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Fertility issues in patients with breast cancer or survivors

par Lambertini, Matteo ;Abdel Azim, Hatem Hamdy ;Peccatori, Fedro Alessandro
Référence Breast Cancer: Innovations in Research and Management, Springer International Publishing, page (729-737)
Publication Publié, 2017-01

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Résumé :

Fertility concerns are common in young breast cancer patients. Thanks to the increased survival outcomes and data suggesting the safety of pregnancy in breast cancer survivors, fertility preservation issues have acquired a growing importance over the past years. According to major international guidelines, patients should be counseled about the possible risk of developing treatment-induced premature ovarian failure and infertility before initiating systemic anticancer therapy. All women interested in preserving fertility should be referred to fertility clinic as soon as possible to discuss the available means for fertility preservation. For patients interested in fertility preservation, embryo and oocyte cryopreservation are standard strategies and should be offered as first choice. The use of “random-start” protocols and letrozole or tamoxifen for controlled ovarian stimulation should be considered in breast cancer patients. In those patients who cannot delay anticancer treatments, cryopreservation of ovarian tissue can be considered as alternative option. Recent data on temporary ovarian suppression with luteinizing hormone-releasing hormone analogs during chemotherapy have suggested the potential efficacy of this strategy in increasing the chances of posttreatment recovery of ovarian function and fertility; hence, this strategy can be considered in patients interested in ovarian function preservation and in those interested in fertility preservation following a cryopreservation strategy or where cryopreservation strategies are not available. Due to the lack of large prospective studies and randomized trials in this filed, further research efforts are needed to better evaluate the efficacy and safety of the available fertility preservation strategies.