. Long-term effects of ovulation-stimulating drugs on cancer risk. Reprod Biomed Online. 2007;15(1):38–44.
  44. Brinton LA, Lamb EJ, Moghissi KS, Scoccia B, Althuis MD, Mabie JE, Westhoff CL. Ovarian cancer risk after the use of ovulation-stimulating drugs. Obstet Gynecol. 2004;103(6):1194–203.
  45. Plante M, Renaud MC, Roy M. Radical vaginal trachelectomy: a fertility-preserving option for young women with early stage cervical cancer. Gynecol Oncol. 2005;99(3 Suppl 1):S143–6.
  46. Chen Y, Xu H, Zhang Q, Li Y, Wang D, Liang Z. A fertility-preserving option in early cervical carcinoma: laparoscopy-assisted vaginal radical trachelectomy and pelvic lymphadenectomy. Eur J Obstet Gynecol Reprod Biol. 2008;136(1):90–3.
  47. Dursun P, LeBlanc E, Nogueira MC. Radical vaginal tracelectomy (Dargent’s operation): a critical review of the literature. Eur J Surg Oncol. 2007;33(8):933–41.
  48. Beiner ME, Covens A, Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer. Nat Clin Pract Oncol. 2007;4(6):353–61.
  49. Ushijma K, Yahata H, Yoshikawa H, Konishi I, Yasugi T, Saito T, et al. Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol. 2007;25(19):2798–803.
  50. Shalitin S, Phillip M, Stein J, Goshen Y, Carmi D, Yaniv I. Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence. Bone Marrow Transplant. 2006;37:1109–17.
  51. Meirow D, Hardan I, Dor J, Fridman E, Elizur S, Ra’anani H, et al. Searching for evidence of disease and malignant cell contamination in ovarian tissue stored from hematologic cancer patients. Hum Reprod. 2008;23:1007–13.
  52. Hodgson DC, Pintille M, Gitterman L, De Witt G, Buckley CA, Ahmed S, et al. Fertility among female Hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol. 2007;25:11–5
  53. Elis A, Tevet A, Yerushalmi R, Blickstein D, Bairy O, Dann EJ, et al. Fertility status among women treated for aggressive non-Hodgkin’s lymphoma. Leuk & Lymph. 2006;47(4):623–7.
  54. Behringer K, Breuer K, Reineke T, May M, Nogova L, Klimm B, et al. Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: A repport from the German Hodgkin’s lymphoma study group. JCO. 2005;23:7555–64.
  55. Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe JM. Fertility after treatment for Hodgkin’s disease. Ann Oncol. 2002;13(Suppl 1):138–47.
  56. Blumenfeld Z, Avivi I, Eckman A, Epelbaum R, Rowe JM, Dann EJ. Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin Lymphoma. Fertil Steril. 2008;89(1):166–78.
  57. Behringer K, Wildt L, Mueller H, Mattle V, Ganitis P, van den Hoonaard B, et al. No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group. Ann Oncol. 2010;2:2052–60.
  58. Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009;360:902–11.
  59. Poirot CJ, Martelli H, Genestie C, Golmard JL, Valteau-Couanet D, Helardot P, et al. Feasibility of ovarian tissue cryopreservation for prepubertal females with cancer. Pediatr Blood Cancer. 2007;49:74–8.
  60. Oktay K, Oktem O.Fertility preservation medicine: a new field in the care of young cancer survivors. Pediatr Blood Cancer. 2009;53:267–73.
  61. Wyns C Curaba M, Vanabelle B, Van Langendonckt A, Donnez J. Options for fertility preservation in prepubertal boys. Hum Reprod Update. 2010;3:312–28.