About 15% of patients diagnosed with metastasis for the first time are under the age of 55 and a third of them are under twenty years of age. According to various sources, after undergoing chemotherapy, 30-70% of patients experience premature ovarian failure and are unable to conceive [1].

You shouldn't think of cancer and chemotherapy as a sentence for future motherhood. After all, medicine is evolving and can actually offer a fertility preservation solution for the first time. The term “carcinoid tumors” was introduced in the USA in 2006 to denote a multidisciplinary trend in medicine and its purpose is to enhance the efforts of oncologists and reproductive specialists to preserve fertility. In patients with malignant tumors [2].

The modern algorithm for deciding whether to maintain reproductive function in oncological patients depends mainly on the diagnosis of the malignant process and the attention of the patient.

The concept of fertility in oncology is to preserve ovarian function to prevent the onset of premature menopause (absent menstruation), which is often caused by treatment with cellular inhibition and radiotherapy [3].

So in women under the age of 25 who received standard Chemotherapy (PCT) with the inclusion of alkylating drugs as the primary treatment, menopause occurs in 28% of cases, in women over 25 years old-in 86% and in patients over 40 years old-in Almost 100%. A similar pattern is observed in the use of radiotherapy.                

Not all cancer patients lose fertility as a result of chemotherapy. However, it must be borne in mind that even with restoration of the ovarian function of the ovaries, the quality of the eggs (ova) may not be sufficient to perform fertilization and bear the baby.

The ovarian cortex contains a limited number of follicles, which gradually decrease during life, due to ovulation, mainly due to atresia mechanisms (the reverse development of immature follicles). Radiation and chemotherapy promote the natural decrease in the number of follicles and prevent them from maturing. These factors, combined with the inability to regenerate ovarian tissue, lead to its premature failure. The number of primordial follicles that will survive chemotherapy depends on the age of the patient, the type of tumor, the agent used (chemotherapy or radiation therapy), the dose and the number of radiation cycles [4,5].

In addition to the cessation of reproductive function, long-term premature failure of the ovaries implies a violation of vascular motility, bones and cardiovascular systems (due to the cessation of hormonal function).

Among pregnant women with childhood cancer, there is a high rate of miscarriage and fetal growth retardation is more common.

The main impetus for developing fertility preservation techniques in oncology has been the increase in the number of young patients who have recovered from cancer [6].

Fertility preservation consultations are designed for each patient and are based on a comprehensive, balanced assessment of the efficacy, potential risks and technical aspects of each method and take into account the specifics of the planned treatment.

During chemotherapy, ovarian follicle death occurs rapidly, resulting in a loss of fertility. When the follicle enters its growth phase, ovulation must occur over a period of time. This sequence of events cannot be interrupted or delayed in development. It is assumed that under the influence of chemotherapy, those follicles that have already entered the growth stage, or those that are in the initial stage of stimulation, die. So chemotherapy affects the growth follicles (up to 85 days) and then works on the primordial pond. Scientists from the Israeli Center for Fertility Preservation at Sheba Medical Center have shown that before immature eggs die during chemotherapy, an abnormally strong wave of their growth occurs, which leads to a rapid decrease in the ovarian tissue supply of eggs [7,8].

Preservation of reproductive function in women with oncological diseases can happen in three ways:

• Obtaining eggs, embryos and ovarian tissue and preserving them by cryopreservation
• Transferring the ovaries from the irradiated area to the pelvic area during radiation therapy

Using hormonal suppression of the ovaries during chemotherapy.

An orderly hunt of bibliographic and dark writing for clinical practice rules in regards to fertilization, protection in TYAs with disease was embraced, notwithstanding master discussion. The writing search consolidated segment explicit terms and the applicable illness-((high school OR adolesce* OR youthful grown-ups) with richness and its safeguarding (ripeness and (protection or preservation)). The hunt was restricted to clinical practice rules. A careful web search was embraced to guarantee that qualified clinical practice rules not indexed inside bibliographic data sets were incorporated. Specialists in the field of TYA oncology were additionally drawn nearer. A comparable hunt system was utilized to recognize richness protection rules for kids and grown-ups to guarantee that no direction pertinent to TYAs was missed. In situations where numerous adaptations of a rule were accessible, the most recent variant was assessed [9]. 

