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Fertility Preservation in Cancer Patients

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Treatment Recommendation 3.3 ➤ Ovarian transposition: Ovarian transposition (oophoropexy) can be offered when pelvic irradiation is performed as cancer treatment. However, because of radiation scatter, ovaries are not always protected, and patients should be aware that this technique is not always successful. ➤ Because of the risk of remigration of the ovaries, this procedure should be performed as close to the time of radiation treatment as possible. Recommendation 3.4 ➤ Conservative gynecologic surgery: It has been suggested that radical trachelectomy (surgical removal of the uterine cervix) should be restricted to stage IA2 to IB cervical cancer with diameter <2 cm and invasion < 10 mm. ➤ In the treatment of other gynecologic malignancies, interventions to spare fertility have generally centered on doing less radical surgery with the intent of sparing the reproductive organs as much as possible. Ovarian cystectomy can be performed for early-stage ovarian cancer. Recommendation 3.5 [Updated] ➤ Ovarian suppression: There is conflicting evidence to recommend GnRHa and other means of ovarian suppression for fertility preservation. The Panel recognizes that, when proven fertility preservation methods such as oocyte, embryo or ovarian tissue cryopreservation are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. However, GnRHa should not be used in place of proven fertility preservation methods. Recommendation 3.6 [Updated] ➤ Ovarian tissue cryopreservation and transplantation: Ovarian tissue cryopreservation for the purpose of future transplantation does not require ovarian stimulation and can be performed immediately. In addition, it does not require sexual maturity and hence may be the only method available in children. Finally, this method may also restore global ovarian function. However, it should be noted further investigation is needed to confirm whether it is safe in patients with leukemias. Qualifying Statement: As of the time of this publication, ovarian tissue cryopreservation remains experimental. However, emerging data may prompt reconsideration of this designation in the future. (This technique is already considered non-experimental in some countries and its experimental status is undergoing evaluation in the U.S.)

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