The approach to fertility preservation in a single oncofertility centre

Abstract

Background: The number of young female cancer survivors is increasing due to advances in cancer therapies, but many face infertility as a result of treatment. These fertility issues are often inadequately addressed. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer treatment and to facilitate fertility preservation including oocyte and ovarian tissue cryopreservation. The aim of this study was to report 2 years’ experience from the San Raffaele Oncofertility Unit. Patients and methods: Data from patients treated from April 2011 to September 2013 were analysed. Results: Sixty-one patients (mean age 26 years; range 3–46). were referred for evaluation to San Raffaele Oncofertility Unit after cancer diagnosis and before gonadotoxic treatment. Twenty-two patients (36%) were affected by breast cancer, 15 (24.6%) by sarcomas, 10 (16.4%) by haematological malignancies, 10 (16.4%) by central nervous system cancers, 3 (4.9%) by bowel tumours and 1 (1.6%) by Wilms tumour. Twenty-four patients were given the option of oocyte cryopreservation before starting chemotherapy; mean level of antimullerian hormone was 1.7 ng/mL (range 0.1–7.8). Four patients failed the procedure, while in 20 patients, a mean number of 7.5 (range 1–21) cryopreserved oocytes was obtained. The mean number of days between patient counselling and oocyte retrieval was 17 (range 2–37). Sixteen patients (26.2%) underwent ovarian tissue cryopreservation. Mean number of days from laparoscopic surgery to the beginning of chemotherapy/radiotherapy was 4 days (range 2–10). Twentyone patients (34.4%) were not recruited for fertility preservation techniques. Conclusions: Fertility preservation should be considered an essential component of the patient’s treatment plan. A multidisciplinary approach, with constant interaction among the treating oncologist, reproductive gynaecologist and support professionals, is important for prompt referral and treatment.