Characteristics and management of cancer patients who wish to preserve their reproductive capacity

Aim. To develop a differentiated management strategy for cancer patients referred for retrieval and cryopreservation of reproductive material based on the structure of oncological diseases by referral, oncological and reproductive status, individual patient characteristics, and the planned/conducted treatment. Materials and methods. We analyzed cancer patients’ medical records, including a complete description of the disease, the stage of the process, and the examination results. The planned treatment, prognosis for the course, and curability of the disease were outlined. Patients referred during stable remission had detailed medical case notes describing the treatment, the results of the examination, and the oncologist's conclusion about the feasibility of therapy to achieve pregnancy. Clinical evaluation at admission included assessing the patient's reproductive system, ovarian reserve, general and gynecological health. Based on the totality of analyzed data, individual treatment algorithms were developed. Results. Between February and December 2019, 259 patients were consulted at the V.I. Kulakov NMRC for OG&P to determine the feasibility and methods of retrieval and preservation of reproductive material and assess the prospects for achieving pregnancy during stable remission. Fifty-six patients completed cancer treatment, and 203 were planned to have gonadotoxic therapy and/or radical treatment. Eighty-five controlled ovarian stimulation programs were conducted, including 68 before the onset of gonadotoxic therapy and 17 after cancer treatment completion. Sixty-one patients underwent retrieval and cryopreservation of ovarian tissue with the collection of immature oocytes, followed by in vitro maturation of oocytes and conservation, or fertilization, and embryo cryopreservation. Treatment was not administered to 113 referred patients due to a sharp decrease in the ovarian reserve and the inability to obtain their oocyte or for other reasons. Conclusion. There is no doubt in need for joint counseling of cancer patients wishing to preserve fertility or in cases when oncologists allow a woman to become pregnant after treatment. The retrieval of reproductive material before the onset of cancer treatment undoubtedly increases patients' chances for subsequent childbirth, including, if necessary, using a surrogate mother. The choice of programs aimed at retrieval and cryopreservation of reproductive material was made on a case-by-case basis taking into account the location, type, and stage of the malignancy and the state of the patient's ovarian reserve.

cancer, preservation of reproductive material, cryopreservation of oocytes/embryos, the oocyte in vitro maturation, ovarian reserve