1. Fertility Preservation in Breast Cancer
Dr s.Hosseini
SBMU
Summer 2019

2. INTRODUCTION
Breast cancer is the most common type of cancer among young adult women
Quality of life for cancer survivors is important because of the high survival rate due to early diagnosis and improvements in cancer treatment

3. why preservation? Gonadotoxic chemotherapy
Long –lasting adjuvant therapies
Non-pharmacologic ovarian suppression
Radiation therapy ?

4. introduction ASCO guidelines recommend :
health care providers should inform cancer patients about the possibility of infertility
Should also be prepared to discuss FP options and /or to refer all potential patients to appropriate reproductive specialists

5. introduction
more than 90% of young breast cancer patients showed to be concerned about the potential risk of developing chemotherapy- induced premature ovarian insufficiency and/or infertility
only 12% of them decided to access cryopreservation strategies

6. effect of chemotherapy
Patient age
Familial ovarian history
Ovarian follicle reserve
History of previous ovarian and pelvic surgery
Previous chemotherapy
Previous pelvic and abdominal radiotherapy
Persistent high level of FSH
Class of the chemotherapeutic agent(alkylating vs nonalkylating)
Concomitant other diseases
Dosing and length of chemotherapy

9. endocrine therapy
While young women are more likely to have TN or HER2 amplified breast cancer, a large proportion of women have estrogen receptor positive (ER+) breast cancer
Endocrine therapy has resulted in a significant increase in disease- free and overall survival for women with ER+ breast cancer

10. endocrine therapy 5 year or 10 year In ER positive cancer
Postpone pregnancy

11. Fertility Preservation Strategies
Oocyte Cryopreservation
Embryo Cryopreservation
Ovarian tissue Cryopreservation
GnRh suppression

12. ovarian stimulation
oocyte and embryo cryopreservation need ovarian stimulation, which results in increased serum estradiol levels that may accelerate breast cancer growth.
In order to avoid estradiol elevation, the protocol of ovarian stimulation with aromatase inhibitor (AI) was proposed as the protocol is unlikely to increase recurrence

13. A recent systematic review of letrozole for ovarian hyperstimulation demonstrated:
adequate oocyte yield
low estradiol levels
no effect on breast cancer recurrence rates.

16. Time?
Random start ovarian stimulation

18. Oocyte cryopreservation
Mature oocytes
Immature oocytes( in vitro maturation)

19. Ovarian cryopreservation
The cumulative clinical and LB + OG rates were 57.5% and 37.7%, respectively, and the endocrine restoration rate was 63.9%.
Success rates with cryopreserved OTT have reached promising levels. Given these recent data, ovarian tissue cryopreservation should be considered as a viable option for FP.

21. The efficacy of GnRH therapy for fertility preservation is difficult to assess because many studies have used unreliable or non-suitable surrogate outcomes.
most of the studies have assessed the treatment in women with different types of diseases

22. Fertility preservation with ART was not associated with treatment delay in patients with breast cancer who were referred to reproductive specialists before cancer treatment