Dados do Trabalho

Title

THE DIFFICULTIES IN PRESERVING FERTILITY IN YOUNG PATIENTS DIAGNOSED WITH CANCER

Objective

The aim of the following study was to evaluate the various methods used for fertility
preservation in pediatric patients diagnosed with cancer and to identify the various difficulties
that each intervention poses.

Methods

A systematic bibliographical review was carried out with a search in the PUBMED
database (Medline) from the descriptors “fertility preservation”, “cancer” and “pediatrics”.
Only review articles published in the last 10 years (from 2013 to 2023) were selected. Works
that reported male fertility only were excluded from the study.

Results

Based on the data collected from the articles, it was noticeable that fertility
preservation procedures, such as cryopreservation, can often cause irreversible damage to the
patient's health. Cancer treatments, including radiotherapy and chemotherapy, cause late
effects such as gonadotoxicity with permanent azoospermia or premature ovarian failure,4
resulting in difficulty conceiving or even sterility.
Patients who opt for the fertility preservation process will face several challenges that
can culminate in physical and emotional harm. Some of these damages include: multiple
daily injections, side effects of ovarian stimulation, risks associated with anesthesia and
laparoscopy, delay in starting cancer treatment and all the consequences linked to the
emotional immaturity of children.
The method of choice for fertility preservation depends on several factors, such as
age, the chosen cancer treatment and the patient's level of maturity. In addition to leaving an
excessive emotional and physical impact on patients who choose to undergo the preservation process, none of the methods offer a clinical pregnancy rate of approximately 100% for
women after a gonadotoxic regimen. According to the American Society for Reproductive
Medicine, oocyte cryopreservation offers a clinical pregnancy rate of only 4-12% per oocyte
(or 36-61% per embryo transfer), while ovarian tissue cryopreservation offers a rate of 57%,
both rates being seriously low.4

Conclusion

The American Society of Clinical Oncology updated its guideline in 2013 to
emphasize the importance of addressing gonadotoxicity and preserving fertility in all patients
of reproductive potential. This is crucial when thinking about planned parenthood for cancer
patients that might be interested in the future.
There is a need for new research and development of guidelines that evaluate
preservation methods with high pregnancy rates that provide less sequelae for patients.
Although fertility preservation is recommended for all patients undergoing cancer
treatment, there are still many barriers and ethical considerations to achieving preservation.

Keywords

Fertility preservation; Pediatrics; Cancer