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Abstract
High-dose chemotherapy and radiotherapy has increased long-term survival of young
patients with cancer. Sometimes however, the price paid is ovarian failure and sterility.
It is highly important to detect who are the patients at risk in order to verify when
fertility preservation is indicated. With conventional chemotherapy, there is significant
differences in ovarian failure rate according to patients age, disease for which patients
are treated for, and the drugs used. Bone marrow transplantation in cancer patients
almost invariably induced ovarian failure, irrespective of patient age, treatment
protocol or administration of hormonal treatment. Moreover, normal reproductive parameters
post-chemotherapy does not necessarily imply that the ovaries escaped damage; ovarian
injury is not an all or none phenomenon--partial loss of primordial follicle reserve
can result in premature menopause as a delayed reaction to treatment. This should
be taken into account while consulting former cancer patients about future planed
pregnancies. The direct mechanisms of chemotherapy induced ovarian failure are poorly
understood. An in vitro study has demonstrated that in the human ovary chemotherapy
acts primarily on primordial follicles through induction of apoptotic changes in pregranulosa
cells which lead to follicle loss. Protecting fertility potential in females exposed
to chemotherapy with IVF and embryo cryopreservation or cryopreservation of ovarian
tissue is practiced. Ovarian tissue cryopreservation: A recent study has demonstrated
that laparoscopic ovarian biopsy performed with the round biopter is a safe and efficient
method for collecting ovarian tissue for cryopreservation in cancer patients. In order
to avoid possible hazards of transferring malignant cells, genetic and immunohistochemical
markers for detection of minimal residual cancer cells in ovarian tissue are currently
used. However, the reproductive potential of this method is still questionable. IVF:
IVF and embryocryopreservation is currently used in infertile patients, however, several
obstacles prevent it's wide implementation in cancer patients such as the need for
male partner and the time needed for ovarian stimulation. A highly important issue
is the possible risk of performing IVF and embryo cryopreservation to preserve fertility
in females already exposed to chemotherapy. An animal study has raised serious concerns
regarding the consequences of chemotherapy on future pregnancies. High abortion and
malformation rates related to the different stages of oocyte maturation at the time
of exposure to chemotherapy were demonstrated. These results should be taken into
account when considering the use of IVF and embryo cryopreservation following chemotherapy
treatment in cancer patients.