Fertility Preservation in Cancer,old age

Fertility Preservation in Cancer,old age

Understanding there are fertility preservation options available and referring at-risk patients in a timely manner to specialists can improve patients’ emotional outlook and future quality of life. However,

  • Patients may not be aware of their options for preserving fertility.
  • Patients may be focused on their cancer diagnosis and unable to think about fertility or the possibility of having a future family.
  • Women may later regret not considering fertility issues prior to starting cancer treatment.
  • Even women with a poor prognosis may want to consider fertility preservation.

Options for Fertility Preservation

  • The following table gives a brief description of options available to women who wish to preserve their fertility.
  • The American Society of Clinical Oncology and American Society for Reproductive Medicine recommend, when possible, at-risk patients be referred to a fertility preservation specialist prior to starting cancer treatment.
  • Several resources are listed on the reverse that can help you and your patients locate a fertility preservation specialist.

Cancer Therapy and the Risk of Infertility

The following table classifies various cancer therapies and regimens based on their known infertility risk in women (defined as permanent amenorrhea).

While this table provides general guidelines, each patient is different and treatment may impair their fertility differently.

High Risk
  • Whole abdominal or pelvic radiation doses >6 Gy in adult women
  • Total body irradiation (TBI)
  • Cranial/brain irradiation >40 Gy
  • CMF, CEF, or CAF x 6 cycles in women >40 years
  • Total cyclophosphadmide 5 g/m2 in women >40 years
  • Total cyclophosphadmidey  > 7.5 g/m2 <20 years
  • Alkylating chemotherapy (e.g., cyclophosphamide, busulfan, melaphan) conditioning for transplant
  • Any alkylating agent (e.g., cyclophosphamide, ifosfamide, busulfan, BCNU [carmustine], CCNU [lomustine]) + TBI or pelvic radiation
  • Protocols containing procarbazine: MOPP, MVPP, COPP, ChlVPP, ChlVPP/EVA, BEACOPP, MOPP/ABVD, COPP/ABVD
Intermediate Risk
  • Abdominal/pelvic radiation
  • CMF, CEF, or CAF x 6 cycles in women 30-40 year
  • Spinal radiation doses >25 Gy CMF, CEF, or CAF x 6 cycles in women 30–40 years
  • Bevacizumab (Avastin)
  • Protocols containing cisplatin
  • FOLFOX4
  • Total cyclophos-phamide 5 g /m2 in women age 30- 40
Low Risk
  • CMF, CEF, or CAF x 6 cycles in women <30 years
  • Nonalkylating chemotherapy: ABVD
  • Anthracycline + cytarabine
No Risk
  • Radioactive iodine
  • MF
  • Multi-agent therapies using vincristine
Unknown Risk
  • Monoclonal antibodies, e.g., cetuximab (Erbitux)
  • Tyrosine  kinase inhibitors, e.g., erlotinib (Tarceva), imatinib (Gleevec)
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