1. Fertility preservation, from cancer to
benign disease to social reasons: the
challenge of the present decade
Jacques Donnez, M.D., Ph.D.
Infertility Research Unit, Socie te de Recherche pour l'Infertilite , Brussels, Belgium
Received and accepted March 26, 2013.
J.D. reports Board membership with PregLem and payment for
lectures by
Serono, MSD, Organon, and Ferring.
Reprint requests: Jacques Donnez, M.D., Ph.D., Socie te de
Recherche pour l'Infertilite (SRI), avenue Grandchamp, 143, - B1150 Brussels, Belgium (E-mail: jacques.donnez@gmail.com).
Fertility and Sterility® Vol. 99, No. 6, May 2013 0015-0282/$36.00
Copyright ©2013 American Society for Reproductive Medicine,
Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.fertnstert.2013.03.040

2. Predicting the likelihood of infertility following
gonadotoxic treatments is extremely difficult.
• In the present issue, several hot topics in the field of
fertility preservation are discussed. (Fertil Steril
2013;99:1467–8. 2013 by American Society for
Reproductive Medicine.)

3. • In de first review the impact of cancer therapy
(radiotherapy and/or chemotherapy) on the female
reproductive tract is discussed.
• In the second review, time constraints, potential
complica- tions, and limited opportunity for ovarian
stimulation for fer- tility preservation (FP) or ovarian
stimulation in women with cancer are reported.
• Different strate- gies to increase the chances of
future pregnancy are presented.

4. • Prevention of ovarian hyperstimulation syndrome
(OHSS) in cancer patients is also a major issue
discussed in the review, and use of gonadotropinreleasing hormone (GnRH) agonist is proposed to
trigger final oocyte maturation in women at risk of
OHSS.

5. • In the review on oocyte vitrification, not only the
results, but also the variables (age, oocyte quality,
cryoprotectant type, and concentration, vitrification
devices, team experi- ence) playing a key role
towards final outcome after oocyte vitrification are
described. It may be concluded that vitrifica- tion is
effective. Vitrified oocytes retain their normal
develop- mental potential, with survival rates of
around 90% and pregnancy rates ranging from
60% to 75%.

6. • Many major scientific societies have changed their
position in this regard and no longer consider
oocyte vitrification as an experimental tool. Of
course, oocyte vitrification implies the disadvantage
of needing COS to harvest oocytes, which delays
chemother- apy initiation.

7. • In the review on embryo cryopreservation, special
con- siderations on ovarian stimulation for FP
purposes are ana- lyzed. Embryo cryopreservation
is an established and very successful method of
FP when there is sufficient time to perform
ovarian stimulation

8. • Eleven patients became pregnant and six of them
have al- ready delivered 12 healthy babies.
• Although all pregnancies were obtained from tissue
frozen according to the slow-freezing technique,
vitrification re- sults in experimental models are
looking increasingly promising. The quality of eggs
obtained by IVF after trans- plantation is not optimal
and there is no doubt that dysfunc- tional
folliculogenesis occurs.

9. • The risk is also evaluated in case of breast cancer,
cervical carcinoma, endometrial carcinoma,
colorectal cancer and central nervous system
tumors. This is of major interest to cli- nicians
(oncologists, pediatricians, gynecologists) who
need to counsel patients (and also parents when
minors) in order to propose the most appropriate
option for FP while analyzing associated risks.

10. • CONCLUSION
– In this issue, fertility preservation in female cancer and
non- cancer patients is extensively discussed. The time
when the only goal was to cure the disease is long
gone. Now, curing the disease, quality of life after
cancer, and fertility preserva- tion are all important
considerations.