Fertility Preservation: Advances and Controversies Botros RMB Rizk, Mohamed A Bedaiwy
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1FERTILITY PRESERVATION2
3FERTILITY PRESERVATION: ADVANCES AND CONTROVERSIES
Editors Mohamed ABedaiwyMD PhD FACOG Professor and Division Head Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology Faculty of Medicine University of British Columbia Vancouver, BC, Canada Botros RMBRizkMD MA FRCOG FRCS HCLD FACOG FACS Professor and Head Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology University of South Alabama Mobile Alabama, USA Foreword Victor Gomel
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Fertility Preservation: Advances and Controversies
First Edition: 2014
9789350909867
Printed at
5Dedicated to
Our Parents, Families,
Mentors and Patients
6
7CONTRIBUTORS 9FOREWORD
Fertility preservation has become an increasingly important issue for women in reproductive age. In turn, it has become an important aspect of reproductive medicine due to the recent advances in cancer treatment and innovations in assisted reproductive technologies.
Women diagnosed with cancers during their reproductive years, often, face the consequences of treatment-induced reproductive and endocrine impairment. Fertility impairment is a consequence of exposure to radical surgery, radiotherapy and chemotherapy. Over the past few decades, there has been a gradual improvement in cancer survival, which is quite significant. Furthermore, the focus has shifted from simply survival driven approach to maximizing the quality of life of cancer survivors. Preserving fertility and maintaining normal ovarian endocrine function are key components of the quality of life of cancer survivors in reproductive age group of women.
Further, in parallel, there has been a gradual and significant delay in childbearing for women in the past four decades, especially in industrialized countries, many of which have such low birth rates resulting in overall population decline. It is evident that fertility declines with increasing age due to decrease in oocyte quality. Many women wish to preserve their fertility until such time as they are ready to have a child. The data for all in vitro fertilization (IVF) clinics in the USA clearly indicates that the majority of the women treated (61.1%) were 35 years of age and more, and only 38.9% were under 35 years. Impairment of men reproductive functions occurs in a similar way consequential to cancer therapy in young age. In addition to fertility impairment, gonadal insufficiency causes many deleterious effects, and significant impairment in the quality of life. These are the most common indications for fertility preservation not related to cancer.
Physicians in various specialties, caring for such patients, will find this book valuable in addressing the different fertility preservation strategies for women and men alike.
The editors are physician scientists with extensive experience in fertility, and internationally known in their field. Dr Mohamed A Bedaiwy is Professor and Division Head of Reproductive Endocrinology and Infertility at the University of British Columbia, Vancouver, BC, Canada; and Dr Botros RMB Rizk is Professor and Head of Reproductive Endocrinology and Infertility at University of South Alabama, Mobile, Alabama, USA. Their goal was to produce a comprehensive, up-to-date book that presented the different medical and surgical strategies for fertility preservation for both women and men. They achieved their goal by recruiting for each chapter, internationally renowned authors for their expertise in the specific field.
The book is clinically oriented with a strong scientific basis; it even has a chapter on basic cryobiology. The book is concise, well-written with frequent use of pictures, tables and algorithms, and contains up-to-date and established references. It represents a current, comprehensive review of an important topic. It will serve as reference to trainees, practicing clinicians and scientists alike.
Victor Gomel MD FRCS
Professor Emeritus
Department of Obstetrics and Gynecology
Faculty of Medicine
University of British Columbia
Vancouver, BC, Canada
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11PREFACE
Few areas in medicine have witnessed significant progress such as fertility preservation in the last decade. In 2013, it is estimated that over 1,665,000 men and women will be afflicted with cancer. A significant proportion of these cancers will be during the reproductive age. The fertility impairment associated with cancer therapy can result in significant impairment of the quality of life. Recent advances in cancer therapy resulted in significant improvement in cancer-free survival. This was paralleled by increased number of reproductive age women requiring access to fertility preservation. With the recent advances in technology, cryopreservation of spermatozoa, oocytes and embryos become very successful. Moreover, the cryopreservation of testicular tissue and ovarian tissue added to the armamentarium of options that could be offered to these patients. In addition, there is an increasing hope that a pharmacological approach to prevent the chemotherapy-induced gonadal toxicity is within the reach. With this plethora of information comes the need to have a practically acceptable and readable guide to serve as a resource to healthcare providers.
This book is written with the primary goal of providing an up-to-date, concise, yet informative guide about fertility preservation options for both men and women. Throughout the chapters, the biological basis of the different treatment strategies is thoroughly discussed. To enhance the multidisciplinary approach to such a unique problem, the chapters are written by experts in their field. This book is divided into two major sections, sharing a similar approach to discuss the different fertility preservation strategies for both men and women. Also, an evidence-based approach is adopted to present relevant clinical recommendations about each strategy. The currently available laboratory techniques such as sperm cryopreservation, embryo cryopreservation and oocyte cryopreservation are discussed thoroughly as viable alternatives when indicated. Experimental approaches such as ovarian tissue cryopreservation are touched upon in the context of possibly becoming a viable option in the near future. The guidelines of the respected committees in the field are quoted and integrated in the respective chapters. To our readers, we put in your hands a book that we hope will assist you to provide cutting edge and evidence-based treatment to your patients.
Mohamed A Bedaiwy
Botros RMB Rizk
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