Strategies for fertility preservation and gonadal protection during gonadotoxic chemotherapy and radiotherapy

With the recent report of a pregnancy and delivery after auto transplantation of cryopreserved-thawed ovariancortical strips, preservation of the reproductive potential resurfaced. There is a growing academic and public interest inexploring the available strategies for fertility preservation in patients at risk. This is due to the increasing incidence of cancer during the reproductive age. The overall survival and cure rates of reproductive age cancers are improving due to improvements in cancer therapy. Reproductive derangement is one of the major consequences of cytotoxicchemotherapy and radiotherapy. GnRh analogues concomitant therapy, laparoscopic ovarian transposition, oocytecryo preservation, embryo cryopreservation and transplantation of cryopreserved-thawed ovarian tissue, are all strategiesfor fertility preservation in patients at risk. However, no evidence-based strategy is available yet. This article discusses the mechanisms of reproductive failure after gonadotoxic therapy and the currently available fertility preservation strategies.