The Fertiprotekt network is a cooperation of university centres, hospitals and practices. It was founded in

Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...

in 2006.Michael von Wolff, Markus Montag: ''6 Jahre FertiPROTEKT – Eine Zwischenbilanz.'' Gynäkologische Endokrinologie. 2 (2012), 86-90, . (in German language) The network now extends to all German-speaking countries and currently units ca. 100 institutions in Germany,

Austria Austria, , bar, Östareich officially the Republic of Austria, is a country in the southern part of Central Europe, lying in the Eastern Alps. It is a federation of nine states, one of which is the capital, Vienna, the most populous ...

and

Switzerland ). Swiss law does not designate a ''capital'' as such, but the federal parliament and government are installed in Bern, while other federal institutions, such as the federal courts, are in other cities (Bellinzona, Lausanne, Luzern, Neuchâtel ...

Aims

The aim of the network is to offer men and women the possibility of seeking advice about scientific information regarding their

fertility Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertili ...

before and after Chemo- or

radiotherapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...

, and to undergo procedures to protect their fertility. The advice about and the performance of fertility-conserving procedures according to the network’s code of ethics is non-profit oriented.

Background

As a result of today’s significantly improved prognosis for patients with

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

is increasingly important after overcoming treatment of the disease. Fears about fertility preservation play an important role for young men and women. The most common types of cancer diagnosed under the age of 40 years are

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...

melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...

cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

non-Hodgkin’s lymphoma Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness. ...

and

leukaemia Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ' ...

. One of the biggest problems in women who have to undergo chemo- or radiotherapy is

premature ovarian failure Primary ovarian insufficiency (POI) (also called premature ovarian insufficiency, premature menopause, and premature ovarian failure) is the partial or total loss of reproductive and hormonal function of the ovaries before age 40 because of fol ...

(premature ovarian insufficiency) and its associated

infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal state ...

. For breast cancer alone, it is assumed that there are ca. 200 patients a year in Germany who wish to conceive. In men, chemotherapy can result in permanent damage to the testicular tissue. Due to advances in reproductive medicine, a variety of fertility-protective methods are now available. These techniques include administration of GnRH-agonists, ovarian stimulation with cryoconservation of fertilised or unfertilised oocytes, as well as cryoconservation of ovarian tissue. Relocation of the

ovaries The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...

by surgically moving them out of the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

(ovarian transposition) to protect them from damage caused by radiotherapy is also possible.

Activity

The Fertiprotekt network has carried out international pioneering work in four areas: * National, comprehensive care structures in the area of fertility conservation have been created, which also serve as a role model for other countries. * Treatment recommendations have been created, which allow a standardised and scientific approach. * So-called luteal phase

stimulation Stimulation is the encouragement of development or the cause of activity generally. For example, "The press provides stimulation of political discourse." An interesting or fun activity can be described as "stimulating", regardless of its physica ...

has been introduced, which allows hormonal stimulation to collect

oocyte An oocyte (, ), oöcyte, or ovocyte is a female gametocyte or germ cell involved in reproduction. In other words, it is an immature ovum, or egg cell. An oocyte is produced in a female fetus in the ovary during female gametogenesis. The female ...

s to be started at any time during the menstrual cycle. The procedure of egg-cell collection is therefore considerably shortened, and chemotherapy can be started earlier. * The combination of ovarian tissue cryopreservation, directly followed by hormonal stimulation to collect egg cells for

oocyte cryopreservation Human oocyte cryopreservation (egg freezing) is a procedure to preserve a woman's eggs (oocytes). This technique has been used to enable women to postpone pregnancy to a later date – whether for medical reasons (such as cancer treatment), or fo ...

was first performed by centres in the network. This technique allows a significant increase in the chance of pregnancy. * The first birth after transposition of ovarian tissue, which was transported to a central cryobank by overnight transport immediately after removal, was achieved by the network. This demonstrated that removed ovarian tissue can be centrally prepared and stored in specialised centres. Network seminars take place annually. The centres involved are obliged to regularly take part in these annual conferences.

Problems

Some methods, such as cryoconservation of sperm and in-vitro fertilisation (IVF) are well established. Others have only been introduced over the last few years, such as cryoconservation of ovarian tissue prior to chemotherapy for later transplantation and the cryoconservation of unfertilized egg cells. These services are therefore not fully covered by statutory health insurance in Germany.''Kinderwunsch und Krebs.'' In: ''Die blauen Ratgeber.'' 49, brochure of the German Cancer Aid (Deutsche Krebshilfe), p. 37, ISSN 0946-4816
online
(PDF; 1,44 MB) (in German language)

References

External links

FertiPROTEKT website

information of the European Leukemia Information Center (ELIC) of European LeukemiaNet (in German language) Oncology Fertility medicine Medical and health organisations based in Germany