가임력 보존의 현재와 앞으로 나아갈 길

이지선,이택후 대한의사협회 2022 대한의사협회지 Vol.65 No.6

Background: In its short history, reproductive medicine has achieved many fertility-related milestones, including: the arrival of in vitro fertilization in the late 1970s, the development of intracytoplasmic sperm injection in the early 1990s, the first ovarian transplant a decade ago, and the first livebirth after uterine transplantation in 2014. This paper provides a brief overview of the indications and methods, as well as future perspectives, available for fertility preservation. Current Concepts: More women are undergoing fertility preservation for medical or social reasons. Fertility preservation aids cancer patients in retaining the ability to procreate. Despite the high survival rate of malignancies in young patients, chemotherapy and whole abdominal irradiation have cytotoxic effects on reproductive organs. Cancer treatments can significantly reduce a patient’s reproductive capacity and thus result in irreversible infertility. Early ovarian failure is also a common by-product of additional cancer treatment, bone marrow transplantation, or autologous transplantation. The current options for fertility preservation in cancer patients include cryopreservation (of embryos, oocytes, and ovarian tissue) and gonadotropic-releasing hormone agonist treatment (before and during chemotherapy). Fertility preservation is a means for female cancer patients to preserve their fertility and delay childbearing. Fertility preservation can also aid women who wish to delay childbearing for personal reasons. Since the indications for fertility preservation are different for each patient, individualized treatment strategies should be employed depending on the patient’s situation. Discussion and Conclusion: Health professionals must inform women who are undergoing cancer treatments or purposefully delaying childbearing about the risks of decreased fertility. Appropriate fertility preservation options must be provided for these female patients.

가임력 보존을 위한 난소조직 동결 보존과 이식

홍연희,이정렬 대한의사협회 2022 대한의사협회지 Vol.65 No.6

Background: As the number of cancer survivors has increased with advancements in cancer treatment, fertility preservation has become a treatment goal. Ovarian tissue cryopreservation (OTC) and transplantation (OTT) has made great progress over the past few decades. It has become the treatment of choice for fertility preservation in adolescents or patients in urgent need of chemotherapy. However, it is considered to be experimental compared with oocyte or embryo cryopreservation in some countries. Nevertheless, OTC and OTT is regarded as the more ideal method for fertility preservation in that it can also restore hormonal functions. Current Concepts: Currently, over 200 live births have been reported worldwide after OTC and OTT, proving the excellence of the technology. However, before its application in clinical settings, some challenges, including cryoinjury, ischemic injury, and cancer cell reimplantation, should be overcome. For cryoinjury, studies are underway on protocol improvement with the addition of agents such as antifreeze protein during cryopreservation. For ischemic injury, various agents have been studied to promote angiogenesis or revascularization. Furthermore, studies are underway on artificial ovary or xenotransplantation for fertility preservation in an effort to avoid cancer cell metastasis. Discussion and Conclusion: OTC and OTT is a clinically applicable option for fertility preservation. To set OTC and OTT as an established method for fertility preservation, further research is necessary to overcome the current challenges.

Fertility Preservation in Young Women With Breast Cancer: A Review

홍연희,박창희,백혜린,이경훈,이정렬,한원식,박세호,정석훈,김희정 한국유방암학회 2023 Journal of breast cancer Vol.26 No.3

Fertility preservation is a major concern in young patients diagnosed with breast cancer and planning to receive multimodality treatment, including gonadotoxic chemotherapy with or without age-related decline through long-term endocrine therapy. Most breast cancer patients undergo multimodality treatments; many short-term and long-term side effects arise during these therapies. One of the most detrimental side effects is reduced fertility due to gonadotoxic treatments with resultant psychosocial stress. Cryopreservation of oocytes, embryos, and ovarian tissue are currently available fertility preservation methods for these patients. As an adjunct to these methods, in vitro maturation or gonadotropin-releasing hormone agonist could also be considered. It is also essential to communicate well with patients in the decision-making process on fertility preservation. It is essential to refer patients diagnosed with breast cancer on time to fertility specialists for individualized treatment, which may lead to desirable outcomes. To do so, a multimodal team-based approach and in-depth discussion on the treatment of breast cancer and fertility preservation is crucial. This review aims to summarize infertility risk related to currently available breast cancer treatment, options for fertility preservation and its details, barriers to oncofertility counseling, and psychosocial issues.

