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The relocation of ovaries for their protection in women diagnosed with cancer in the pelvis was mentioned as early as 1958 by McCall et al. At that time, the procedure was termed oophoropexy and considered to be revolutionary, controversial and "cutting edge" fertility preservation. Ovarian function is compromised when damaged during surgery, exposed to radiation, and/or chemotherapy. Chemotherapy has been found to have a highly variable chance of acute ovarian failure. In general, for gynecological malignancies, cervical and uterine cancers are the most likely indications for adjuvant or definitive radiation treatment to the pelvis, but pelvic radiation is also done for Hodgkin's lymphoma, pediatric sarcomas and rectal cancer. Ovarian function is almost guaranteed to be entirely lost without some intervention before pelvic radiation therapy. Ovarian transposition is a relatively simple option that should be considered with all patients at risk for ovarian failure due to radiation.
This chapter discusses fertility preservation and reviews the recent evidence on the pathophysiology of chemotherapy/radiotherapy-induced gonadal toxicity and the recent data on the indications and the outcomes of techniques used for fertility preservation in female cancer patients. The exact incidence of premature ovarian failure (POF) following chemotherapy is difficult to establish since many factors contribute to ovarian failure. Several reproductive-age malignancies afflicting pelvic organs can be cured with radiotherapy. These include cervical, vaginal, and anorectal carcinomas, some germ cell tumors, Hodgkin's disease, and central nervous system tumors. A wide variety of strategies have been assessed for fertility preservation in females which includes chemoprotection, ovariopexy, and assisted reproductive technologies. Keeping the testicles outside the field of radiation or being shielded has been shown to be an effective strategy to prevent radiation-induced testicular damage. Semen cryopreservation and testicular tissue cryopreservation are fertility preservation measures in male using assisted reproductive technologies.
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