All recognized clinical practice rules were audited as indicated by the Appraisal of Guidelines for Research and Evaluation (AGREE-II) rules by two scientists (a TYA oncology expert and a scholastic oncology student). The AGREE-II is an online evaluation apparatus used to survey the methodological meticulousness and straightforwardness by which a rule is created. The AGREE-II apparatus is contained 23 individual components sorted into six gatherings: degree and reason, partner association, the thoroughness of advancement, lucidity of introduction, materialness and article freedom. The thoroughness of the improvement classification is part into eight proclamations [10].

Female fertility is determined by its physiology. For pregnancy to occur, a woman must have regular menstruation and ovulation, which indicates periodic changes in the uterus and ovaries, the maturation and release of the egg. Fertility changes constantly throughout life. In many ways, it depends on the health of the reproductive system and the condition of the endometrium and fallopian tubes. Inflammatory processes in the pelvic region, inflammation and endometriosis lead to problems in pregnancy and pregnancy. Having bad habits affects a woman negatively as well. Other factors can be distinguished:

• Excess weight, which can cause a hormonal imbalance

• Stress

• Adhesions in the small pelvis

• Fusion of tissues inside the uterine cavity (synechia)

• Hyperthyroidism or hypothyroidism, diabetes mellitus, provoking improper hormone production

• Intrauterine interventions (abortion, surgery)

Transposition of the ovaries out of the area which will be irradiated may reduce the risk of radiogenic ovarian insufficiency.

Today, effective methods in reproductive medicine allow you to become a parent after cancer treatment by choosing the most appropriate method to preserve your reproductive function.

Cryopreservation is a procedure to freeze and later thaw eggs, where their viability is fully maintained. This method allows patients diagnosed with cancer to have a baby in the future without the use of donor materials. An important component remains the personal approach to each specific case - specialists take into account individual factors, such as the patient's age, disease stage, tumor type and the prescribed cancer treatment protocol.

Preserving Fertility in Women

• Cryopreservation- the patient is prescribed a course of hormonal therapy to stimulate ovulation, after which the eggs are removed, fertilized with her husband's sperm and frozen. After cancer treatment ends, embryos are implanted into the uterus of the patient or surrogate. In 95% of cases, the operation is successful

• Cryopreservation-Unfertilized eggs are frozen. After thawing, approximately 80% of the eggs are successfully fertilized, but it should be borne in mind that pregnancy, compared to the previous method, occurs less frequently than cryopreservation

• Cryopreservation of ovarian tissue and subsequent implantation

Preserving Fertility in Men

Cryopreservation of sperm before starting treatment with subsequent storage in a special bank.

Testicular tissue cryopreservation-A small piece of testicular tissue is removed from the patient, then frozen and can be stored for a long time.

Eggs can only be frozen if chemotherapy is not started. If at least one course of chemotherapy has been completed, the eggs cannot be vitrified, as they may already be damaged by the chemotherapy drugs. It should be noted that not all oncological diseases can perform controlled ovarian stimulation, since it will be possible to obtain more than one egg, but in large quantities at once in order to preserve the largest possible number of eggs and increase the percentage of eggs. Chances of pregnancy. If the above is impossible, then in these cases ovarian tissue is frozen. This means that we do not store as many eggs, but everything in the ovary. And their number in the thousands! Also, an indisputable advantage is that the ovarian cryopreservation procedure takes only two days, while it takes about two weeks for about 20 eggs to grow. This is extremely important when it is necessary to start anti-cancer treatment right away.

