Preserve female fertility in view of the therapy
Currently practiced strategies to preserve female fertility in view of chemotherapy treatment are:
- Ovarian protection through drugs similar to the gonadotrophin-releasing hormone (GnRH): this strategy brings fertile women to an ovarian stage similar to that preceding puberty. The analogue or antagonist to GnRH are used for various diseases: these have the effect of completely putting the ovary to rest, by suppressing the ovulation and all that goes with it.
- Freeze egg cells:this represents an important strategy for the preservation of fertility and it can be recommended to all patients who can postpone the chemotherapy treatment by 2 to 3 weeks and who have a suitable ovarian reserve.
- Freeze ovarian tissue: through a minor laparoscopic operation, fragments of ovarian cortical are removed and frozen. This operation is carried out before the exposure to gonadotoxic agents. Following remission, the auto-transplantation of the ovarian cortical is carried out to reactivate the reproductive capacity.
- Ovarian transposition: this strategy can be used whenever radiotherapy treatment is focused on the ovarian area. It consists in a temporary “relocation” of ovaries in a different area. The success of this technique is quite high.
Preserve male fertility in view of the therapy
- Cryopreservation of sperm: a simple and efficient technique. It consists in the preservation of sperm in liquid nitrogen at -196°. This technique cannot be used with children and in those cases in which the disease is at a very advanced stage. It foresees an insemination in vitro of the preserved semen in a second moment.
- Cryopreservation of testicular tissue: èit is possible both with children as well as with patients with low sperm count. Such technique is nevertheless still only experimental.
- Use of hormone analogues or antagonists: easily applied but with an uncertain clinical efficacy (no controlled trials have been carried so far).