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  3. Principles and Practice of Fertility Preservation
Principles and Practice of Fertility Preservation
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Book description

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.

Reviews

'One of the outstanding features of this book is the merging of oncology and reproduction so that people in both fields will benefit from reading it … appropriate for a wide audience.'

Source: Doody's Notes

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Contents

Page 1 of 3

Contents
  • Chapter 8 - Cancer epidemiology and environmental factors in children, adolescents and young adults
    pp 83-100
  • View abstract

    Summary

    The first instance of assisted reproductive technology (ART) was when an eminent surgeon, John Hunter of London assisted a woman in becoming pregnant by taking a semen sample produced by her husband, who had hypospadias, and inseminated her with that specimen. Some of the earliest observations on fertilization of human oocytes were made by Robert Edwards and published in 1965 in a landmark paper: "Maturation in vitro of human ovarian oocytes". It was the need for Edwards to be able to obtain the supplies of pre-ovulatory human oocytes that brought him and gynecologist Patrick Steptoe (1913-88) together in 1968. After 102 failed embryo transfers (ET), Leslie Brown was treated and subsequently became pregnant following her first embryo transfer. The world's second in vitro fertilization (IVF) baby was achieved in India, following work by Dr. Subhash Mukhopadhyay. A baby was born on October 3, 1978 following IVF and ET.
  • Chapter 10 - Molecular aspects of follicular development
    pp 114-128
  • View abstract

    Summary

    Cancer is more common after puberty during the reproductive life span of men and women, and many of the patients will be cured by combination treatment with surgery, chemotherapy and radiotherapy. The model of human ovarian reserve allows us to estimate the number of non-growing follicles (NGFs) present in the ovary at any given age, and it suggests that 81% of the variance in NGF populations is due to age alone. The ovary is susceptible to chemotherapy-induced damage, particularly following treatment with alkylating agents such as cyclophosphamide. Ovarian damage is drug- and dose-dependent and is related to age at the time of treatment, with progressively smaller doses required to produce ovarian failure with increasing age. Preventing chemotherapy-induced damage to the ovary or testes remains an elusive ideal in the field of fertility preservation. Both chemotherapy and radiotherapy can impair future fertility, and treatments for certain cancers can be sterilizing.
  • Chapter 11 - Fundamental cryobiology of reproductive cells and tissues
    pp 129-144
  • Concepts and misconceptions
  • View abstract

    Summary

    This chapter focuses on female fertility preservation procedures because of their complexity and peculiarities. Ovarian failure leads to the impossibility of childbearing apart from other problems related to the menopause, such as vasomotor, skeletal or cardiovascular alterations. Early menopause and infertility are two of the main consequences for patients treated with gonadotoxic agents. Gonadotoxicity, a decrease in ovarian activity, depends on several factors, including the age of the patient; the initial status of the ovaries; the treatment applied and cumulative doses; and the type of agent used. Ovarian tissue freezing for later autotransplantation is alternative for fertility preservation in women with oncological or non-oncological diseases. Any patient with a high risk of premature ovarian failure is a possible candidate for fertility preservation. Oocyte and ovarian tissue cryopreservation are useful as they overcome some of the disadvantages, ethical concerns and legal restrictions related to embryo cryopreservation.
  • Chapter 12 - Fundamental aspects of vitrification as a method of reproductive cell, tissue and organ cryopreservation
    pp 145-163
  • View abstract

    Summary

    The science of histopathology revealed that like normal tissues, tumors are composed of cells. During development and in physiological contexts, proliferation is regulated by exposure of cells to soluble growth factors within their environment. Cells use a number of distinct signaling pathways to control their proliferation. A cell's decision to divide or to become quiescent is influenced by mitogenic signals in the cell's surroundings. In rapidly dividing tissues, parenchymal cells are born from asymmetric division of a stem/progenitor cell, differentiate and then undergo programmed cell death. Intact DNA damage repair systems are critical to maintain genomic stability and prevent tumorigenesis. Inactivation of the apoptotic machinery permits the survival of cells with accumulatingmutations and promotes evolution of premalignant to malignant cells. Failure in the ability of the immune system to distinguish self from non-self can result in autoimmune reactions or facilitate the development of a tumor.
  • Chapter 14 - Cryopreservation of spermatozoa
    pp 176-198
  • Old routine and new perspectives
  • View abstract

    Summary

    This chapter covers issues most likely to be raised by young women who have been diagnosed with breast cancer or those at high risk of the disease contemplating assisted fertility procedures. The type of adjuvant regimen selected for an individual woman is determined by menopause status, biological characteristics of the tumor and risk of relapse. Large meta-analyses of multiple trials with longterm follow-up have been used to assess the effects of systemic therapy on breast cancer outcomes. Achievement of amenorrhea appears to be associated with a reduction in relapse and improvement in survival in premenopausal women with estrogen receptor positive (ER+) tumors. There are three main barriers to implementing fertility preservation in women with breast cancer: cost; concern about treatment delays; and concern that increasing sex hormones as a result of controlled ovarian stimulation (COS) protocols will stimulate proliferation in ER+ tumors.
  • Chapter 15 - Transplantation of cryopreserved spermatogonia
    pp 199-208
  • View abstract

    Summary

    Younger women with breast cancer are more likely to have poor prognostic features, such as larger tumor size, regional lymph node positivity, high nuclear grade, estrogen receptor negativity and inflammatory disease. Treatment for breast cancer can impact fertility for a variety of reasons, including a toxic effect of chemotherapy on ovarian follicles, advice to delay pregnancy due to concern for recurrence of disease and the recommendation for 5 years of adjuvant endocrine therapy for hormone-responsive disease. As a result of higher survival rates among women treated for breast cancer, there is an increasing emphasis on quality of life among survivors, and fertility preservation is a key issue among young women undergoing therapy for breast cancer. Embryo cryopreservation is considered the more effective approach to fertility preservation. The process of ovarian tissue cryopreservation involves freezing thin slices of the ovarian cortex.
  • Chapter 16 - Cryopreservation and transplantation of testicular tissue
    pp 209-224
  • View abstract

    Summary

    This chapter reviews pediatric cancer therapy and its consequences on fertility. Chemotherapy can cause infertility, premature ovarian failure, menstrual irregularity and delayed puberty. The effects of chemotherapy on ovarian function are both agent and dose-dependent, and this effect may be additive to that resulting from abdominopelvic radiotherapy. Testicular dysfunction is among the most common long-term side effect of chemotherapy in men. The germinal epithelium is very susceptible to injury by cytotoxic drugs secondary to its high mitotic rate. Reduction in the dose or use of alkylating agents and abdominopelvic radiotherapy is the most effective means of preserving ovarian function and promoting positive reproductive outcomes in pediatric cancer survivors. Sperm cryopreservation after masturbation is the most established and effective method of fertility preservation in males. Oncologists have a responsibility to inform parents and age-appropriate patients about the likelihood that their cancer treatment may permanently affect their fertility.

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