Breast Cancer and Fertility Preservation in Young Female Patients: A Systematic Review of the Literature

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Author Ioannis Boutas and colleagues have written a literature review titled “Breast Cancer and fertility preservation in young female patients: a systemic review of the literature”. The review summarizes 7 studies from the past 15 years on suitable treatments for fertility preservation methods for breast cancer patients on chemotherapy. The review is well-written and presents an important perspective on the reproductive health of breast cancer survivors on chemotherapy, keeping in mind the extremely low rate of conception among breast cancer survivors as compared to other cancer types.   

Author Response

Author Ioannis Boutas and colleagues have written a literature review titled “Breast Cancer and fertility preservation in young female patients: a systemic review of the literature”. The review summarizes 7 studies from the past 15 years on suitable treatments for fertility preservation methods for breast cancer patients on chemotherapy. The review is well-written and presents an important perspective on the reproductive health of breast cancer survivors on chemotherapy, keeping in mind the extremely low rate of conception among breast cancer survivors as compared to other cancer types.

 

We would like to thank you very much for your kind words and comments on our work. It is highly appreciated.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors!

Thank you for working on the very important but often underestimated problem of fertility preservation in cancer patients!

Unfortunately, the paper is biased into direction of "ovarian suppression with GnRHa" ( "A total of 7 eligible studies were identified" - what about the other methods?)

No data were presented in the abstract and in the paper itself only one table shows in an undifferentiated way only one of the available methods for fertility preservation.

While you are focusing on breast cancer patients, please look at the "POSITIVE-trial" where the influence of pregnancies following breast cancer is studied.

Comments on the Quality of English Language

only minor revision

Author Response

Dear authors!

Thank you for working on the very important but often underestimated problem of fertility preservation in cancer patients!

Unfortunately, the paper is biased into direction of "ovarian suppression with GnRHa" ( "A total of 7 eligible studies were identified" - what about the other methods?)

Thank you for your comment and suggestions. The reason we have leaned towards the direction of ovarian suppression with GnRHa is because we focused on breast cancer and there were no relevant studies utilizing any other protocols, unfortunately.

 

No data were presented in the abstract and in the paper itself only one table shows in an undifferentiated way only one of the available methods for fertility preservation.

Thank you for flagging this. We have added a section in the abstract outlining the results and slightly amended our results section. If you still believe this is not sufficient please do let us know and we will amend accordingly.

 

While you are focusing on breast cancer patients, please look at the "POSITIVE-trial" where the influence of pregnancies following breast cancer is studied.

Thank you for suggestion. We have added a new section, IV.c Embryo Cryopreservation and refer to the POSITIVE TRIAL study in the second paragraph of this subsection.

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for giving me an opportunity to review an excellent review article. The authors thoroughly reviewed about the fertility preservation option in young female patients with breast cancer. Several options for fertility preservation for AYA cancer patients were introduced and the current status of the technology was included. Although manuscript was well-written and organized, I recommend several minor points to improve the quality of the manuscript.

 

1.     Line 171:

-Replace 'Vetrification' with 'Vitrification'.

-Add a brief discussion on the pros and cons of slow-freezing for a comprehensive understanding of the technologies involved in oocyte cryopreservation.

 

2.     Line 235:

-Separate discussions on oocyte cryopreservation and embryo cryopreservation. Emphasize that these options may not always be considered simultaneously.

-Reference the recent ASCO guideline (DOI: 10.1200/JCO.2018.78.1914) which recommends embryo cryopreservation as the first choice for patients with partners, while oocyte cryopreservation is a well-established alternative for those without a male partner or who do not wish to use donor sperm.

 

3.     Include Future Perspectives:

-Recommend including information on future perspectives in the field, such as whole-ovarian transplantation or artificial ovaries. This will provide readers with insights into emerging technologies. Since there may be existing review articles covering similar topics, the current article should aim to present relatively novel facts or results from newer technologies.

Comments on the Quality of English Language

No opinion.

Author Response

Thank you for giving me an opportunity to review an excellent review article. The authors thoroughly reviewed about the fertility preservation option in young female patients with breast cancer. Several options for fertility preservation for AYA cancer patients were introduced and the current status of the technology was included. Although manuscript was well-written and organized, I recommend several minor points to improve the quality of the manuscript.

 

1. Line 171:

-Replace 'Vetrification' with 'Vitrification'.

We are sorry we missed this in our spelling check and thank you for noticing. We have amended the manuscript accordingly.

 

-Add a brief discussion on the pros and cons of slow-freezing for a comprehensive understanding of the technologies involved in oocyte cryopreservation.

Thank you for your comment. We have added two more paragraphs in subsection IV.b Oocyte cryopreservation to accommodate for this. Please do let us know if you would like us to elaborate more.

2. Line 235:

-Separate discussions on oocyte cryopreservation and embryo cryopreservation. Emphasize that these options may not always be considered simultaneously.

Thank you for flagging this. We have added a new section, named IV.c Embryo Cryopreservation in order to facilitate for your request.

 

-Reference the recent ASCO guideline (DOI: 10.1200/JCO.2018.78.1914) which recommends embryo cryopreservation as the first choice for patients with partners, while oocyte cryopreservation is a well-established alternative for those without a male partner or who do not wish to use donor sperm.

We have added a reference, reference number 74 to accommodate for your request which has been added to our new section named IV.c Embryo Cryopreservation.

 

3. Include Future Perspectives:

-Recommend including information on future perspectives in the field, such as whole-ovarian transplantation or artificial ovaries. This will provide readers with insights into emerging technologies. Since there may be existing review articles covering similar topics, the current article should aim to present relatively novel facts or results from newer technologies.

Thank you for your recommendation. We have added a new section, VII. Future Perspectives to provide this information.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I think the manuscript has been revised with much improvement. 

It could be accepted with current form.