Fertility preservation in oncologic patients

Background: Advances in the diagnosis and treatment of malignancies in girls and young women had significantly increased survival rates, but surgical removal of the ovaries, potentially sterilizing radiotherapy or chemotherapy often result in premature ovarian failure, infertility and premature menopause. The degree of ovarian damage depends on the gonadotoxicity of chemotherapeutic agent and radiation dose, while surgical removal of the ovaries results in irreversible loss of ovarian function. Recently, with the purpose of fertility preservation, on one side, less radical surgical procedures in early stages of cancer are performed while on the other, advances in laboratory techniques in in vitro fertilization enable cryopreservation of own genetic material. Conclusions: While cryopreservation of embryos and oocytes is already an established and successful procedure, ovarian transplantation despite reports of livebirths following the transplantation - still remains at experimental stage. The indication for fertility preservation should take into account type of cancer, prognosis of the disease, age (<= 38 let), planned therapy, such as type of surgical procedure, gonadotoxicity of chemotherapeutic agents and irradiation dose, and therefore cooperation of oncologists, reproductive gynecologists and embryologists is mandatory, because each indication must be carefully taken into consideration.