[Breast cancer and fertility: critical review, considerations and perspectives]

In young breast cancer patients, adjuvant therapies may have some impact on fertility and ovarian function. Adjuvant chemotherapy can induce ovarian failure, which depends on age, type and dose of cytotoxic agents and must be discussed with patients. A variety of techniques of fertility preservation were recently proposed in cancer patients, namely embryo cryopreservation, oocyte cryopreservation, cryopreservation of ovarian tissue, and coprescription of LH-RH analogues during chemotherapy. These experimental techniques are reviewed, and their use in women with breast cancer is discussed, especially with regards of hormonal aspects. Infertility approach after breast cancer is complex and requires a careful analysis by both oncologists and fertility specialists. The age of woman, and a precise evaluation of her ovarian reserve are key factors to determine the options available. Alternatives to hormonal stimulation may sometimes be useful, and must be proposed. The problem of ovarian stimulation after breast cancer is discussed, as the use of Assisted Reproduction Techniques such as in vitro fertilisation, oocyte donation, and embryo donation.