before the age of 20 years.

INTRODUCTION

3 INTRODUCTION

Cancer can be a devastating diagnosis. Despite the considerable advances done and the extensive knowledge acquired over time, however, it remains a major health problem with repercussions not only on a physical level, but also on the psychological and social spheres

In 2010, 740,000 of new cases of cancer were diagnosed in female patients. It was estimated that 10% would be diagnosed before the age of 45 years and approximately 1%

before the age of 20 years.

Cancer patients survive at increasing rates, but successful treatment in younger patients often lead to risk of developing a number of late sequelae, including impaired fertility, adverse pregnancy outcome and health problems in offspring (1).

Loss of fertility is one of the most devastating consequences of radio- or cytotoxic

therapy for these young patients who, having overcome their disease, have expectations of

a normal reproductive life. Ovarian damage is drug and dose dependent and is related to

age at the time of treatment, with progressively smaller doses producing ovarian failure as

INTRODUCTION

4 the patient‘s age increases. Total body, abdominal, or pelvic irradiation may cause ovarian and uterine damage, depending on radiation dose, fractionation schedule, and age at time of treatment.

Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation.

Fertility preservation and the ability to maintain future parenthood are issues that present and persist from the moment of a cancer diagnosis and they are essential components of a comprehensive approach to cancer treatment (2).

In female cancer patient, various strategies have been used for fertility preservation.

The combining use of GnRH agonist or oral contraceptive during chemotherapy is common but not so effective in order to protect ovary and fertility. To date, embryo cryopreservation is the only method widely used for fertility preservation. However, if it is not allowed or not available both oocyte cryopreservation and ovarian tissue banking followed by tissue transplant have also been successful. Each approach has associated advantages and disadvantages relating to current success rate, required delay in cancer treatment, sperm requirement, and risk of reintroducing cancer cells (2).

Variations in type of cancer, time available to onset of treatment, age, partner status,

type and dosage of any chemotherapy and radiotherapy, and the risk of sterility with a

given treatment regimen require that each case have its own treatment strategy.