Fertility preservation methods in women subjected to gonadotoxic treatment or gonadoreducing surgery

E. Brătilă, M. Cîrstoiu, C. Mehedințu, C. Berceanu, R. Bohîlțea, O. Toader, D.E. Comandașu, M. Mitran, S. Vlădăreanu

Rezumat: All patients in whom gonadotoxic treatment or gonadal resection is recommended and also present future reproductive intentions should be referred to a specialist in infertility and endocrinology to be detailed fertility preservation options. The gold standard in these cases is the cryopreservation of embryos, being superior to the freezing of oocytes or other techniques. For the cases where freezing embryos it is not possible, cryopreservation of mature oocytes is reasonable. Maturation of oocytes in vitro is an experimental method, with implantation and pregnancy rates lower than if using oocytes matured in vivo. Ovarian tissue cryopreservation is an investigational technique not recommended in patients with ovarian cancer or at increased risk for this pathology, with still uncertain eficacy, but more and more increasingly used. If cryopreservation of embryos or oocytes is not feasible, alternative methods are needed to protect fertility. For cases which are to undergo pelvic radiotherapy, but not to chemotherapy, ovarian transposition outside the field of radiation may be an option. The use of GnRH agonists in women following chemotherapy is not recommended, having unproven benefits and theoretical risks. Alternative methods (ovarian tissue transplantation, donation of oocytes or embryos, the use of surrogate mothers, adoption) are the last choices for cases where the other methods are not available.
Cuvinte cheie: gonadotoxic treatment, gonadoreducing surgery, fertility preservation