Fertility preservation options in breast cancer patients

Abstract

The purpose of this review is to analyse current options for fertility preservation in young women with breast cancer (BC). Considering an increasing number of BC survivors, owing to improvements in cancer treatment and delaying of childbearing, fertility preservation appears to be an important issue. Current fertility preservation options in BC survivors range from well-established standard techniques to experimental or investigational interventions. Among the standard options, random-start ovarian stimulation protocol represents a new technique, which significantly decreases the total time of the in vitro fertilisation cycle. However, in patients with oestrogen-sensitive tumours, stimulation protocols using aromatase inhibitors are currently preferred over tamoxifen regimens. Cryopreservation of embryos and oocytes are nowadays deemed the most successful techniques for fertility preservation in BC patients. GnRH agonists during chemotherapy represent an experimental method for fertility preservation due to conflicting long-term outcome results regarding its safety and efficacy. Cryopreservation of ovarian tissue, in vitro maturation of immature oocytes and other strategies are considered experimental and should only be offered within the context of a clinical trial. An early pretreatment referral to reproductive endocrinologists and oncologists should be suggested to young BC women at risk of infertility, concerning the risks and benefits of fertility preservation options.

Chinese abstract

本文旨在分析目前针对年轻乳腺癌患者生殖力保护的选择方法。由于癌症治疗技术的进步及延迟生育，越来越多的乳腺癌似乎应将其生殖力保护视为一项重要的问题。目前乳腺癌幸存者生殖力保护的选择范围囊括了完善的标准技术及实验性或临床性干预研究。标准方法中，随机启动卵巢刺激方案作为一项新技术可显著降低体外受精周期的总体时长。然而，目前对于雌激素敏感的肿瘤患者，使用芳香化酶抑制剂刺激方案优于接受他莫昔芬治疗。胚胎和卵母细胞冻存被认为是当今乳腺癌患者生殖力保护最成功的技术。由于应用GnRH激动剂的远期疗效尚存争议，且考虑其安全性和有效性，目前将化疗期间应用GnRH激动剂视为患者生殖力保护的实验性方法。卵巢组织冻存、卵母细胞体外成熟技术及其他技术都处于实验性阶段，且仅处于临床试验范围内。对于存在不孕不育风险的年轻乳腺癌患者，在权衡生殖力保护方法利弊后，应给予早期及时转至生殖内分泌专家和肿瘤学专家进行诊治。

• Breast cancer
• chemotherapy
• fertility preservation options
• young age

Declaration of interest

The authors report no declarations of interest.