Fertility Preservation in Patients with Cancer: ASCO Clinical Practice Guideline Update Summary

Fertility Preservation in Patients with Cancer: ASCO Clinical Practice Guideline Update Summary
ASCO first published evidence-based clinical practice guidelines on fertility preservation in 2006 with an update in 2013. This is the most recent iteration of the guideline which although it is adult focused, also applies to the pediatric population.
The guideline re-affirms some of the previous recommendations including a discussion of the possibility of infertility as early as possible before treatment starts, which is thought to reduced distress and improve quality of life. The discussion should be re-addressed after completion of therapy.
Options for post-pubertal males continue to include sperm cryopreservation, ideally done pre-treatment to ensure optimal quality. With technologies like IVF and intra-cytoplasmic sperm injection however, cryopreservation can still occur for patients on treatment if there is an urgency to begin therapy. Hormonal gonado-protection has not been shown to be effective. Testicular tissue cryopreservation and grafting of human testicular tissue remain experimental.
Options for women include embryo and oocyte cryopreservation. Oocyte preservation would be more feasible for a larger group of patients as it is no longer considered experimental. Flexible ovarian stimulation protocols can be initiated with less delay than previous and newer protocols including aromatase inhibitors would make stimulation feasible even for women with estrogen sensitive malignancies without an increase in their risk of cancer recurrence. Ovarian transposition during pelvic irradiation remains a viable option, although is not always successful due to scatter. There is conflicting evidence for GnRH agonists/ovarian suppression for fertility preservation. This can be considered when other methods are not feasible in young women. Perhaps most exciting is that while ovarian tissue cryopreservation remains experimental in North America, emerging data is very promising and some countries consider it nonexperimental. It is one of the best options for pediatrics and pre-pubertal patients. The safety of it in patients with leukemia is unknown.
Adult guidelines; limited options remain for pre-pubertal children.
A multitude of fertility preservation options exist for post-pubertal patients and should be discussed in a timely manner and on an ongoing basis. Exciting new data on the success of ovarian tissue transplantation may make this a viable option for a larger proportion of patients.

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