JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):117
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263751

P-105. Fertility Preservation in Women with Breast Cancer: A Current Oncofertility Approach

Gustavo Wandresen¹, Renata Paes de Barros Wandresen², Carina Toledo Scoparo Barioni², Beatriz Vicenzi Rocha², Carolina Polo Salvador Vicentini

¹ Universidade Federal do Paraná - Curitiba - PR – Brasil
² Universidade Positivo- Curitiba - PR – Brasil
³ Pontificia Universidade Catolica do Parana - Curitiba - PR – Brasil

Objective: A critical subpopulation of breast cancer (BC) patients, approximately 15% of new diagnoses, are women under age 45. Standard adjuvant chemotherapy regimens for these patients are often gonadotoxic, posing a significant risk of premature ovarian insufficiency and subsequent infertility. Given the excellent survival rates for early-stage BC, preserving long-term quality of life, including reproductive autonomy, has become an essential aspect of comprehensive oncological care. This study provides a critical analysis of current fertility preservation strategies for this patient group, evaluating their efficacy, safety, and the primary systemic, clinical, and psychosocial barriers that limit access to care.
Methods: A narrative literature review was conducted, employing a systematic approach to data search and selection. The search was performed in the PubMed/MEDLINE database, covering the period from January 2015 to December 2025, to ensure the inclusion of the most contemporary practices and guidelines. The search strategy was designed using a combination of MeSH (Medical Subject Headings) and free-text terms, including: ("Breast Neoplasms" OR "Breast Cancer") AND ("Fertility Preservation" OR "Oncofertility") AND ("Oocyte Cryopreservation" OR "Embryo Cryopreservation" OR "Ovarian Tissue Cryopreservation" OR "GnRH Agonist"). The search was supplemented with corresponding terms in Portuguese to broaden its scope. Inclusion criteria were: randomized controlled trials, prospective and retrospective cohort studies, systematic reviews and meta-analyses, and guidelines from international societies (ASCO, ESHRE, ASRM). Case reports, small case series, editorials, letters to the editor, and studies with poorly described methodology were excluded. The selection process followed a two-stage flow: initially, the titles and abstracts of identified articles were screened by two independent reviewers for relevance. Subsequently, eligible articles were read in full for data extraction and inclusion confirmation. The final analysis was based on 30 publications that met all eligibility criteria.
Results: Current evidence consolidates oocyte and embryo cryopreservation as the gold-standard and first-line techniques for post-pubertal women, requiring a period of controlled ovarian stimulation (COS) of 10 to 14 days. Modern protocols, such as random-start COS, allow stimulation to begin at any phase of the menstrual cycle, thereby minimizing delays to the initiation of chemotherapy. Vitrification technology has been a landmark achievement, elevating oocyte survival rates to over 90% and resulting in live birth rates per transfer cycle ranging from 35% to 50%, which are strongly dependent on the patient's age and the number of oocytes cryopreserved. For specific clinical scenarios, such as in pre-pubertal patients or women who cannot postpone cancer treatment, ovarian tissue cryopreservation (OTC) is transitioning from an experimental status to an established option in many reference centers, with over 200 live births reported worldwide. In parallel, ovarian suppression with GnRH analogues during chemotherapy, although studies like the POEMS/S0230 have shown a reduction in premature ovarian insufficiency rates, offers a controversial benefit for fertility preservation and is now recommended as an adjuvant therapy, not as a substitute for cryopreservation techniques. Despite the robustness of these technologies, their universal implementation faces significant multifactorial barriers, including the high cost of procedures and lack of health system coverage, delayed or non-existent referrals from oncology teams, and psychosocial factors, such as the inherent stress of the diagnosis, which can hinder patient decision-making in a short timeframe.
Conclusion: Oncofertility must be integrated as an essential and non-negotiable component of the treatment plan for young women with breast cancer. A prompt, multidisciplinary approach involving oncologists and reproductive specialists is critical to success. To ensure patients can make informed decisions about their reproductive future, it is imperative to develop clear institutional pathways and supportive health policies that promote equitable and timely access to fertility preservation services, thereby significantly improving long-term quality of life post-cancer.