I-22: Fertility Preservation and Ovarian Stimulation in Cancer Patients

Cancer is not uncommon and no longer considered to be an incurable disorder. 10% of cancer cases occur under the age of 45. There is a remarkable improvement in treatment and survival rates. Today women have been delaying initiation of childbearing because the incidence of most cancers increases with age. Delayed childbearing results in more female cancer survivors. As a consequence there is an increase in the number of patients surviving cancer interested in fertility preservation. There are strategies aiming to preserve fertility in women with different types of cancers these include oocyte and embryo cryopreservation, cortical and whole ovary cryopreservation, ovarian transplantation, ovarian transposition, and GnRH agonist protection. Embryo or oocyte cryopreservation is the most preferred option for fertility preservation in cancer patients, due to its higher success rates. And other modalities are more experimental. Malignancy affects other tissues throughout the body and can result in a variety of complications during ovarian stimulation. Ovarian stimulation protocol and gonadotropin dose requires an individualized approach. There are mixed reports about how cancer patients respond to the ovarian stimulation but it seems risk of inadequate response leading to cycle cancellation is higher in these patients. In patients with diminished ovarian reserve higher doses of gonadotropins required. Different simulation protocols are proposes, majority of them treated with a GnRH antagonist. Some cases, owing to the urgency of the cancer treatment should not to wait for the next menstrual cycle, so random-start stimulation protocols have been suggested. During ovarian stimulation, a potential risk that the higher Estrogen evels may have adverse affect on the Estrogen -sensitive tumors. This lecture highlights the new stimulation protocols and strategies aiming to reduce time constraints and emphasizes management considerations to reduce complications.