Oncofertility and breast cancer. Decision making algorithm before starting treatment

Summary. Adjuvant chemotherapy pursued for women of reproductive age are diagnosed with breast cancer, leads to a significant reduction in ovarian reserve, up to the complete shutdown of the ovaries — a syndrome of premature ovarian failure. For proper rehabilitation certain category of patients raises the question of the restoration of reproductive function. Choice of curation of those patients is based on joint work of oncologist and reproductologist. Oncologist task is to define the basic treatment (first surgical treatment or chemotherapy) and predicting disease outcome. Physician of reproductive medecine must to determine the feasibility of reproductive function, which is determined by age, ovarian reserve, reproductive history, risk assessment of premature ovarian failure. At the Center for Human Reproduction «Clinic of professor Feskov», the following methods of fertility preservation are available: embryo cryopreservation, oocyte cryopreservation, cryopreservation of ovarian tissue. In the period between surgery and the start of radiotherapy and chemotherapy, controlled ovarian stimulation and cryopreservation of embryos/oocytes are available. If it’s necessary to start chemotherapy before surgery, patients conducted ovarian tissue cryopreservation with subsequent autologous tramsplantation. Aim is recovery of folliculogenesis for the purpose of production of their own oocytes. Chemotherapy for breast cancer includes alkylating agents, which leads to a more pronounced destruction of the follicles and irreversible damage of genetic material of oocyte in their early stages of development. After such treatment the assisted reproductive technologies may offer only oocyte donation. Therefore, this category of patients advice about preserving fertility is necessary at the stage of the decision making disease treatment strategies.