Fifty international specialists share best practices for effective fertility preservation treatments

Some fifty international specialists in oncology and reproductive medicine are meeting at the Museu Colet in Barcelona for the workshops entitled Fertility Preservation Update: Consensus Meeting organized by the International Center for Scientific Debate (ICSD) —a Biocat initiative driven by the “la Caixa” Welfare Projects— and the Dexeus Foundation for Women's Health. Over two days, participants will work together to revise current fertility preservation techniques and those that are still in the experimental stages in order to move forward together on new best practices for carrying out effective treatment to preserve fertility in women and men being treated for oncological and autoimmune diseases.

The workshop aims to draft a document of consensus on fertility preservation that includes an update of medical and social instructions, available techniques and results obtained. As Dr. Anna Veiga, director of the workshop, explains, “The main goal is to draft a document that clearly lays out the instructions for preserving fertility: which methods can be used, the results that can be expected, and where this methodology is now. This is not just for specialists, but also for gynecologists and oncologists that are treating young people with cancer, so they can communicate their possibilities of preserving fertility despite having received aggressive treatment for their disease.” Through scientific debate, participants will also draft recommendations for oncology and fertility specialists to take into account when treating patients.

Participants in the debate workshops will include renowned international experts in this field, such as Dr. Anna Veiga and Dr. Pere N. Barri, from the Dexeus University Institute; Dr. Jacques Donnez, from Saint-Luc University Hospital in Brussels; Dr. Guido Pennings, from Ghent University in Belgium; Dr. Françoise Shenfield, from the Elisabeth Garret Anderson & Obstetric Hospital in London; and Dr. Claus Yding Andersen, from the University Hospital of Copenhagen.

Anna Veiga: "We will work on a document that clearly lays out the instructions for preserving fertility and which methods can be used.”

Recent breakthroughs in cancer diagnostics and treatment have significantly improved survival rates, so two in three children diagnosed with cancer are cured and one in 250 adults is a childhood-cancer survivor. Furthermore, an estimated 2% of all women under 40 will be diagnosed with cancer.

However, chemotherapy and radiotherapy used as oncology and autoimmune treatments often have dramatic consequences on patient fertility, both in women and men. In fact, rising survival rates are linked to more aggressive treatments that can be associated with alterations in gonad function in adult life. Furthermore, we must also consider the current trend among many women to postpone motherhood for social or work-related motives, which leaves many with an unfulfilled desire to have children when they are diagnosed with cancer and, thus, the demand for fertility preservation is constantly increasing. In this sense, Anna Veiga explains that “social preservation now has a certain degree of demand, which refers to young women who decide to freeze their ova for use further down the road, and we must debate is whether this is something we want to offer and in what cases.”

Nonetheless, there are also some non-oncological processes that can damage fertility, either as a result of the diseases itself or the treatment patients undergo. These situations that damage fertility include gynecological disorders, gonad surgery, genetic predisposition, exposure to environmental toxins and neoplasms, and some benign hematological and autoimmune diseases.

Fertility preservation is an emerging field in assisted reproduction that provides solutions for people who have survived treatments like chemotherapy and radiotherapy.

For this reason, fertility preservation has become and emerging field in assisted reproduction, because it provides solutions for cancer survivors and patients that have been treated or taken medications for diseases that have affected their fertility. The main candidates are young people, even children, that have been treated with radiotherapy or chemotherapy that could compromise their future fertility. Other candidates include patients with autoimmune diseases or premature ovary failure that we can predict ahead of time and therefore believe it is worthwhile to freeze ova or a portion of an ovary.

There are different techniques, some more developed than others, to preserve fertility in young people at risk, including preservation of ovary and testicular tissue, of ovocytes and sperm, as well as embryos. Cryopreservation of embryos or ovocytes is the best option if time isn’t an issue and there is no problem in hyperstimulating the ovaries.  In other cases, patients will be treated with aromatase inhibitors in addition to the stimulation treatment in order to reduce serum estradiol levels.

New experimental techniques are being carried out in a variety of clinical and university research centers to improve the results of these treatments. In such a wide field, it is vital that specialists in reproductive medicine and oncology share their experience and expertise in order to offer patients the best options.

• Anna Veiga: "The main candidates for fertility preservation techniques are young people with cancer” (interview published in the Biocat E-News, May 2011)
• Press call in Catalan (6/6/2011, at 11:00 am, Museu Colet Barcelona)

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