2015 Group Project 5

2015 Student Projects
2015 Projects: Three Person Embryos | Ovarian Hyper-stimulation Syndrome | Polycystic Ovarian Syndrome | Male Infertility | Oncofertility | Preimplantation Genetic Diagnosis | Students
2015 Group Project Topic - Assisted Reproductive Technology
This page is an undergraduate science embryology student and may contain inaccuracies in either description or acknowledgements.

Research/Review articles

[Oncofertility and breast cancer: Where have we come from, where are we going?].

<pubmed>25991386</pubmed>

This article focuses on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients' claims, this study aims to make a survey about the management of patients' breast cancer regarding oncofertility. This article concludes that , in order to satisfy patients' requests, several improvements have to be made regarding the patients' information, the health professionals' awareness and care coordination.I don't go through it now but very interesting article to read and useful for our group project.

Emergency fertility preservation for female patients with cancer: clinical perspectives.

<pubmed>26026071</pubmed>

This article explains about clinical perspectives to explore the new as well as the currently available options and strategies that can be used for emergency fertility preservation of female cancer patients.Such options include emergency ovarian stimulation, embryo freezing, egg freezing, ovarian tissue freezing and autotransplantation, in vitro maturation, and ovarian protection techniques. This article also mentions the advantages and disadvantages of each option as well as a new comprehensive multi-step strategy for these situations.

Sexual dysfunction and infertility as late effects of cancer treatment

<pubmed>26217165</pubmed>

As all we know, Sexual dysfunction is the main consequence of cancer treatment. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function. This article emphasizes on these sexual dysfunction and does in depth. It addresses that innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction. Therefore, advances in both technologies and in knowledge about how cancer treatments can damage fertility, offer hope to patients who want children.

Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: A systematic review

<pubmed>26264701</pubmed>

This article explains about psychological outcomes in female cancer patients who undergo fertility preservation counseling/consultation (FPC), with or without fertility preservation (FP).I read through the whole article as I found it really interesting and relevant to our group project. This is another subheadings we can add to those.

--Z3463890 (talk) 11:24, 24 August 2015 (AEST)

Introduction

Oncofertility refers to the medical field that bridges the specialties of oncology and reproductive endocrinology with the purpose of maximizing the reproductive potential of cancer patients and survivors.

Infertility causing cancers

<pubmed>26217165</pubmed> <pubmed>16304430</pubmed>

Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term.

Sexual dysfunction is a common consequence of cancer treatment, affecting at least half of men and women treated for pelvic malignancies and over a quarter of people with other types of cancer. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function.Innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction.Some new and effective cancer treatments, including aromatase inhibitors for breast cancer or chemoradiation for anal cancer also have very severe sexual morbidity.Men frequently have erectile dysfunction (ED) related to damage to the autonomic nervous system and/or reduced circulation of blood to the penis. Hormonal impairment of sexual function is less common. Women, in contrast, are able to overcome damage to autonomic nerves if genital tissues remain structurally intact and estrogenized. Female sexual dysfunction is frequently associated with sudden premature ovarian failure or direct effects of radiation fibrosis or scar tissue causing pain with sexual activity.

Beside Chemotherapy, other treatment can affect the ability to have a child such as targeted and biologic (immune) therapies, Bone marrow or stem cell transplant, Radiation therapy and surgery.

Targeted drugs attack cancer cells differently from standard chemo drugs. Use of these medicines has increased a lot in recent years, but little is known about their effects on fertility or problems during pregnancy. Bevacizumab (Avastin) is one exception – studies have found that this drug can cause ovarian failure, and some women’s ovaries never recover. Another group of drugs that are of concern are targeted drugs called tyrosine kinase inhibitors (TKIs) such as imatinib (Gleevec), which cause birth defects in lab animals. At this time the recommendation is that women talk to their doctors before becoming pregnant while taking TKIs.

Bone marrow or stem cell transplant usually involves high doses of chemo and sometimes radiation to the whole body before the transplant. In most cases, this permanently stops a woman’s ovaries from releasing eggs.

