• Petra Vuković, Miro Kasum, Jelena Raguž, Nikolina Lonjak, Sara Bilić Knežević, Ivana Orešković, Lidija Beketić Orešković, and Ermin Čehić.
• 1Division of Radiotherapy and Medical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Zadar General Hospital, Department of Oncology and Nuclear Medicine, Zadar, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Clinical Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia; 6Human Reproduction Unit, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina.
• Acta Clin Croat. 2019 Mar 1; 58 (1): 147-156.

AbstractAlthough breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.

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