[Fertility problems in oncofertility treatment -- including ASCO guidelines].

Owing to the progress in early detection and multidisciplinary treatment of cancer, the interest in better quality of life (QOL) among young cancer patients has increased in recent years. Previously, the top priority of these patients was cancer treatment; therefore, little focus was placed on various complications of cancer treatment. Consequently, some patients were forced to accept the prospect of fertility loss and not being able to bear children after cancer treatment. Young cancer patients face both the risk to their lives due to cancer and the risk of fertility loss, and the practice of fertility preservation with accurate information available at the appropriate time may become a great source of hope for these patients. However, whether this precise information relating to fertility is adequately provided to patients before cancer treatment is not known. Health care providers should have accurate knowledge of such issues and offer the best oncofertility treatment to young cancer patients. It is also necessary to emphasize to these patients that cancer treatment is the top priority, as well as to convey the limits of reproductive medicine, such as the fact that infertility treatment may have to be postponed or terminated because of the underlying disease situation.

The role of menstrual cycle phase and AMH levels in breast cancer patients whose ovarian tissue was cryopreserved for oncofertility treatment.

PURPOSE: To determine the factors that affect oocyte extraction efficiency when using the "combined procedure". In the present "combined procedure" ovarian tissue cryopreservation and oocyte extraction from an isolated ovary, later used in In Vitro Maturation (IVM), are performed concurrently. METHODS: Data were analyzed retrospectively and obtained from the clinical records of 27 young breast cancer patients referred for fertility preservation. RESULTS: The patients' mean age was 33.7 (±3.8) years, mean serum anti-Müllerian hormone (AMH) concentration was 3.5 (±2.1) ng/ml, and mean number of extracted oocytes was 8.3 (±6.1). The phase of menstruation (follicular or luteal) did not affect either the number of oocytes extracted (P = 0.99) nor oocyte survival or maturation rates. Likewise, the number of oocytes that could be extracted was not affected by the type of laparoscopic procedure (multiple-port or single-incision laparoscopy; P = 0.94) or the molecular subtype of breast cancer (either Luminal A or B; P = 0.52). Analysis revealed that the number of extracted oocytes was well-correlated with the patient's AMH serum level and age (coefficient of correlation: 0.60 and -0.48, respectively). CONCLUSION: We conclude that the outcome of the "combined procedure" primarily depends upon the patient's serum AMH level and age. Importantly, the "combined procedure" may be used during any phase of the menstrual cycle to preserve the fertility of breast cancer patients.

Analysis of late-onset ovarian insufficiency after ovarian surgery: retrospective study with 75 patients of post-surgical ovarian insufficiency.

The primary objectives of the present study are to determine the period of onset of ovarian insufficiency after surgery and to confirm potential risk factors for ovarian insufficiency after surgery for the removal of benign ovarian cysts. Data were obtained from 75 patients who underwent surgery for benign ovarian cysts prior to the onset of ovarian insufficiency. Our analysis included 835 ovarian insufficiency patients who were referred to our institution from July 2003 to July 2013. Several epidemiological parameters of ovarian insufficiency after surgery (age at operation, period of onset of ovarian insufficiency, operation procedure, and pathological diagnosis) were investigated. Of the 835 patients who had ovarian insufficiency, 75 patients (9.0%) underwent ovarian surgery before the onset of ovarian insufficiency. Of those 75 patients, 66 patients (88.0%) underwent cystectomy. For the majority of the 75 patients the surgical indication was the presence of endometriotic cysts (57 patients; 76.0%). Twelve patients (16.0%) underwent multiple surgeries (all bilateral cystectomies). The mean age of the patients at the time of surgery was 27.8±5.5 years-old, and the mean period of onset of ovarian insufficiency was 5.8±3.8 years. In patients with cystectomy, the patient's age at the time of surgery and period of onset of ovarian insufficiency was well-correlated (coefficient of correlation; hemilateral endometriotic cystectomy: -0.64, bilateral endometriotic cystectomy: -0.61, and multiple endimetriotic cystectomy: -0.40). We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy. Therefore, it is important to monitor ovarian reserve for an extended period of time after ovarian surgery. It is particularly important to monitor ovarian reserve long-term for patients who wish to conceive in the future and to suggest a variety of infertility treatments appropriate for their ovarian reserve.