Female Fertility Preservation in Patients with Musculoskeletal Cancer

Introduction. Besides the improvement of the survival rate in young patients with musculoskeletal cancer, we should always consider that infertility and premature menopause due to treatment might dramatically affect their quality of life. Material and methods. This article is a review of literature. Results. After puberty, the first option should be ovarian controlled hyperstimulation (COS) resulting in oocytes that are consequently fertilized using FIV or ICSI and the cryopreservation of the embryos. If the patient does not have a partner at that moment, the next method is the vitrification of the oocytes resulting from the COS. The disadvantages of using COS are the need to postpone the radio and chemotherapy for at least 2-3 weeks and high oestradiol levels, but there are very few hormone dependent musculoskeletal tumors that may be affected. Ovarian tissue cryopreservation (OTC), with ovarian tissue transplantation (OTT) is the only method used if the patient is before puberty, plus, this technique allows patients to spontaneously conceive, if they do not have any other fertility pathology, but this freezing/ thawing procedure may have success or not. There is currently no evidence to suggest that OTT causes reseeding of the original cancer, and the restoring of the ovarian endocrine function was reported in about 95% of the cases. Conclusions. The success of fertility preservation techniques is related to the cryopreservation methods used and the age of the patient. The reproductive cells with the best survival are the embryos, the next are oocytes, or ovarian tissue may be cryopreserved. For best outcomes, the fertility preservation must be pluridisciplinary discussed, involving the ART specialist gynecologist, the oncologist and the surgeon of the musculoskeletal tumor.