FERTILITY PRESERVATION: ARE WE DOING TOO MUCH OR TOO LITTLE?

• Published in: Reproductive biomedicine online 2024-11, Vol.49
• Main Author: Macklon, Kirsten Tryde
• Format: Article
• Language: English
• ISSN: 1472-6483
• DOI: 10.1016/j.rbmo.2024.104502

Fertility preservation (FP) has evolved over the past decades both to prevent age-related but also iatrogenic ovarian follicular depletion. For many, this represents a hope for future fertility, particularly for those faced with the possibility of acute ovarian failure due to chemotherapy or radiation therapy. In many centers FP has become standard of care, at least in cases of imminent iatrogenic ovarian failure, and various FP methods are offered to girls and women of fertile age with successful results. Increased focus on awareness, distribution of knowledge and education along with patient wishes means that many oncology and fertility clinics now discuss and offer FP to most of their younger patients newly diagnosed with cancer. Many cancer survivors, who have frozen their eggs or ovarian tissue before chemotherapy, have used these later to become pregnant, but many never come back to use their stored eggs/tissue. This raises the question of whether we, as empathic and eager healthcare professionals (HCPs), have taken our wish to help all patients a step too far and are in fact offering it to women, who might be better off not going through the effort of maturing and taking out eggs or surgical removal of their ovarian tissue. Examples of such cases could be: 1. The risk of ovarian failure is very small. Some chemotherapy protocols are not very gonadotoxic or given in such small doses that the infertility risk that the patient faces is negligent. If these patients are offered in vitro fertilization (IVF) or ovarian tissue cryopreservation (OTC) the chance of them ever coming back to use their eggs/tissue is very small and the risk of the biological material staying in the freezer forever is very high. 2. The ovarian reserve is already depleted. This applies to women of advanced reproductive age or women with a known low ovarian reserve. Although we as HCPs always want to help as best we can, there are cases, in which the expected outcome after IVF or OTC is so poor that we maybe in fact do the opposite of helping by letting the patients go through IVF or surgery for collection of ovarian tissue. 3. The health of the patient. Cancer is a serious illness and can sometimes affect the patient to such a degree that is poses significant threat to her health to let her undergo hormonal stimulation and egg retrieval in case of IVF, or surgery and general anaesthesia in case of OTC. If the health (and ultimately life) of the patient is at risk, then FP should b