Oocyte cryopreservation for a female cancer patient after reaching adulthood

Recent advances in chemotherapy, surgery, and radiotherapy have enhanced disease-free survival in pediatric and young adult cancer patients. Intensive multimodality treatments, however, can cause late adverse events, including infertility. In particular, high-doses of alkylating agents and radiation therapy to the ovaries can lead to premature ovarian insufficiency (POI) and a reduced window of fertility in girls and young women, despite their recovery of regular menses. The median age at menopause in these patients is 30–40 years, although some may undergo menopause at <20 years of age. Methods of fertility preservation, including the cryopreservation of oocytes and ovarian cortices, are increasingly utilized before treatment of female cancer patients at high risk of infertility. Oocyte cryopreservation has been difficult, however, in patients with hematological malignancies, such as acute leukemia and malignant lymphoma, because they usually require immediate treatment. Ovarian tissue cryopreservation is generally the first choice for these patients, except for those lacking evidence of disease contamination to the ovary. Malignant lymphomas can metastasize to the ovaries, limiting fertility preservation before cancer treatment. Several case reports have described fertility preservation after the end of cancer treatment. The present report describes the case of a young adult woman with Burkitt’s lymphoma who underwent oocyte cryopreservation after reaching adulthood for fear of therapy-induced POI. A 14-year-old girl with multiple intra-abdominal tumors and massive ascites was diagnosed with stage III Burkitt’s lymphoma. The patient was medically ineligible for fertility preservation due to the need for immediate treatment and the suspicion of ovarian metastases (Fig. 1a,b). During treatment, the patient experienced frequent recurrences in intra-abdominal organs or bones. Treatment included multiple alkylating agentbased chemotherapy regimens, with total cumulative doses of ifosfamide (IFO) and cyclophosphamide (CPA) of 88.5 and 10 g/m, respectively, and local irradiation (33.8–40.0 Gy) of bone metastases in the right scapula, right ilium, and sacrum. Ultimately, she went into remission 10 times, with the last (current) remission lasting 3 years and 6 months.