Table Of ContentFertility Challenges
and Solutions in
Women with Cancer
Hatem A. Azim Jr
Isabelle Demeestere
Fedro A. Peccatori
Editors
123
Fertility Challenges and Solutions
in Women with Cancer
Hatem A. Azim Jr • Isabelle Demeestere
Fedro A. Peccatori
Editors
Fertility Challenges
and Solutions in Women
with Cancer
Editors
Hatem A. Azim Jr Isabelle Demeestere
School of Medicine CUB-Erasme, Fertility Clinic
Tecnologico de Monterrey Université Libre de Bruxelles
Monterrey Brussels
Mexico Belgium
Fedro A. Peccatori
Division of Gynecologic Oncology
European Institute of Oncology
Milan
Italy
ISBN 978-3-030-24085-1 ISBN 978-3-030-24086-8 (eBook)
https://doi.org/10.1007/978-3-030-24086-8
© Springer Nature Switzerland AG 2020
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Preface
This book addresses a highly controversial and challenging subject, which is related
to fertility management of young women with cancer. In light of the improvement
in cancer survival and the rising trend of delaying childbearing over the past decade,
an increasing number of oncologists and fertility specialists are often faced with
young women with cancer inquiring into fertility-related issues in routine clinical
practice.
Over the past decade, the field of fertility management of cancer patients has
evolved enormously moving from managing patients based on anecdotes and per-
ceptions to counseling based on evidence, thanks to a large amount of clinical and
experimental research that has been generated and published by several groups
around the globe.
This book gathers worldwide experts who have made important contributions in
the field of fertility management of young cancer patients. Several subjects are dis-
cussed spanning from understanding the feasibility and safety of pregnancy in can-
cer survivors to the various fertility preservation methods that could be used, in
addition to fertility counseling of special subgroups of patients like those with
germline mutations or with endocrine sensitive tumors. The book also addresses
controversies related to the role of ovarian tissue cryopreservation and LHRH
analogues. We strongly believe that this book will fulfill its aim in providing busy
clinicians with a valuable resource in counseling their patients in routine clinical
practice.
Monterrey, Mexico Hatem A. Azim Jr
Brussels, Belgium Isabelle Demeestere
Milan, Italy Fedro A. Peccatori
v
Contents
Part I O verview on Pregnancy in Cancer Survivors and Fertility
Preservation Options
1 Epidemiology and General Considerations of Pregnancy Following
Cancer Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Barbara Buonomo, Hatem A. Azim Jr, Carlo Alviggi,
and Fedro A. Peccatori
2 Safety and Challenges of Pregnancy in Women with a History of
Endocrine-S ensitive Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Hatem A. Azim Jr
3 Pregnancy After Gynecological Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 17
Marieke van der Zalm, Frederic Amant, and Joris van Drongelen
4 Overview of Fertility Preservation Approaches in Cancer Patients . . . 25
Isabelle Demeestere
5 Fertility Preservation in Women with Hematological Malignancies . . 43
Javier Domingo and Antonio Pellicer
Part II C hallenges to Fertility Preservation in Women with Cancer
6 Organizational Strategies to Overcome Barriers to Addressing
Fertility Preservation in the Oncology Setting . . . . . . . . . . . . . . . . . . . . 57
Joanne Frankel Kelvin
7 Impact of Systemic Anticancer Therapy on Fertility . . . . . . . . . . . . . . . 67
Antonio Di Meglio, Ines Vaz-Luis, and Barbara Pistilli
8 Fertility Counseling in Routine Practice: Why, When, and How? . . . . 81
Sukhkamal B. Campbell and Terri L. Woodard
9 Challenges in Fertility Counseling of Cancer Patients:
A Developing Nation Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Ghina Ghazeeri and Dalia Khalife
vii
viii Contents
Part III Controversial Topics in Fertility Counseling of Breast Cancer
Patients
10 Ovarian Stimulation in Women with Breast Cancer . . . . . . . . . . . . . . . 105
Volkan Turan and Kutluk Oktay
11 Role of GnRH Agonists for Fertility Preservation in Breast Cancer . . 117
Cynthia Villarreal-Garza, Edna A. Lopez-Martinez,
and Hatem A. Azim Jr
12 Fertility and Pregnancy Counseling of Breast Cancer Patients with
Germline BRCA Mutations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Margherita Condorelli and Matteo Lambertini
About the Editors
Hatem A. Azim Jr, MD, PhD is a medical oncologist and an adjunct professor at
the School of Medicine of the Monterrey Institute of Technology and the American
University of Beirut. He also serves as faculty for the European Society for Medical
Oncology (ESMO) and the European School of Oncology. He holds a master’s
degree from the University of Newcastle Upon Tyne (UK) and a PhD from the
Université Libre de Bruxelles (Belgium). Dr. Azim has published more than 120
peer-reviewed articles, contributed to 10 books, and been an invited speaker at the
major oncology conferences. In recognition to his research in the field of breast
cancer in young women and its relation to pregnancy and fertility, Dr. Azim has
received the American Society of Clinical Oncology Merit Award, the ESMO
Translational Research Award, and the University of Padua Breast Cancer Research
Award.
