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Figure 1

Figure 1. Cancer Treatments Have the Potential to Compromise Nearly All Aspects of the Reproductive Axis. From: The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients.

Common cancer treatments in response to a cancer diagnosis include chemotherapy, radiation, and surgery. The majority of these treatments can have direct or indirect effects on the ovary (pink), hypothalamic-pituitary-gonadal (HPG) axis (blue), and uterus (green) that ultimately compromise a patient’s fertility. It is not clear whether chemotherapy has an effect on the uterus. In addition to potential reproductive outcomes, these treatments can also have several measurable psychologic outcomes.

Francesca E Duncan, et al. US Obstet Gynecol. ;6(1):24-34.
Figure 2

Figure 2. The Ovary Is a Robust Source of Tissue that Can Be Used for Numerous Fertility Preservation Options. From: The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients.

Female gametes can be obtained following hyperstimulation or natural cycle protocols. If oocytes are obtained, they can be in vitro matured (IVM) to produce an egg. Eggs can be fertilized using assisted reproductive (ART) procedures such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), and embryos ultimately can be transferred to a recipient uterus. If gametes cannot be obtained, a patient’s ovarian tissue can be surgically removed. This ovarian tissue can be cryopreserved and later thawed and used for transplantation. Alternatively, follicles can be isolated from fresh or previously cryopreserved ovarian tissue. These follicles can be used for transplant, or they can be used for in vitro follicle growth (IVFG) to obtain oocytes that can be used for IVM. Although there are many potential fertility preservation options, patient-specific factors dictate which strategy will be employed. Furthermore, the fertility preservation methods presented here and in Table 1 range from standard to theoretical, and IVFG and follicle transplantation, for example, are still under development and not yet used clinically. It is important to note that methods exist to cryopreserve oocytes, eggs, embryos, follicles, and/or ovarian tissue, which can be stored for a patient’s future use.

Francesca E Duncan, et al. US Obstet Gynecol. ;6(1):24-34.

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