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Fertility Preservation in Cancer Patients

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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.

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