Home

Loading...

Table of contents

Fertility preservation

What's new

Updated 2023 SOGC, 2020 ESMO, and 2020 ESHRE guidelines for fertility preservation in patients with cancer.

Background

Overview

Definition
Fertility preservation for patients with cancer is a therapeutic option designed to maximize the reproductive future of oncological patients, including oocyte/embryo cryopreservation for female patients and sperm cryopreservation for male patients.
1
2
Pathophysiology
Fertility preservation for patients with cancer is for female and male cancer patients at risk for infertility due to anticancer treatment.
3
4
Disease course
Fertility preservation techniques for females include embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (for pediatric and patients with hormone-dependent diseases), ovarian transposition (oophoropexy), fertoprotective adjuvant agents. Emerging techniques include activation of ovarian follicles, in vitro follicle culture, artificial ovaries, and specific target tissue drugs (nanoparticles, novel fertoprotective agents). Fertility preservation techniques for males include cryopreservation of spermatozoa and cryopreservation of SSC in prepubertal children.
1
2
Prognosis and risk of recurrence
Fertility preservation for patients with cancer is not associated with increased mortality.
5
6

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of fertility preservation are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023), the European Society of Human Reproduction and Embryology (ESHRE 2020), the European Society of Medical Oncology (ESMO 2020), the American Society of Clinical Oncology (ASCO 2018), and the ...
Show more

Classification and risk stratification

Risk assessment
As per ESHRE 2020 guidelines:
Obtain an individual assessment of the indications and risks before fertility preservation interventions. Ensure a multidisciplinary team approach for an accurate assessment of risks.
B
Assess the risk of gonadotoxicity in all patients undergoing gonadotoxic treatments, taking into consideration the characteristics of the proposed treatment, the patient, and the disease.
B
Create free account

Diagnostic investigations

Ovarian reserve testing: as per ESHRE 2020 guidelines, obtain antral follicle count or anti-Müllerian hormone level measurement for predicting high and low responses to ovarian stimulation.
B
Show 4 more

Medical management

Setting of care
As per ESMO 2020 guidelines:
Refer all patients with a potential interest in fertility preservation to an appropriate fertility specialist/unit.
B
Offer fertility preservation strategies preferably at the time of diagnosis before treatment initiation.
B

More topics in this section

  • Fertility preservation in females (oocyte/embryo cryopreservation)

  • Fertility preservation in females (ovarian tissue cryopreservation)

  • Fertility preservation in females (ovarian tissue retransplantation)

  • Fertility preservation in females (ovarian suppression)

  • Fertility preservation in females (aromatase inhibitors)

  • Fertility preservation in females (ovarian transposition)

  • Fertility preservation in females (in vitro oocyte maturation)

  • Fertility preservation in females (gonadal shielding)

  • Fertility preservation in males (sperm cryopreservation)

  • Fertility preservation in males (testicular tissue cryopreservation)

  • Fertility preservation in males (hormonal gonadoprotection)

  • Fertility preservation in males (gonadal shielding)

Specific circumstances

Pediatric patients
As per ASCO 2018 guidelines:
Consider offering established methods of fertility preservation, such as sperm or oocyte cryopreservation, in postpubertal minor pediatric patients, with appropriate patient assent and parent or guardian consent.
E
Recognize that the only available fertility preservation options for prepubertal minor pediatric patients are ovarian and testicular tissue cryopreservation, which are considered experimental.
E

More topics in this section

  • Patients with gynecologic malignancies

  • Patients with hereditary cancer syndromes

  • Patients with premature ovarian insufficiency

Patient education

General counseling: as per ESHRE 2020 guidelines, counsel patients with cancer eligible for fertility preservation regarding the following:
impact of cancer, other diseases and their treatments on reproductive function
impact of cancer, other diseases and their treatment on fertility
fertility preservation options
issues related to cryopreservation storage after fertility preservation
infertility and fertility treatments
pregnancy after gonadotoxic treatment or underlying condition
other childbearing and parenting options.
B
Show 3 more

Follow-up and surveillance

Pregnancy after cancer treatment: as per ESHRE 2020 guidelines, assess fitness for pregnancy, taking into account treatment late effects, the age of the patient, and the interval since treatment before the use of stored material.
B
Show 10 more