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Updated: Sep 4, 2025
Fertility Preservation in Patients with Severe Ovarian Dysfunction
Published on: March 25, 2021
Fertility preservation for patients with melanoma
Francesca Filippi1, Nicole Serra1,2, Paola Vigano1
1Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.
Abstract:
The advent of immunotherapy and targeted therapy has outstandingly improved the prognosis in subjects with melanoma. Their use is now advocated also in earlier stages as an adjuvant therapy, and some neoadjuvant clinical trials are ongoing. Consequently, survivors free of disease are increasing, as well as those exposed to these new agents. Parenthood in survivors is, therefore, receiving growing interest. Evidence on the effects of immunotherapy and targeted therapy on future fertility is limited, but not entirely reassuring, in particular for immunotherapy. The necessity of delaying pregnancy seeking up to the end of treatments and follow-up (iatrogenic aging) is an additional albeit neglected source of concern, in particular for women in their late 30s. Subjects with melanoma should be informed on the multifaceted issue of future fertility at the time of cancer diagnosis. Available options of fertility preservations, including sperm and oocytes storage, should also be discussed, especially considering that at the age 0-39, melanoma represents the second most frequent neoplasia. In the decision-making process, most attention should be given to sex, age, and exposure to immunotherapy.
Insights
Melanoma survivors treated with new therapies face fertility concerns. Discussing fertility preservation options like sperm and oocyte storage is crucial for patients, especially women.
Area of Science:
- Oncology
- Reproductive Medicine
- Dermatology
Background:
- Immunotherapy and targeted therapy have improved melanoma prognosis, increasing the number of survivors.
- These treatments are increasingly used in earlier stages of melanoma, including neoadjuvant and adjuvant settings.
- The growing population of melanoma survivors raises interest in their reproductive health and future fertility.
Purpose of the Study:
- To review the current evidence on the effects of immunotherapy and targeted therapy on fertility in melanoma survivors.
- To highlight the importance of discussing fertility preservation options with patients diagnosed with melanoma.
- To address the impact of treatment delays (iatrogenic aging) on fertility, particularly for older women.
Main Methods:
- Literature review of studies investigating the impact of melanoma treatments on fertility.
- Analysis of data regarding fertility preservation techniques relevant to melanoma patients.
- Consideration of factors influencing fertility decisions, including age, sex, and treatment type.
Main Results:
- Limited but concerning evidence exists regarding the effects of immunotherapy and targeted therapy on fertility.
- Immunotherapy, in particular, raises concerns about future reproductive capacity.
- Delayed pregnancy seeking due to treatment and follow-up schedules (iatrogenic aging) is a significant concern, especially for women in their late 30s.
Conclusions:
- Melanoma patients should be comprehensively informed about fertility issues at diagnosis.
- Fertility preservation options, such as sperm and oocyte storage, should be discussed proactively.
- Key factors in decision-making include patient's sex, age, and specific treatment exposure, particularly immunotherapy.