Radiation treatments use high-energy rays to kill cancer cells. These rays can also damage a woman’s ovaries. For a woman getting radiation therapy to the abdomen (belly) or pelvis, the amount of radiation absorbed by the ovaries will determine if she becomes infertile. High doses can destroy some or all of the eggs in the ovaries and might cause infertility or early menopause. Even if the radiation is not aimed right at the ovaries, the rays can bounce around inside the body and might still damage the ovaries. When radiation is directed inside the vagina, the ovaries absorb a high dose of radiation. Radiation to the uterus can cause scarring, which restricts flexibility and blood flow to the uterus. These problems can limit the growth and expansion of the uterus during pregnancy, and increase the risk of miscarriage, low-birth weight infants, and premature births. Sometimes radiation to the brain affects the pituitary gland. The pituitary gland normally signals the ovaries to make hormones, so interfering with these signals can affect ovulation (the release of eggs from the ovaries). This might or might not affect fertility depending on the focus and dose of the radiation. Women may be fertile when they start getting radiation treatments, but it’s important not to become pregnant until treatment is completed because radiation can harm the fetus. Surgery on certain parts of the reproductive system can cause infertility. For some cancers, a hysterectomy is part of the treatment. A hysterectomy is surgery to remove the uterus (womb) either through the vagina or through a cut made in the abdomen (belly). Once the uterus is removed, a woman cannot carry a child.The ovaries might be removed (called an oophorectomy) at the same time the uterus is taken out. Without ovaries, a woman can’t get pregnant because she no longer has any eggs. In some women with early stage ovarian or cervical cancer, the surgeon will try to save one ovary, if possible, to preserve eggs, which might still allow a woman to become pregnant. Keeping at least one ovary also preserves the hormones that prevent menopause symptoms like hot flashes and vaginal dryness. Some women with small cervical cancers can have a surgery called a trachelectomy, which removes the cervix but leaves the uterus behind so a woman can carry a pregnancy. Sometimes surgery can cause scarring in the fallopian tubes. These scars may block the tubes and prevent eggs from traveling to meet the sperm. This means they can’t become fertilized and move on to the uterus to implant in the lining.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs on the body to destroy and kill cancer cells. Chemotherapy can be applied with the use of only drug, or through a use of a variety of anti-cancer drugs at the same time, known as combination chemotherapy. The severity and types of anti-cancer drugs used is largely dependant on the type of cancer cells and degree of aggressiveness. Chemotherapy is also commonly used in conjunction with radiation therapy.

Chemotherapy drugs kill cells that are undergoing the process of dividing into 2 new cells – known as mitosis. Because cancer cells are rapidly dividing cells, and divide much more often then regular cells, they are more likely to be targeted and killed by the chemotherapy drugs. Each specific chemotherapy drug used kill cells in a different way, and the response is varied across the types of chemotherapy drugs. Some common mechanisms used to kill cancer cells are by damaging the part of the cell ‘s control centre that makes it divide – this often includes altering and/or disabling the checkpoint system in the cell cycle to ensure mitosis cannot complete. Other chemotherapy drugs work by interrupting the chemical processes involved in cell division.

Fertility preservation

Variability in the practice of fertility preservation for patients with cancer.

<pubmed>26010087</pubmed> This is an interesting article on how reproductive endocrinologists counselled cancer patients on fertility preservation. This is relevant to our group projects because it gives us an idea of what techniques and services are currently being utilised to help women.

Strategies for fertility preservation in young patients with cancer: a comprehensive approach.

<pubmed>24669162</pubmed> This article recognises that as cancer treatment improves the life span of patients, with it comes the treat to fertility. It is a great article as it clearly states what methods are currently available for addressing fertility preservation in males and females.

Clinical guide to fertility preservation in hematopoietic cell transplant recipients.

<pubmed>24419521</pubmed> This article focuses specifically on patients suffering infertility due to hematopoietic cell transplantation. It lists the options available to the patients whether female or male, which are applicable to patients who underwent other treatments and also lists the barriers to fertility preservation.

Fertility preservation in patients with haematological disorders: a retrospective cohort study.

<pubmed>24140311</pubmed> This article addresses fertility treatment in patients with haematological disorders specifically. However, is it a really good article as it is a cohort study comparing patients at various stages in their cancer journey, such as those who have had prior chemotherapy, those who pursued ovarian stimulation and those who did not pursue fertility treatment at all.