Synopsis
Many technologies exist for men and women to preserve fertility, and advances are being made all the time. Sadly, this information is not always well known in the oncology community and is, therefore, not presented to all eligible cancer patients. Reflecting the latest advances in the field and offering practical information useful to clinicians and scientists, Preservation of Fertility addresses new concepts, progress in reproductive techniques, novel treatment modalities, pregnancy after cancer treatment, patient care issues, and professional responsibilities.
Tulandi and Gosden have assembled an outstanding group of internationally recognized specialists to address the entire spectrum of issues regarding fertility preservation. They begin with a discussion of age and fertility, epidemiology of cancer survival and fertility, and the vulnerability of the reproductive system to radiotherapy and chemotherapy. The book includes coverage of methods for preserving fertility, new developments in the laboratory for preserving gametes and gonadal tissue, and the psychosocial, legal, and ethical issues of fertility preservation. A powerful knowledge tool for the medical community, this pioneering book provides a complete understanding of the techniques for preserving fertility.
Reviews
In September 2004, a woman from Belgium gave birth to a child after receiving an ovarian-tissue transplant. This was a culmination of several efforts to preserve fertility in women who undergo treatment for cancer. Radiotherapy and chemotherapy are particularly toxic to eggs and sperm, and to the trauma of the diagnosis of cancer and its subsequent treatment is added the tragedy of subsequent infertility. For young women in whom ovarian damage is likely to result from treatment for cancer, there are various possibilities, including the freezing of eggs, the creation of embryos that can be subsequently frozen, the storage of ovarian tissue, and the transplantation of ovaries. All of these procedures are associated with considerable practical, scientific, ethical, and legal problems that involve a range of medical and health professionals as well as the patient. Tulandi and Gosden take on these issues in Preservation of Fertility, which is largely dedicated to the subject of the protection of male and female fertility in situations in which cancer needs to be treated rapidly. Although this is an important and interesting problem that arises occasionally, the much bigger picture involves the preservation of fertility in populations in which women and their partners choose to delay pregnancy into their late 30s and 40s. The biologic decline of fertility with aging has been well documented and is covered by de Bruin and te Velde in a chapter in this book. (Figure) Unfortunately, it appears that there is nothing further in the book regarding this larger issue that threatens the viability and long-term stability of Western populations. What we learn from the preservation of fertility in situations involving cancer will have a major effect on the preservation of fertility under natural circumstances. Clearly, the freezing and storage of eggs while a woman is young for use if needed later in life offer the most acceptable prospect for the preservation of fertility in the face of aging or cancer. This book points out, however, that the technique of egg freezing is still not well enough developed to be offered on a regular basis to patients in any situation. The challenge for the community, oncologists, and gynecologists is to determine how patients can retain reproductive choices in the presence of disease or lifestyle circumstances that prevent pregnancies at a young age. If we learn more about the biology of the ovary, the egg, and the ovarian follicle, we will be able to address both the medical and the social issues that arise as a consequence of the natural aging of the egg. This book has outstanding references to clinical situations related to cancer, chemotherapy, and radiotherapy that are valuable for anyone working in this area. Its greatest potential, however, is for use in the management of natural reproductive aging. It is hoped that the science and technology in this area will develop much faster than they have in the past 20 years. Robert J. Norman, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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