Pregnancy after cancer

Fertility and sexuality are important aspects in life of long term survivors of cancer. Patients are often fearful that their history of cancer or its treatment will have an adverse effect on their offspring. 

The gonadotoxic effect of chemotherapy is largely drug- and dose-dependent and is related to age. Alkylating agents (cyclophosphamide, ifosfamide, chlorambucil, …) impose the highest risk in causing ovarian failure. Ablative regimens for stem cell transplantation have an extremely high risk of ovarian failure. The effect of radiotherapy is also dependent on dose and age and on the radiation therapy field. 

Methods for fertility preservation should be discussed prior to cancer treatment.

In women, depending on the type of cancer the presence of an adequate ovarian reserve, and time to delay cancer treatment, in vitro fertilization (IVF) with embryo cryopreservation constitutes a valid alternative. On the other hand, cryopreservaion of mature oocytes following IVF/ICSI offers some advantages, but it is still limited by its low success rate. 

Emerging and exciting techniques of ovarian tissue banking, where thousands of immature oocytes (within primordial follicles) can be stored effectively, both in pre -and postpubertal females, and is followed by autotransplantation. Advances are expected in the development of techniques to detect any risk of residual cancer in the stored tissue as well as in the enhancement of graft survival and function.