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This new edition provides a much-needed reference book to accommodate emerging and expanding knowledge in fertility preservation, the rapidly growing field of reproductive medicine associated with advances in oncology. Written by a team of world-leading experts in the field and comprehensive in its scope, the book covers the full range of techniques and scientific concepts in detail. It opens with an introduction to fertility preservation in both cancer and non-cancer patients, followed by fertility preservation strategies in males and females, including medical/surgical procedures, ART, cryopreservation and transplantation of ovarian tissue, and in-vitro follicle culture. Concluding chapters address new technologies, as well as ethical, legal and religious issues. The book has been thoroughly updated, includes additional contributors, and now provides greater focus on practical and clinically relevant issues. Richly illustrated throughout, this is a key resource for clinicians specializing in reproductive medicine, gynecology, oncology, hematology, endocrinology and infertility.
During fetal life, 100–2000 primordial germ cells enter a massive proliferation process and, by mid-gestation, there are several million potential oocytes. However, most (85 per cent) of them are lost prior to birth  (Figure 6.1).
The use of gonadotropin-releasing hormone agonists (GnRHa) for prevention of chemotherapy-induced gonadotoxicity remains controversial. With the initial dose of GnRHa, the pituitary gland releases endogenous gonadotropins. This initial follicle stimulating hormone (FSH) release stimulates the ovary. After continued GnRHa exposure, further FSH release is prevented. Gonadotropin-releasing hormone analogues can be administered in many formulations with different durations of action. The most common side effects of GnRH analogues are related to the subsequent estrogen deprivation. Vasomotor symptoms, hot flushes, night sweats, vaginal dryness and headaches can occur. Cotherapy of a GnRHa during chemotherapy has been under investigation since the mid 1990s. If prolonged GnRHa administration decreases ovarian blood flow, then less chemotherapy may reach the ovary. Direct effects of GnRHa or FSH on ovarian tissue may influence ovarian response to chemotherapy. For GnRHa to be of benefit to fertility preservation, they would likely need to spare both oocyte quantity and quality.
The specialty of fertility preservation offers patients with cancer, who are rendered infertile by chemo- and radiotherapy, the opportunity to realize their reproductive potential. This gold-standard publication defines the specialty. The full range of techniques and scientific concepts is covered in detail, and the author team includes many of the world's leading experts in the field. The book opens with introductions to fertility preservation in both cancer and non-cancer patients, followed by cancer biology, epidemiology and treatment, and reproductive biology and cryobiology. Subsequent sections cover fertility preservation strategies in males and females, including medical/surgical procedures, ART, cryopreservation and transplantation of both ovarian tissue and the whole ovary, and in-vitro follicle growth and maturation. Concluding chapters address future technologies, as well as ethical, legal and religious issues. Richly illustrated throughout, this is a key resource for all clinicians specializing in reproductive medicine, gynecology, oncology, hematology, endocrinology and infertility.