Fertility preservation for patients with breast cancer: The Korean Society for Fertility Preservation clinical guidelines

Kim, Hoon,Kim, Seul Ki,Lee, Jung Ryeol,Hwang, Kyung Joo,Suh, Chang Suk,Kim, Seok Hyun The Korean Society for Reproductive Medicine 2017 Clinical and Experimental Reproductive Medicine Vol.44 No.4

With advances in the methods of cancer treatment used in modern medicine, the number of breast cancer survivors has been consistently rising. As the number of women who wish to become pregnant after being diagnosed with breast cancer increases, it is necessary to consider fertility preservation in these patients. However, medical doctors may be unaware of the importance of fertility preservation among cancer patients because most patients do not share their concerns about fertility with their doctors. Considering the time spent choosing and undergoing treatment, an early referral to a reproductive specialist is the best way to prevent a delay in cancer treatment. Since it is not easy to make decisions on matters related to cancer diagnosis and fertility, patients should be provided with enough time for decision-making, and to allow for this, an early referral will provide patients with sufficient time to choose an appropriate method of fertility preservation. The currently available options of fertility preservation for patients with breast cancer include cryopreservation of embryos, oocytes, and ovarian tissue and gonadotropin-releasing hormone agonist treatment before and during chemotherapy. An appropriate method of fertility preservation must be selected through consultations between individual patients and health professionals and analyses of the pros and cons of different options.

가임력 보존의 역사

김혜윤,김성우 대한의사협회 2022 대한의사협회지 Vol.65 No.6

Background: Fertility preservation refers to a procedure performed to maintain the ability to become pregnant before receiving treatment with a risk of fertility loss, such as chemo- or radiation therapy. Examples of fertility preserving procedures include freezing, sperm freezing, embryo freezing through in vitro fertilization, and ovarian tissue freezing. Current Concepts: Until the late 1990s, awareness of fertility preservation among clinicians and patients was relatively low, and the only way to preserve and restore fertility in women with cancer was the cryopreservation of embryos. However, as the survival rate of cancer patients increased and the treatment results of various diseases improved, interest in quality of life such as pregnancy and childbirth after treatment gradually increased, and became a driving force for the development of fertility preservation. In the 2000s, several centers began cryopreserving ovarian tissue, including primordial follicles from young patients before chemotherapy. Currently, ovarian tissue cryopreservation can be used in combination with in vitro maturation and egg vitrification techniques. Novel methods to improve follicle survival after transplantation are currently being investigated. Methods to improve follicle survival after transplantation and new ovarian protective agents to protect the ovaries from cytotoxic agents are currently being studied. Discussion and Conclusion: Advances in fertility-preserving technologies in the future will contribute to the delivery of healthy children by providing tailored treatments and more individualized fertility-preserving strategies to patients whose fertility is at risk.

Current Practices toward Fertility Issues for Young Breast Cancer Patients: A Survey of the Korean Breast Cancer Society; The SMARTSHIP Study

Haiyoung Son,Hak Min Lee,Yun-Jung Yang,Hyun Jo Youn,Jong Won Lee,Jihyoun Lee,So Youn Jung,Min Hyuk Lee,Ilkyun Lee 한국유방암학회 2020 Journal of Breast Disease Vol.8 No.2

