Chemotherapy for gynaecological malignancies and fertility preservation

Abstract

Infertility is an increasingly important issue for patients surviving cancer. Significant improvements in cancer management have led to greater numbers of patients living healthy and fulfilling lives for many years after a diagnosis of cancer, and the ability to bear children is a major component of well-being. Infertility is particularly challenging in gynaecological cancer, where multiple treatment modalities are often employed. Surgery may involve the removal of reproductive organs and subsequent chemotherapy may also lead to infertility. Mitigation of this through the use of cryopreservation of embryos, oocytes or ovarian tissue before chemotherapy may enable subsequent pregnancy in the patient or a surrogate mother. Suppression of ovarian function during chemotherapy is less well established, but promises a reduction in infertility without the risks associated with surgery. Similarly, evolving chemotherapy regimens with replacement of alkylating agents will reduce the incidence of infertility. With a combination of these techniques, an increasing proportion of patients may be able to conceive after completion of treatment, and there is no evidence of an increase in congenital abnormalities. This review discusses chemotherapy-induced infertility, interventions and success rates, and demonstrates that individualisation of management is required for optimum outcome.

Keywords: Infertility, Chemotherapy, Gynaecological malignancies, Ovarian, Cryopreservation

Core tip: This paper summarises the main scenarios in which infertility presents a clinical problem in gynaecological malignancies subsequent to the use of chemotherapy. Many patients may have pre-existing infertility due to related medical conditions, and prior surgical interventions may be an important factor. Other factors to be considered include the associated prognosis and the potential need for rapid commencement of chemotherapy. The various technologies for fertility preservation are reviewed and their strengths and weaknesses discussed. The paper stresses that an individualised approach is necessary for each patient and that discussion of the issues at an early stage of management is important.