This report represents a unique collaborative effort among international specialists in the field of oncology and reproductive medicine. An evidence based approach was used to develop recommendations regarding surveillance for premature ovarian insufficiency in female childhood, adolescent and young adult cancer survivors. In particular, because females exposed to specific gonadotoxic treatments including alkylating agents and ovarian radiation are at highest risk for ovarian insufficiency, these survivors should be monitored closely before and after puberty. The focus of monitoring should be on growth, pubertal development, assessment of menstrual function and measurement of serum FSH and Estradiol. The authors concluded that AMH may be a reasonable adjunct for assessing ovarian reserve in women at least 25 years of age. Referral to a reproductive specialist is strongly recommended for females with premature ovarian insufficiency for consideration of hormone replacement therapy, and for post-pubertal females concerned about their future fertility. While there are limited data on fertility preservation in cancer survivors remote from treatment, fertility preservation such as egg freezing may be an option for survivors who plan to delay childbearing. Counseling cancer survivors about the reproductive impact of cancer therapies may improve health, quality of life, and expand the reproductive options for young cancer survivors. This guideline provides clinicians with important recommendations to improve the health and wellbeing of survivors.
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Author: Clarisa Gracia, MD, MSCE, University of Pennsylvania