Strategies for fertility preservation and gonadal protection during gonadotoxic chemotherapy and radiotherapy

With the recent report of a pregnancy and delivery after autotransplantation of cryopreserved-thawed ovarian cortical strips, preservation of the reproductive potential resurfaced. There is a growing academic and public interest in exploring the available strategies for fertility preservation in patients at risk. This is due to the increasing incidence of cancer during the reproductive age. The overall survival and cure rates of reproductive age cancers are improving due to improvements in cancer therapy. Reproductive derangement is one of the major consequences of cytotoxic chemotherapy and radiotherapy. GnRh analogues concomitant therapy, laparoscopic ovarian transposition, oocyte cryopreservation, embryo cryopreservation and transplantation of cryopreserved-thawed ovarian tissue, are all strategies for fertility preservation in patients at risk. However, no evidence-based strategy is available yet. This article discusses the mechanisms of reproductive failure after gonadotoxic therapy and the currently available fertility preservation strategies.