Treatment
Recommendation 2.3
➤ Other methods to preserve male fertility: Other methods, such as testicular
tissue cryopreservation and reimplantation or grafting of human testicular
tissue, should be performed only as part of clinical trials or approved
experimental protocols.
Recommendation 2.4
➤ Post-chemotherapy: Men should be advised of a potentially higher risk of
genetic damage in sperm collected after initiation of therapy. It is strongly
recommended that sperm be collected before initiation of treatment
because the quality of the sample and sperm DNA integrity may be
compromised after a single treatment. Although sperm counts and quality
of sperm may be diminished even before initiation of therapy, and even
if there may be a need to initiate chemotherapy quickly such that there
may be limited time to obtain optimal numbers of ejaculate specimens,
these concerns should not dissuade patients from banking sperm.
Intracytoplasmic sperm injection allows the future use of a very limited
amount of sperm; thus, even in these compromised scenarios, fertility may
still be preserved.
Adult Women
Recommendation 3.1
➤ Embryo cryopreservation: Embryo cryopreservation is an established
fertility preservation method, and it has routinely been used for storing
surplus embryos after in vitro fertilization.
Recommendation 3.2
➤ Cryopreservation of unfertilized oocytes: Cryopreservation of unfertilized
oocytes is an option and may be especially well suited to women who do
not have a male partner, do not wish to use donor sperm, or have religious
or ethical objections to embryo freezing.
➤ Oocyte cryopreservation should be performed in centers with the necessary
expertise. As of October 2012, the American Society for Reproductive
Medicine no longer deems this procedure experimental.
Qualifying Statement: More flexible ovarian stimulation protocols for oocyte collection are
now available. Timing of this procedure no longer depends on the menstrual cycle in most
cases, and stimulation can be initiated with less delay compared with old protocols. Thus,
oocyte harvesting for the purpose of oocyte or embryo cryopreservation is now possible on a
cycle day-independent schedule. Of special concern in estrogen-sensitive breast and g ynecologic
malignancies is the possibility that these fertility preservation interventions (e.g., ovarian
stimulation regimens that increase estrogen levels) and/or subsequent pregnancy may increase
the risk of cancer recurrence. Aromatase inhibitor-based stimulation protocols are now well-
established and may ameliorate this concern. Studies do not indicate increased cancer recurrence
risk as a result of aromatase-inhibitor supplemented ovarian stimulation and subsequent
pregnancy.
