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fertility preservation in cancer patients

Faculty disclosure. Dr. Rama Suresh has no financial conflict of interest to disclose.. Infertility in cancer patients. Type of drugLocation of radiation field/dose/doseintensityDiseaseAgePretreatment fertility. Male infertility. Disease itselfAnatomic problemsPrimary or secondary hormonal insufficiencyDamage or depletion of germinal stem cellsMeasurable effects: sperm

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fertility preservation in cancer patients

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    1. Fertility Preservation in cancer patients – ASCO recommendation Rama Suresh MD.

    2. Faculty disclosure Dr. Rama Suresh has no financial conflict of interest to disclose.

    3. Infertility in cancer patients Type of drug Location of radiation field/dose/doseintensity Disease Age Pretreatment fertility

    4. Male infertility Disease itself Anatomic problems Primary or secondary hormonal insufficiency Damage or depletion of germinal stem cells Measurable effects: sperm#, motility, DNA integrity and morphology

    5. Female infertility Decrease in primordial follicles Hormonal balance Interfering with function of reproductive organs Fertility maybe compromised despite maintainence or resumption of menses Premature menopause

    8. Questions Are cancer patients interested in interventions to preserve fertility? What is the quality of evidence supporting current and forthcoming options for fertility preservation in males? What is the quality of evidence supporting current and forthcoming options for fertility preservation in females? What is the role of oncologist in advising patients about fertility preservation options?

    11. LHRH agonist with chemo in men 6 men (5HD, 1LL) LHRH agonist 50mcg/d sq started before chemo and ended 1 week post chemo Testosetrone levels decreased and all patients were oligospermic/azoospermic within 8 weeks of chemo Post chemo testosterone/LH/FSH normalized but only one patient recovered spermatogenesis at 84 weeks post chemo

    12. Buserelin in Hodgkin's disease patients 30 men and 18 women with Hodgkin's disease randomized to Buserelin starting before chemo till after chemo vs. control LH suppressed After 3 years Buserelin arm all men oligospermic and 4 of 8 women amenorrhoeic Control all men oligospermic and 6 of nine females amenorrhoeic

    13. Lupron and irradiation 12 men with seminoma got Lupron during XRT 8 men with seminoma were control LH and testosterone were low before XRT 18 month f/u all patients reached normal testosterone, LH levels and motile spermatozoa levels in the treatment and the control group

    14. Lupron and PVB chemo Post orchiectomy 2 cycles of PVB chemo 6 patients received Lupron and 8 patients control Lupron patients had their hormone levels suppressed before chemo Post chemo all patients (study and control) had elevated FSH and azoospermia. They normalised within 24 months

    18. Ovarian protection Lupron 18 patients (13 HL, 5 NHL) Monthly depot Lupron x 6months starting 7 days before chemo 15 pts got MOPP/ABV(D) Control 18 patients of which 14 pts got same regimen 2 patients died in each group. 16 patients in the GnRH agonist arm and 7 pts in the control arm resumed menses within 3-8 months of chemo

    19. Ovarian protection with Lupron 24 patients Ages 23-42 with early stage breast cancer ACx4 (n12), ACx4+T(n10), CAF (n1), AT+CMF(n1) Lupron 5 to 14 days before cycle 1 and and then day 1 of each subsequent cycle Amennorhea by cycle 3 and resumed menses in 23 of 24 pts within 12 months of chemo 6 pregnancies in 5 patients: 3 miscarriages, 1 Downs syndrome terminated, one live birth,one ongoing pregnancy. 3 patients unsuccessful despite fertility treatment

    20. Ovarian protection with Goserelin 64 pts with early stage breast cancer received 3.6mg Goserelin q 28 days for one year Ages 27-50 44% ER+, 56% ER neg CMF (n18) , Anthracylcine (n46), ABMT (n9) ER + got tamoxifen for 5 yrs F/U 55 months 86% resumed menses, 1 patient was pregnant with normal childbirth

    21. Ovarian preservation with OC pills 1994 to 1998 Hodgkin's Lymphoma patients surveyed 405 women aged < 40 yrs of 3186 patients answered F/U 3.2 yrs 51% patients who got dose escalated had amenorrhea Advanced stage, age >30, women who did not take OC pills correlated with increased risk

    22. Ovarian follicle preservation with OC pills 6 women with Hodgkin’s disease Ages 18 to 31 f/u for 26 months MVPP x 6 cycles and OC pills at the beginning of chemo Pregnancy in one woman and regular menses in 3 women, 2 had amenorrhea before establishing regular menses and one patient continued OC pills Pre chemo ovarian biopsy 18-55 follicles, post chemo with OC pills 22 follicles and one >1000 follicles (post chemo with no OC pills 0-4 follicles)

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