Since the improvement of cancer diagnosis and treatment, survival rates of these patients increase. Gonadal damages are frequent consequences of cancer treatments with different evidence of impaired fertility. In this context, fertility preservation should be proposed to patients exposed to potentially gonadotoxic treatments. Different preservation approaches may be proposed depending on patient age, sex, cancer type and type of treatment. The indications of fertility preservation depend on sexual maturity. In young girls, ovarian cortex cryopreservation is the only technique feasible in order to preserve their reproductive potential. Vitrification of oocytes which needs ovarian stimulation or oocytes in vitro maturation is becoming more commonly performed for pubertal women to preserve their fertility. Ovarian cortex freezing could be offered to emergency fertility preservation of adult female cancer patients. In prepubertal boys, testicular tissue cryopreservation is the only line treatment for fertility preservation. For future use, various approaches are being evaluated such as spermatogonial stem cell injection or in vitro maturation. Cryopreservation of spermatozoa is, today, an established and successful technique for male adults. When there are no spermatozoa in ejaculate, sperm can be retrieved after treatment of testicular biopsy. The French bioethics law clearly indicates that fertility preservation should be proposed to patients exposed to potentially gonadotoxic treatment. Today, many approaches are possible. Fertility preservation indications are based on multidisciplinary consultations within platforms for the fertility preservation in order to optimize the patient care.
Bulletin du cancer. 2017 Dec 05 [Epub ahead of print]
Laure Chaput, Anne-Sophie Grémeau, Solène Vorilhon, Hanae Pons, Cécile Chabrot, Victoria Grèze, Jean-Luc Pouly, Florence Brugnon
CHU de Clermont-Ferrand, service de biologie et médecine de la reproduction, AMP-CECOS, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: ., CHU de Clermont-Ferrand, service de biologie et médecine de la reproduction, AMP-CECOS, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France., CHU de Clermont-Ferrand, service de biologie et médecine de la reproduction, AMP-CECOS, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France; CHU de Clermont-Ferrand, université Clermont Auvergne, Inserm, U1240 imagerie moléculaire et stratégies théranostiques, 63000 Clermont-Ferrand, France., CHU de Clermont-Ferrand, service de thérapie cellulaire et hématologie clinique, site Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France. Electronic address: ., CHU de Clermont-Ferrand, service d'hématologie et d'oncologie pédiatrique, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: .