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December 22/29, 2015

Prevention of Premature Menopause and Preservation of Fertility in Young Cancer Survivors: Hopeful Though Modest Long-term Results

Author Affiliations
  • 1Dana-Farber Cancer Institute, Boston, Massachusetts
  • 2Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;314(24):2625-2627. doi:10.1001/jama.2015.17299

Young adults diagnosed with cancer may confront not only a potentially life-threatening malignancy at an untimely age but often must contend with the risk of infertility following cancer therapy and during their survivorship. Infertility is an important consequence of cancer, and cancer therapy for some patients—and concerns about fertility and premature menopause for young women—may contribute to long-term psychosocial distress and feelings of unresolved grief.1,2 In recent years, efforts have been made to improve communication about the potential for fertility impairment and to develop and implement interventions to reduce the risk of subsequent infertility in young patients with cancer. Preservation of fertility for men with cancer typically involves sperm banking (which has its own limitations), whereas fertility preservation options for women are generally more complex and have included embryo or oocyte cryopreservation. However, these strategies are resource- and time-intensive, requiring reproductive endocrinology specialty care, ovarian stimulation with resulting exposure to additional hormones, and surgery for optimal harvesting of oocytes. Despite efficacy and limited safety data for ovarian stimulation protocols designed to minimize hormonal levels, barriers and safety concerns remain, particularly for young women with hormone-sensitive breast cancer.3-5

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