Ovarian function, reproduction and strategies for fertility preservation after breast cancer

Abstract

There is strong evidence that infertility is a dramatic and frequent side effect in men and women of childbearing age who are undergoing chemotherapy for their cancer treatment. This, severe and often underestimated complication heavily deteriorates the quality of life of affected patients and risks to reduce the therapeutic efforts and the compliance towards the suggested treatments. Moreover, cancer related infertility is still considered a marginal aspect of the quality of life in cancer patients. Reproduction's preservation plays today an emerging role in the culture of industrialized countries and moves extraordinary interests from the scientific and economic points, of view. Unfortunately medical oncologists, surgeons and gynaecologists have little consideration, for this complication and often possess a limited knowledge about the clinical aspects of cancer, related infertility and the possibilities of prevention and treatment of cancer related gonadic failure. Since more young people are offered adjuvant treatments at earlier stages of cancer, the problem of, chemotherapy related gonadic toxicity has considerably increased in the last years. It is also important to consider the new opportunity derived from the assisted reproductive techniques available. From this point of view the treating physicians need to be able to make accurate assessments of risks and benefits of antineoplastic treatments in order to schedule the best approach to and to preserve the possibility of reproduction in their young patients. These aspects are more relevant in breast cancer patients, mainly in the early phase of the disease, due to the high probability to retain reproductive possibilities also after aggressive and integrated therapies.