Reproductive Challenges in Young Female Cancer Patients

The last three decades have seen a significant improvement and advancement in both the diagnostic and therapeutic modalities with improved surgical technique, chemo-radio and supportive therapy in cancer treatment. This has produced a correspondingly increase in the 5-year relative survival rate for many cancers and for all races. However, the chemo-radiotherapy which is often gonadotoxic, has a substantial impact on quality of life issues especially that of reproduction in young female patients on account of increasing survival rates and delayed childbearing in the western hemisphere. This case based discussion paper using two real life case scenarios from our department focuses on the negative impact of cancer treatments on fertility and various options available for fertility preservation and/or fertility preservation measures. It is concluded that a lot of variables have to be considered when deciding upon fertility preservation treatments including patient's age, cancer stage, proposed treatment regime and time before it is initiated, availability of partner sperm and issues of individual patients. The latter include surgical complications, ovarian hyperstimulation syndrome, delay in cancer treatment and reintroduction of cancer cells, cost, low success rates and experimental nature of these treatments and the disposition of gametes in the event that the patient does not survive her cancer. It is very important for physician to advise patients of all these factors so that they can make an informed decision regarding the fertility preservation options and each case is unique and requires a different strategy of fertility preservation.