[Protection of reproductive functions in patients with tumors]. / Ochrana reprodukcních funkcí u nemocných s nádorovým onemocnením.

ABSTRACT

BACKGROUND: Survival from cancer continues to improve. Antimitotic therapy can induce failure of spermatogenesis and oogenesis, gonadal disturbances and infertility. Recent advances in reproductive medicine have opened opportunities for the preservation of reproductive potential of patients with cancer. The aim of our study was to analyse by a multidisciplinary team the contemporary state of art and proposal of the Czech model of fertility preservation starting in childhood and continuing through the whole reproductive period. METHODS: This paper highlights the problems associated with gonadal failure as a consequence of therapy for malignancy in childhood, adolescence and adulthood. Analysis of these problems served as a principle for the management strategy for fertility preservation. CONCLUSIONS: Patients undergoing treatment for malignancy are at the high risk of gonadal damage and infertility. Therefore, alternative treatments with less gonadal toxicity and different treatment protocols were evaluated. Fertility can be preserved with the freezing and banking of spermatozoa, embryos, and oocytes obtained prior to the cancer treatment. In female patients (starting in puberty) pharmacological preservation of gonads with gonadoliberin analogues is also possible. Chance for the future fertility preservation for children offers freezing and thawing of primordial follicles and spermatozoa obtained during the gonadal biopsies. Long-term follow-up study by a multidisciplinary medical team is necessary.