Isabelle Demeestere, MD, PhD is a gynecologist at the fertility clinic in Erasme
Hospital (Brussels, Belgium) and the Director of the Research Laboratory on
Human Reproduction at the Université Libre de Bruxelles (ULB). After earning a
PhD in fertility preservation for cancer patients, she completed her research training
at McGill University, Canada, and became research associate at the FNRS. She was
among the earliest innovators in the fertility preservation field and is responsible for
the oncofertility unit at Erasme Hospital. She is a member of several scientific soci-
eties and author or coauthor of over 60 articles and book chapters in the field.
Fedro Alessandro Peccatori, MD, PhD is a specialist in Medical Oncology and
Obstetrics & Gynecology. He acts as Director of the Fertility and Pregnancy Unit at
the European Institute of Oncology (IEO) and Scientific Director of the European
School of Oncology (ESO) Milan, Italy. Fertility and pregnancy issues in young
women with cancer are his main research interests. He has published more than 190
peer-reviewed articles in international journals and has been the editor or author of
more than 10 books on cancer and reproduction. He has been invited as speaker for
ASCO, ESGO, and ESMO, where he is part of the Adolescent and Young Adults
working group.
ix
Part I
Overview on Pregnancy in Cancer Survivors
and Fertility Preservation Options
Epidemiology and General 1
Considerations of Pregnancy
Following Cancer Diagnosis
Barbara Buonomo, Hatem A. Azim Jr, Carlo Alviggi,
and Fedro A. Peccatori
Introduction
Nowadays, there is a rising trend of delaying childbearing for personal, educational,
and professional reasons. Given that cancer incidence increases with age, more
women inquire into the feasibility and safety of pregnancy following cancer diagno-
sis [1]. In addition, several concerns exist regarding the impact of cancer therapy on
pregnancy outcome and the possibility of adverse effects among their offspring.
However, it is not only the oncologic treatment that may have a potential negative
impact on reproductive rates among cancer survivors. These patients may choose
not to start a family for concerns related to the risk of transmitting predisposing
genetic mutations to offsprings, for worries about cancer relapse and for the
potentially increased risks of obstetric and perinatal complications [2]. Cancer sur-
vivors often suffer sexual health problems as well, which could be partly related to
psychological challenges [3]. It was shown that decreased arousal, pleasure, and
B. Buonomo (*)
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences
and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute
of Oncology IRCCS, Milan, Italy
e-mail: [email protected]
H. A. Azim Jr
Tecnologico De Monterrey, School of Medicine, Monterrey, Mexico
C. Alviggi
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences
and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
F. A. Peccatori
Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute
of Oncology IRCCS, Milan, Italy
© Springer Nature Switzerland AG 2020 3
H. A. Azim Jr et al. (eds.), Fertility Challenges and Solutions in Women with
Cancer, https://doi.org/10.1007/978-3-030-24086-8_1