Ovarian tissue was obtained by surgery (using laparoscopy). Therefore, before starting high-dose chemotherapy or radiotherapy, ovarian tissue is cryopreserved and stored in a cold bank for 3-5 years or more. Cryopreservation of ovarian tissue is the only way to preserve fertility in girls before puberty and women who cannot delay the start of chemotherapy. Freezing, as it were, shuts down a patient's biological clock and thus spares the effects of anti-cancer drugs. The tissue is stored in a cooling bank for as long as needed. It may take years or decades for a patient to undergo anti-cancer treatment and recover from the underlying disease. Moreover, with the permission of the oncologist, a woman can plan motherhood. To do this, the surgeon will restore the ovarian tissue to its "original" place through the implant. First, cryopreserved ovarian tissue is thawed and implanted into the pelvic cavity during laparoscopy. Then, within a few days, the ovarian tissue takes root and after a few months we can observe the growth of follicles and the development of eggs in the implanted tissue. Moreover, with the help of assisted reproductive techniques, you can obtain an egg, perform fertilization, transfer the developing embryo into the uterine cavity and predict pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. First, cryopreserved ovarian tissue is thawed and implanted into the pelvic cavity during laparoscopy. Then, within a few days, the ovarian tissue takes root and after a few months we can observe the growth of follicles and the development of eggs in the implanted tissue. Moreover, with the help of assisted reproductive techniques, you can obtain an egg, perform fertilization, transfer the developing embryo into the uterine cavity and predict pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. First, cryopreserved ovarian tissue is thawed and implanted into the pelvic cavity during laparoscopy. Then, within a few days, the ovarian tissue takes root and after a few months we can observe the growth of follicles and the development of eggs in the implanted tissue. Moreover, with the help of assisted reproduction techniques, you can obtain an egg, perform fertilization, transfer the developing embryo into the uterine cavity and predict pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. Then, within a few days, the ovarian tissue takes root and after a few months we can observe the growth of follicles and the development of eggs in the implanted tissue. Moreover, with the help of assisted reproductive techniques, you can obtain an egg, perform fertilization, transfer the developing embryo into the uterine cavity and predict pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. Then, within a few days, the ovarian tissue takes root and after a few months we can observe the growth of follicles and the development of eggs in the implanted tissue. Moreover, with the help of assisted reproductive techniques, you can obtain an egg, perform fertilization, transfer the developing embryo into the uterine cavity and predict pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. Transfer of the developing fetus into the uterine cavity and the expectation of pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for cancer patients. Transfer of the developing fetus into the uterine cavity and the expectation of pregnancy. In this difficult way, we can completely save reproductive cells and tissues from the harmful effects of chemotherapy/radiotherapy. This technique is very important for malignant disease.

Cryopreservation of Unfertilized Oocytes

Outcomes for unfertilized oocytes after slow freezing or vitrification (Table 1).

Table 1: Presents the Outcomes of Unfertilized Oocytes following Slow Freezing or Vitrification

In women and men with oncological diseases, reproductive function suffers as a result of the disease itself and as a result of treatment. Risk factors for developing infertility during anti-tumor therapy are the patient's age, degree of cytotoxicity and dose of chemotherapy drugs used, as well as the need for radiotherapy to the pelvic area. Thus, in women under 25 years of age who received standard Polychemotherapy (PCT) with alkylating drugs being included as primary treatment, menopause occurs in 28% of cases, in women over 25 years of age in 86% and in patients over 40 years of age. Similar patterns are observed with the use of radiotherapy: irradiation of the iliac-inguinal areas at a dose greater than 40-50 Gray causes persistent amenorrhea in 40% of women under the age of 20 and in 90-95% of patients over 35 years of age. Early ovarian cancer persists in about 100% of failures from several months to 3 years in young women or becomes permanent in most patients over 35 years of age with combined use of radiotherapy and chemotherapy, especially combinations with alkylating agents. Male azoospermia occurs in 100% of cases. Menopause; the latter occurs in younger patients and women over 25 years of age in 30 and 80% of cases, respectively. 

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