PMC3226819_01
Timeline of events. Events relating to cancer detection and treatment, as well as fertility work-up and treatments in a young female patient, are chronicled. Time elapsed, relative to her date of lumpectomy, is listed at the bottom along with her age. Abbreviations: IVF, in vitro fertilization; POD, post-operative day.
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F1
However, 7 years later, she presented to our tertiary care fertility center after several unsuccessful attempts at both natural conception and at in vitro fertilization (Figure 1).
Antral follicle count. Transvaginal ultrasound images reflect a | high and b | low antral follicle counts. The triangles indicate antral follicles. c | The variability in antral follicle count in 252 healthy Caucasian women stratified by age group. Boxes represent 25th and 75th percentiles. Error bars represent standard deviation; stars represent statistical outliers.
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F2
New evidence from the Ovarian Aging study (NIH R01 HD044876) suggests that there is considerable variation in ovarian reserve in women of similar age (Figure 2).
Options for fertility preservation and for conception. A timeline of cancer and motherhood events is shown at the top of the flow chart. Patients meeting referral criteria should see a reproductive endocrinologist as soon after diagnostic biopsy as possible. Boxes demarcate viable time windows for established and experimental fertility preservation and motherhood options are shown below the timeline. Options for fertility preservation before cancer treatment commences include embryo, oocyte, and ovarian tissue cryopreservation, as well as ovarian suppression therapy. Once treatment has commenced, the only options may involve ovarian tissue cryopreservation or ovarian suppression. 2-5 years after treatment, patients may attempt natural conception, use preserved tissues, attempt IV F, use donor eggs and/or embryos, surrogacy, or choose adoption. Abbreviations: IVF, in vitro fertilization; POD, post-operative day.
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F3
However, we emphasize the importance of allowing patients to make their own decisions about family in the presence of the best available clinical data, and, as close to the time of diagnosis as possible, when the most options are available (Figure 3).