Purpose: This study aimed to investigate and analyze the current fertility-related practices for breast cancer patients; the results are intended to help improve the quality of life of young patients and survivors. Methods: This study collected voluntary responses to a questionnaire that was used to survey Korean breast cancer specialists. The questionnaire consisted of five categories: knowledge, practice behaviors regarding fertility preservation, barriers to discussing fertility preservation, attitude toward fertility issues, and demographics and medical background. Results: A total of 120 copies of the questionnaire were distributed; the response rate was 89%. The section of the questionnaire regarding knowledge indicated that most respondents had adequate fertility preservation knowledge for cancer patients. However, 13.1% of the respondents indicated that they thought pregnancy increased the cancer recurrence risk. Respondents’ knowledge and attitudes about fertility preservation were not correlated with actual practice. The absence of patient’s expressions (24.30%), high recurrence risk (27.10%), insufficient time in the clinic (21.50%), and hospital conditions such as no reproductive specialists or infertility clinic (16.82%), were considered major barriers to discussing fertility issues. Conclusion: Although more than 50% of the respondents thought that cancer treatment is more important than fertility preservation and it is complex and difficult, the Korean breast surgical oncologists were generally encouraging when discussing fertility issues with young breast cancer patients. Hence, breast clinicians should share with young patients the updated evidence regarding the feasibility and safety of pregnancy after cancer treatment and the available options so that the best decisions can be made.

Fertility preservation for patients with gynecologic malignancies: The Korean Society for Fertility Preservation clinical guidelines

Lee, Sanghoon,Kim, Seul Ki,Hwang, Kyung Joo,Kim, Tak,Kim, Seok Hyun The Korean Society for Reproductive Medicine 2017 Clinical and Experimental Reproductive Medicine Vol.44 No.4

Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.

Fertility preservation in patients with early epithelial ovarian cancer

Yong-Soon Kwon,Ho-Suap Hahn,김태진,이기헌,임경택,이인호,심재욱,Jung-Eun Mok 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.1

Objective: To assess the role of fertility preservation in the treatment of patients with early epithelial ovarian cancer (EOC). Methods: We retrospectively analyzed the medical records of 21 patients with early EOC from January 1995 to December 2006. All eligible patients with a strong desire to preserve fertility were younger than 35 years and underwent fertility-sparing surgery with or without adjuvant chemotherapy. Results: Twenty-one eligible patients with a median age of 26.7 years (range, 20 to 33 years) were identified, and the mean follow-up period was 43 months (range, 5 to 86 months). Only one patient with stage IC recurred 34 months after the first operation. A total of five patients were able to become pregnant at least once after the first fertility preserving treatment, with or without adjuvant chemotherapy. All five patients succeeded in full-term vaginal delivery with healthy infants. No patients died of their disease. Conclusion: Fertility preserving treatment in patients with early EOC can be considered as a proper treatment strategy in patients with early EOC, who have the strong desire for fertility preservation.

여성 암 환자의 가임력 보존

박찬우 한국모자보건학회 2016 한국모자보건학회지 Vol.20 No.3

Recent anticancer treatments have led to significant reduction in mortality, but also to an increase in unwanted side effects such as loss of fertility. Combined with an increased age for childbearing, a higher number of cancer survivors require fertility preservation to be pregnant after cancer treatment. The threat of cancer treatment-related infertility can lead to psychological distress, and many patients are interested in maintaining fertility and future pregnancy at the time of cancer diagnosis. International guidelines recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and inform fertility preservation options. Embryo/oocyte cryopreservation are standard strategies for fertility preservation in female patients. Another strategy is pharmacological protection with gonadotropin releasing hormone agonist (GnRH agonist). Ovarian tissue cryopreservation is still considered experimental techniques. In the present manuscript, we summarize and discuss the up-to-date knowledge on fertility preservation in women with cancer patients.

Controlled ovarian hyperstimulation for fertility preservation in women with breast cancer: Practical issues

박소연,Jeong Kyungah,Cho Eun Hye,Chung Hye Won 대한생식의학회 2021 Clinical and Experimental Reproductive Medicine Vol.48 No.1

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer.