Melo Anderson Sanches de, Paula Camilla Teles Vidal de, Rufato Marcelo Augusto Feres, Rufato Mariana Carvalho Assad Carneiro, Rodrigues Jhenifer Kliemchen, Ferriani Rui Alberto, Barreto Jorge
Fertility Center of Ribeirão Preto (CEFERP) - Ribeirão Preto - São Paulo - Brasil.
Member of Latin America Oncofertility Network, Oncofertility Consortium.
JBRA Assist Reprod. 2019 Oct 14;23(4):418-429. doi: 10.5935/1518-0557.20190011.
Advances in the early diagnosis and treatment of cancer have reduced mortality rates and improved patient survival. For this reason, professionals from different areas have strived to implement actions to increase patient quality-of-life during and after cancer treatment. Among these measures, integral attention in reproductive health is one of the main points for the inclusion, safety, and autonomy of female patients. The approach to fertility in these cases should include counseling on fertility preservation and contraceptive options. Oocyte/embryo freezing is an effective technique that does not delay the start of cancer treatment, since controlled ovarian stimulation can be initiated at any stage of the menstrual cycle. At the same time, contraceptive counseling should be conducted based on the eligibility criteria established by the World Health Organization and the Centers for Disease Control and Prevention. However, there is still a lack of studies on (i) the suitability of contraceptives to patients of reproductive age with relatively frequent tumors (lymphoma, leukemia, bone cancer), and (ii) the use of contraceptive concurrently with chemotherapeutic agents. Therefore, the choice of contraceptive method should consider other factors such as tumor type, thrombogenic risk factors linked to cancer/chemotherapy, immunosuppression, blood disorders (thrombocytopenia/anemia), bone mass reduction, metabolic/cardiovascular effects, and drug interaction.
癌症早期诊断和治疗方面的进展降低了死亡率，提高了患者生存率。因此，来自不同领域的专业人员努力采取行动，以提高癌症治疗期间及之后患者的生活质量。在这些措施中，对生殖健康的全面关注是女性患者纳入、安全和自主的要点之一。这些情况下的生育问题处理应包括生育力保存和避孕选择的咨询。卵母细胞/胚胎冷冻是一种有效的技术，不会延迟癌症治疗的开始，因为可以在月经周期的任何阶段开始控制性卵巢刺激。同时，应根据世界卫生组织和疾病控制与预防中心制定的资格标准进行避孕咨询。然而，仍缺乏关于（i）避孕药对肿瘤相对常见的育龄患者（淋巴瘤、白血病、骨癌）的适用性，以及（ii）避孕药与化疗药物同时使用的研究。因此，避孕方法的选择应考虑其他因素，如肿瘤类型、与癌症/化疗相关的血栓形成危险因素、免疫抑制、血液疾病（血小板减少症/贫血）、骨量减少、代谢/心血管影响以及药物相互作用。
