Impact of pelvic radiotherapy on the female genital tract and fertility preservation measures

Table 1 Options for fertility preservation in women undergoing radical radiotherapy to the pelvis

Intervention	Procedure	Status	Time required	Pros	Cons
Ovarian transposition	Surgery to relocate ovaries within the abdomen outside of radiotherapy field	Established	Minimal (1 d)	Preserves oocytes and prevents premature menopause	Invasive surgical procedure; may require IVF; does nothing to protect uterus
Embryo cryopreservation	Mature oocyte aspiration, IVF, embryo freezing for later use	Established	2-3 wk	Established pregnancy rate of 20%-30% per transfer of 2 to 3 embryos	Requires 2 wk of ovarian stimulation; requires partner or donor sperm; requires functioning uterus or surrogacy
Donor oocytes and gestational surrogacy	IVF using donor oocytes and/or implantation of the embryo in a surrogate carrier	Established but infrequent	Not applicable	May be the only available option for some women with non-functioning uterus	Requires donor oocytes and gestational surrogate; ethical difficulties
Oocyte cryopreservation	Mature oocyte aspiration and freezing for later use	Experimental, live births reported, but only recommended as part of research	2-3 wk	Avoids need for partner or donor sperm at time of cryopreservation	Requires 2 wk of ovarian stimulation; requires functioning uterus or surrogacy
Ovarian tissue cryopreservation	Harvesting and freezing of ovarian tissue; re-implantation after radiotherapy or other gonadotoxic treatment	Experimental, but live births reported	Minimal (1 d)	Avoids need for partner or donor sperm at time of cryopreservation	Not appropriate if significant risk of ovarian involvement with malignancy

IVF: In vitro fertilisation.