A 26 yo nulligravid woman is referred to your office because she was recently diagnosed with breast cancer. She and her partner desire future childbearing. The treatment most likely to preserve her fertility is:
Ovarian tissue freezing
Gonadal suppression with GnRH agonist
IVF involves administration of exogenous gonadotropins with surgical extraction of eggs followed by fertilization using sperm. The resultant embryos can be frozen for future use.
Oocytes can also be cryopreserved, but this process is not as successful as embryo cryopreservation. Implantation and pregnancy rates are lower with frozen oocytes compared to frozen embryos.
Embryos are multicellular and can survive the freeze thaw process well
Ovarian transposition involved moving ovaries outside the field of radiation (if radiation needed to pelvis)
Ovarian tissue freezing involves surgically stripping the cortex of the ovary which is then frozen for future use. The tissue can be reimplanted at a later time. There is limited data regarding the success of this procedure
RCTs have shown mixed results regarding the effectiveness of gonadal suppression with GnRH for the preservation of hormonal function and fertility