Fertility potential in patients with ovarian cancer

Malignant neoplasms of the reproductive system are the most common form of oncological morbidity in women, accounting for over 30% of all cancer cases. Most antineoplastic agents act by inducing DNA damage in highly proliferating cancer cells, resulting in oocyte death. Ovarian toxicity is the most common side effect of cancer treatment in young women. Both chemotherapy and radiotherapy have been shown to be toxic to the ovaries, increasing the risk of premature ovarian failure, early menopause, endocrine disorders, and infertility. Patients who have undergone cancer treatment have severe follicular atresia, even if they have a regular menstrual cycle. Currently, the most effective methods of preserving fertility in cancer patients include cryopreservation of oocytes and embryos after ovarian hyperstimulation. Other fertility preservation methods include ovarian tissue cryopreservation, follicle or embryo maturation in vitro, ovarian transposition, ovarian suppression, and adjuvant therapy. Despite promising fertility prospects, iatrogenic infertility is one of the most undesirable adverse effects of cancer therapy for young women. Timely referral to a gynecologist prior to chemotherapy or radiation therapy is key to successful fertility preservation. Women should be aware of the available opportunities of assisted reproductive technologies, along with potential risks and failures with regard to their age, stage of disease, and treatment method. At this stage, it is necessary to develop well-defined and effective algorithms for oncologists, obstetrician-gynecologists, fertility specialists, and embryologists.