Background: Fertility preservation before or during cancer treatment in young women has become an important health issue because of delayed motherhood and improved survival rates. This study evaluates the necessity and the efficacy of fertility preservation, with a focus on actual pregnancy wish and outcome after fertility preservation and cancer treatment. Patients and Methods: All consecutive patients who received fertility preservation in 2 university referral centers before or during cancer treatment were included. After a minimal follow-up of 3 years, pregnancy wish, pregnancy attempts and fertility outcome were assessed during a dedicated consultation or during a telephone interview. Results: A total of 159 patients received fertility preservation including hormonal protection with gonadotropin-releasing hormone agonist (n = 93, 58.5%), ovarian tissue cryopreservation (n = 44, 27.7%), and combined hormonal protection and ovarian tissue cryopreservation (n = 22, 13.8%). Among the 91 (57.2%) patients in remission after a mean follow-up of 61.5 months, 29 (31.9%) women actively attempted pregnancy. Patients who had received ovarian cryopreservation were more likely to attempt pregnancy (18/66) than those who only received hormonal protection (11/93, p = 0.02). Out of the 29 women who attempted pregnancy, 16 (55.2%) became pregnant, and most of them conceived spontaneously (87.5%, 14/16). Out of the 13 women who did not become pregnant, 1 patient adopted a child and 12 patients still wanted to become pregnant, including 1 patient who underwent a transplantation of her cryopreserved ovarian tissue without success. Conclusion: In one of the first studies reporting real-life experience in centers for fertility preservation, we found that, within 5 years following the end of cancer treatment, only one third of patients in remission attempted to become pregnant, with a pregnancy rate of 55%, mostly after spontaneous conception.

Marhhom E, Cohen I: Fertility preservation options for women with malignancies. Obstet Gynecol Surv 2007;62:58-72.
Donnez J, Martinez-Madrid B, Jadoul P, et al: Ovarian tissue cryopreservation and transplantation: a review. Hum Reprod Update 2006;12:519-535.
Peccatori FA, Azim HA Jr, Orecchia R, et al: Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(suppl 6):vi160-vi170.
Moore HC, Unger JM, Phillips KA, et al: Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015;372:923-932.
Lambertini M, Ceppi M, Poggio F, et al: Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: a meta-analysis of randomized studies. Ann Oncol 2015;26:2408-2419.
Urruticoechea A, Arnedos M, Walsh G, et al: Ovarian protection with goserelin during adjuvant chemotherapy for pre-menopausal women with early breast cancer (EBC). Breast Cancer Res Treat 2008;110:411-416.
Badawy, Elnashar A, El-Ashry M, et al: Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril 2009;91:694-697.
Clowse ME, Behera MA, Anders CK, et al: Ovarian preservation by GnRH agonists during chemotherapy: a meta-analysis. J Womens Health (Larchmt) 2009;18:311-319.
Munster PN, Moore AP, Ismail-Khan R, et al: Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. J Clin Oncol 2012;30:533-538.
Gerber B, von Minckwitz G, Stehle H, et al: Effect of luteinizing hormone-releasing hormone agonist on ovarian function after modern adjuvant breast cancer chemotherapy: the GBG 37 ZORO study. J Clin Oncol 2011;29:2334-2341.
Del Mastro L, Boni L, Michelotti A, et al: Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA 2011;306:269-276.
De Vos M, Smitz J, Woodruff TK: Fertility preservation in women with cancer. Lancet 2014;384:1302-1310.
Schmidt KT, Larsen EC, Andersen CY, Andersen AN: Risk of ovarian failure and fertility preserving methods in girls and adolescents with a malignant disease. BJOG 2010;117:163-174.
Mispelaere B, Van de Werf E, et al: Reproduction rates after cytotoxic therapy. J Clin Oncol 2009;27:e118-e119; author reply e120.
Sobota A, Ozakinci G: Fertility and parenthood issues in young female cancer patients - a systematic review. J Cancer Surviv 2014;8:707-721.
Demeestere I, Simon P, Moffa F, et al: Birth of a second healthy girl more than 3 years after cryopreserved ovarian graft. Hum Reprod 2010;25:1590-1591.
Müller A, Keller K, Wacker J, et al: Retransplantation of cryopreserved ovarian tissue: the first live birth in Germany. Dtsch Arztebl Int 2012;109:8-13.
Donnez J, Jadoul P, Pirard C, et al: Live birth after transplantation of frozen-thawed ovarian tissue after bilateral oophorectomy for benign disease. Fertil Steril 2012;98:720-725.
Hubinont C, Debieve F, Biard JM, Bernard P: Livebirth after cryopreserved ovarian tissue transplantation. Lancet 2012;380:106; author reply 107; discussion 107-108.
Dominick SA, Whitcomb BW, Gorman JR, et al: Factors associated with pregnancy attempts among female young adult cancer survivors. J Cancer Surviv 2014;8:571-579.
Wong M, O'Neill S, Walsh G, et al: Goserelin with chemotherapy to preserve ovarian function in pre-menopausal women with early breast cancer: menstruation and pregnancy outcomes. Ann Oncol 2013;24:133-138.
Greve T, Schmidt KT, Kristensen SG, et al: Evaluation of the ovarian reserve in women transplanted with frozen and thawed ovarian cortical tissue. Fertil Steril 2012;97:1394-1398.e1.
Bastings L, Beerendonk CC, Westphal JR, et al: Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review. Hum Reprod Update 2013;19:483-506.
Imbert R, Moffa F, Tsepelidis S, et al: Safety and usefulness of cryopreservation of ovarian tissue to preserve fertility: a 12-year retrospective analysis. Hum Reprod 2014;29:1931-1940.
Koskas M, Bendifallah S, Luton D, et al: Independent external validation of radiotherapy and its impact on the accuracy of a nomogram for predicting survival of women with endometrial cancer. Gynecol Oncol 2011;123:214-220.
Schubert B, Canis M, Darcha C, et al: Follicular growth and estradiol follow-up after subcutaneous xenografting of fresh and cryopreserved human ovarian tissue. Fertil Steril 2008;89:1787-1794.
von Wolff M, Dittrich R, Liebenthron J, et al: Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women. Reprod Biomed Online 2015;31:605-612.
Gurgan T, Salman C, Demirol A: Pregnancy and assisted reproduction techniques in men and women after cancer treatment. Placenta 2008;29(suppl B):152-159.
Schmidt KT, Nyboe Andersen A, Greve T, et al: Fertility in cancer patients after cryopreservation of one ovary. Reprod Biomed Online 2013;26:272-279.
van der Kaaij MA, van Echten-Arends J, Simons AH, Kluin-Nelemans HC: Fertility preservation after chemotherapy for Hodgkin Lymphoma. Hematol Oncol 2010;28:168-179.
Loren AW, Mangu PB, Beck LN, et al: Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013;31:2500-2510.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.