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Early detection and aggressive chemotherapy/radiotherapy treatments have improved the long-term survival rates for many young women with various types of cancer. As a consequence of these cytotoxic treatments, their reproductive future can be either short lived or eradicated. For young single women with cancer, oocyte cryopreservation offers the best potential option for achieving a future pregnancy using their own gametes. Unfortunately, the urgent need to commence cytotoxic treatment often does not permit adequate time for cryopreservation of mature oocytes. Conversely, cryopreservation of ovarian tissue eliminates the delay necessary to obtain mature oocytes, but the subsequent potential for establishing pregnancy is currently unknown. Although ovarian tissue cryopreservation is an attractive alternative and frequently used for patients with these conditions, little has been published on the efficacy of various protocols. Cryopreservation of ovarian tissue is more complex than that of gametes or embryos, requiring preservation of multiple cell types, which may vary in volume and water permeability. Essentially, ovarian tissue cryopreservation is more similar to organ cryopreservation than to that of gametes or embryos.
This chapter focuses on patients with testicular cancer and lymphoma that generally affects younger patients in the reproductive window with an excellent overall survival. The chance of recovery of spermatogenesis depends on the chemotherapeutic regimen as well as the baseline function of the patient. The existence of a previously cryopreserved sperm greatly simplifies the algorithm for the post chemotherapeutic azoospermic man and, essentially, the couple can go directly to in vitro fertilization (IVF). Azoospermia after chemotherapy can be due to the patient's chemotherapeutic regimen, the use of radiation, the extent of surgery, the disease itself, the baseline function of the patient or any combination of the aforementioned factors. Additional counseling is recommended for those patients who choose the assistance of third-party reproduction. Gamete donation has made it possible for participants to cross generational lines and has raised many complicated ethical issues.
Pregnancies and live births from human cryopreserved in vitro fertilization (IVF) embryos provide proof of principle and lead to the adoption of embryo cryopreservation as a routine adjunct to IVF and embryo transfer (IVF/ET). Embryo cryopreservation is an essential tool when embryo transfer is not possible in the cycle of oocyte collection. The widely accepted criterion for embryo survival and eligibility for transfer in a clinical situation is that a minimum of 50% of the original blastomeres survive. Human embryos can be successfully cryopreserved using a range of techniques at all stages of development and can result in the birth of normal, healthy children when transferred back to the uterus. Application of this technology in the context of infertility treatment has had a major impact on the development of more conservative approaches to the number of embryos transferred and the overall cumulative efficiency of treatment.