May 22, 2018
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ASCO updates fertility preservation guidelines

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Health care providers should discuss fertility preservation with patients as early as possible, according to updated ASCO guidelines.

The guideline authors also noted that ovarian tissue cryopreservation may soon be a viable option.

“ASCO first published evidence-based clinical practice guidelines on fertility preservation in 2006, and an updated guideline was published in 2013,” Kutluk Oktay, MD, PhD, director of the laboratory of molecular reproduction and fertility preservation at Yale School of Medicine, and colleagues wrote. “The goal of this 2018 guideline update is to provide current guidance regarding fertility preservation options for people with cancer anticipating treatment.”

The panel conducted a systematic literature review of 61 publications released between January 2013 and March 2017. The review prompted the panel to update two of the 2013 guidelines regarding ovarian suppression and ovarian tissue cryopreservation and transplantation.

Seven guidelines identified by the panel in the literature review provided mixed recommendations regarding gonadotrophin-releasing hormone agonists: two recommended the therapy for fertility preservation, two did not recommend it and three recommended it for fertility preservation among premenopausal women who had ER-negative breast cancer.

Although Oktay and colleagues found conflicting evidence regarding the use of gonadotrophin-releasing hormone agonists and other ovarian suppression methods for fertility preservation, they recommended the therapy be offered to young women with breast cancer to reduce the likelihood of chemotherapy-induced ovarian insufficiency. They added, however, that gonadotrophin-releasing hormone agonists should not be used in lieu of proven methods of fertility preservation.

The panel also wrote that ovarian tissue cryopreservation for possible future transplantation — which does not require patients to be sexually mature — may be an option for children.

The method is still in the experimental phases in the U.S., although it is in use in some countries. However, Oktay and colleagues noted that the field “is advancing quickly” and the method may become a standard therapy in the years to come.

Oktay and colleagues also reiterated the original recommendations from 2013.

“People with cancer are interested in discussing fertility preservation,” they wrote. “Health care providers caring for adult and pediatric patients with cancer (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, surgeons and others) should address the possibility of infertility as early as possible before treatment starts.” – by Andy Polhamus

Disclosures: Oktay reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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