A review of fertility preservation in patients with breast cancer

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2022-06, Vol.82, p.60-68
• Main Authors: Ulrich, Nicole D., Raja, Nicholas S., Moravek, Molly B.
• Format: Article
• Language: English
• Subjects: Access to care; Breast cancer; Cost; Fertility preservation; GnRH agonist; Oocyte cryopreservation; Oocyte tissue cryopreservation
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2022.01.004

Breast cancer remains the most common cancer diagnosed in women and causes more lost disability-adjusted life years (DALYs) than any other cancer worldwide; however, improvements in therapies have led to increased survival and therefore a new focus on quality of life following treatment. Fertility is an important concern among cancer survivors of reproductive age. The purpose of this article is to contextualize the importance of oncofertility services for women with breast cancer and review options for fertility preservation, including oocyte/embryo cryopreservation, GnRH agonist therapy, and ovarian tissue cryopreservation. We also discuss special considerations for preimplantation genetic testing for women with germline pathogenic mutations associated with breast cancer, as well as issues related to endocrine therapy. Finally, we review barriers to accessing fertility preservation services, including cost of treatment and lack of referral to reproductive care providers or fertility preservation programs. •Oncofertility counseling is important but under-utilized for cancer patients.•Options include egg, embryo, or ovarian tissue freezing and ovarian suppression.•Tools to provide individualized fertility risk counseling are in development.•Cost and access to care remain critical barriers to fertility preservation services.