Fertility preservation for female cancer patients prior to cancer therapy has emerged as an essential component of comprehensive patient care. In the US, approximately 6% of women diagnosed with invasive cancer between 2007 and 2011 that were under 45 years old. The incidence of cancers in reproductive age women signifies a need for fertility preservation options and this need is increasing with the current trend of delayed childbearing and increasing cancer survival. Cancer treatment is cytotoxic and may result in complete or partial ovarian failure with subsequent subfertility and premature menopause. Studies indicate that alkylating agents are particularly gonadotoxic with significantly diminished ovaries response.Pelvic radiation therapy is also highly gonadotoxic to oocyte. Multiple strategies are available to preserve fertility in these patients including embryo and oocyte cryopreservation, cortical and whole ovary cryopreservation, ovarian transplantation, ovarian transposition, IVM and ovarian suppression with GnRH-a controlled ovarian stimulation (COS) for oocyte/embryo cryopreservation is still the preferred method for fertility preservation due to higher success compared to other technologies. Preserving a woman’s fertility requires time for ovarian stimulation and oocyte retrival which would delay life saving cancer therapy. Ovarian hyper stimulation syndrome an iatrogenic sequelae of COS and in cancer patients if OHSS develops it can cause the delay in cancer treatment. Thromboembolic events are one of the most concerning events as patients with aneoplam inherently have a hypercoagulable state that poses and increased risk of morbidity and mortality. Elevated serom stradiol levels as a result of COS with gonadotropins may promote growth of tumors in estrogen sensitive cancers. For all the above problems we discuss about random start protocols and for the patient with estrogen sensitive cancer, we use natural cycle-aromatase inhibitors-tamoxifen and combined tamoxifen and gonadotropins. Recent data suggest that GnRH-a used to stimulate endogenous LH surge for oocyte maturation results in reduced risk of OHSS. For prevention of embolism we can use anticoagulant such as low molecular weight heparin.
Materials and methods