Fertility preservation: nonsurgical and surgical options

Improved surveillance and treatment regimens have resulted in decreased mortality rates among cancer patients, allowing these women to focus on survival and quality of life, including the ability to preserve their fertility. The treatments that have improved survival among both adults and children diagnosed with cancer are often gonadotoxic, especially those that employ high doses of alkylating agents and radiation therapy directed near or toward the pelvis. The impact on the ovarian reserve is related to the accelerated depletion of the primordial germ cell pool resulting from these therapies. Nonsurgical approaches to fertility preservation, including embryo cryopreservation from in vitro fertilization, oocyte cryopreservation from controlled ovarian hyperstimulation, and in vitro maturation of oocytes, are discussed. Surgical approaches such as conservative gynecologic surgery, ovarian transposition, and ovarian tissue cryopreservation are reviewed. Guidelines from the American Society for Reproductive Medicine and the American Society of Clinical Oncology classify these treatments into established and experimental procedures, and they provide the practitioner with an optimal approach to preserve the fertility of these patients before the initiation of their cancer therapies.