Fertility preservation in women with breast cancer undergoing adjuvant chemotherapy: a systematic review

Objective

To investigate methods of fertility preservation in younger women exposed to adjuvant chemotherapy for breast cancer.

Design

Systematic review of literature.

Setting

Academic Department of Medical Oncology.

Patient(s)

Premenopausal women exposed to adjuvant chemotherapy for breast cancer.

Main Outcome Measure(s)

Fertility preservation.

Result(s)

Data for fertility preservation in this setting come from nonrandomized trials and observational studies. The main methods of fertility preservation are ovarian protection by gonadotropin-releasing hormone (GnRH) agonists, cryopreservation of embryos after in vitro fertilization, and preservation of operatively sampled ovarian tissue or eggs after stimulation and puncture. Ongoing trials are assessing the role of ovarian protection by GnRH agonists.

Conclusion(s)

At present, there are no high-level, evidence-based recommendations for preservation of fertility or of ovarian function in women with breast cancer. This is an important issue for young breast cancer survivors, and further studies are needed. Moreover, the interplay between ovarian protection by GnRH agonists and the efficacy of adjuvant chemotherapy remains elusive.

Key Words: Breast neoplasms, disease-free survival, drug therapy, fertility, gonadotropin-releasing hormone, goserelin, prognosis, survival analysis, tamoxifen