The experience of a multidisciplinary team in maintaining fertility in oncohematological patients

Background. Over the past few decades, the advancements in antitumor therapy, early diagnosis, and the development of stem cell transplantation techniques have led to a notable increase in the survival rates of oncohematological patients. Although effective chemotherapy has been shown to prolong lifespan, it can also contribute to toxic effects on gland function, which in women can result in impaired fertility and hormonal disorders related to sex hormone production. In order to mitigate or prevent the irreversible complications of antitumor therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate a variety of options for preserving and restoring fertility should be implemented prior to, during, and following the chemotherapy or radiotherapy.
Aim. To test in clinical practice the principles of creating a management plan for oncohematological patients of reproductive age prior to starting special treatment.
Materials and methods. The study included 34 female patients of reproductive age with morphologically confirmed hematological diseases who underwent examination, treatment, and follow-up observation at the State Budgetary Healthcare Institution, City Clinical Hospital No. 52 of the Moscow Healthcare Department. All patients were referred for consultation with an obstetrician-gynecologist to evaluate their hormonal status and reproductive potential. Additionally, a multidisciplinary team, including a reproductive health specialist from REMEDI Institute of Reproductive Medicine LLC, assessed ovarian reserve and selected appropriate fertility preservation technique. A comprehensive review and discussion of all clinical cases was conducted within the framework of a multidisciplinary team, leading to a determination of the feasibility of fertility preservation.
Results. The material for fertility preservation was collected in 82 % of the patients. Hodgkin’s lymphoma was the most common malignancy (76 %). The methods employed for material collection included transvaginal follicle puncture following controlled ovarian stimulation in 89 % of cases and laparoscopy with ovarian resection / ovariectomy followed by cryopreservation of ovarian tissue in 11 % of cases. The fertility preservation methods included oocyte cryopreservation in 71 % of cases, embryo cryopreservation in 11 % of cases, ovarian tissue cryopreservation in 11 % of cases, and both oocyte and embryo cryopreservation in the remaining 7 % of cases. No complications were reported following assisted reproductive technology procedures.
Conclusion. Given the importance of reproductive potential and overall survival in the context of oncohematological diseases, reproductive specialists should prioritize selecting a fertility preservation method before initiating specialized treatment in all patients of reproductive age. The opportunity to procreate constitutes a pivotal component of quality of life for this particular patient population.