Advanced search

Vol 20, No 2 (2024)
Guidelines / Expert consensus
Published online: 2023-08-04

open access

View PDF Download PDF file
Page views 531
Article views/downloads 215
Get Citation

Connect on Social Media

Connect on Social Media

Fertility preservation during oncological treatment

Joanna Kufel-Grabowska1, Krzysztof Łukaszuk23, Magdalena Błażek4, Agnieszka Jagiełło-Gruszfeld5, Anna Horbaczewska67, Ninela Irga-Jaworska8, Robert Jach67, Piotr Jędrzejczak910, Izabela Kopeć11, Maryna Krawczuk-Rybak12, Maciej Krzakowski13, Katarzyna Pogoda5, Maria Sąsiadek14, Robert Spaczyński10, Monika Urbaniak15, Elżbieta Wojciechowska-Lampka16, Sławomir Wołczyński17, Jacek Jassem1
DOI: 10.5603/OCP.2023.0033
Oncol Clin Pract 2024;20(2):100-116.

Abstract

Not available

Article available in PDF format

View PDF Download PDF file

References

  1. Wojciechowska W, Barańska K, Michałek I, et al. Nowotwory złośliwe w Polsce w 2020 roku. Ministerstwo Zdrowia, Warszawa. https://onkologia.org.pl/sites/default/files/publications/2023-01/nowotwory_2020.pdf (30.03.2023).
  2. Knudson AG. Overview: genes that predispose to cancer. Mutat Res. 1991; 247(2): 185–190.
    CrossRefPubMed
  3. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011; 144(5): 646–674.
    CrossRefPubMed
  4. Bashyam MD, Animireddy S, Bala P, et al. The Yin and Yang of cancer genes. Gene. 2019; 704: 121–133.
    CrossRefPubMed
  5. Stratton MR, Campbell PJ, Futreal PA. The cancer genome. Nature. 2009; 458(7239): 719–724.
    CrossRefPubMed
  6. McClellan J, King MC. Genetic heterogeneity in human disease. Cell. 2010; 141(2): 210–217.
    CrossRefPubMed
  7. Filippi F, Peccatori F, Manoukian S, et al. Fertility Counseling in Survivors of Cancer in Childhood and Adolescence: Time for a Reappraisal? Cancers (Basel). 2021; 13(22).
    CrossRefPubMed
  8. Jones G, Hughes J, Mahmoodi N, et al. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update. 2017; 23(4): 433–457.
    CrossRefPubMed
  9. Kufel-Grabowska J, Podolak A, Maliszewski D, et al. Fertility Counseling in -Mutated Women with Breast Cancer and Healthy Individuals. J Clin Med. 2022; 11(14).
    CrossRefPubMed
  10. Jach R, Pabian W, Spaczyński R, et al. Recommendations of the Fertility Preservation Working Group in Oncological, Hematological and Other Patients Treated With Gonadotoxic Therapies "ONCOFERTILITY" (GROF) of the Polish Society of Oncological Gynecology. J Adolesc Young Adult Oncol. 2017; 6(3): 388–395.
    CrossRefPubMed
  11. Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org. Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion. Fertil Steril. 2018; 110(3): 380–386.
    CrossRefPubMed
  12. Anderson RA, Amant F, Braat D, et al. ESHRE Guideline Group on Female Fertility Preservation. ESHRE guideline: female fertility preservation. Hum Reprod Open. 2020; 2020(4): hoaa052.
    CrossRefPubMed
  13. Colombo N, Sessa C, du Bois A, et al. ESMO-ESGO Ovarian Cancer Consensus Conference Working Group. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Ann Oncol. 2019; 30(5): 672–705.
    CrossRefPubMed
  14. Basta A, Bidziński M, Bieńkiewicz A, et al. Recommendation of the Polish Society of Oncological Gynecology on the diagnosis and treatment of epithelial ovarian cancer. Oncol Clin Pract. 2015; 11: 233–243.
  15. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016; 27(1): 16–41.
    CrossRefPubMed
  16. Kyrgiou M, Arbyn M, Bergeron C, et al. Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC). Br J Cancer. 2020; 123(4): 510–517.
    CrossRefPubMed
  17. Trost L, Brannigan R. Fertility Preservation in Males. In: Gracia C, Woodruff T. ed. Oncofertility Medical Practice. Springer, New York, NY 2012.
  18. Ståhl O, Eberhard J, Jepson K, et al. Sperm DNA integrity in testicular cancer patients. Hum Reprod. 2006; 21(12): 3199–3205.
    CrossRefPubMed
  19. Ash P. The influence of radiation on fertility in man. Br J Radiol. 1980; 53(628): 271–278.
    CrossRefPubMed
  20. Marci R, Mallozzi M, Di Benedetto L, et al. Radiations and female fertility. Reprod Biol Endocrinol. 2018; 16(1): 112.
    CrossRefPubMed
  21. Silvestris E, Cormio G, Skrypets T, et al. Novel aspects on gonadotoxicity and fertility preservation in lymphoproliferative neoplasms. Crit Rev Oncol Hematol. 2020; 151: 102981.
    CrossRefPubMed
  22. Mahajan N. Fertility preservation in female cancer patients: An overview. J Hum Reprod Sci. 2015; 8(1): 3–13.
    CrossRefPubMed
  23. Littley MD, Shalet SM, Beardwell CG, et al. Radiation-induced hypopituitarism is dose-dependent. Clin Endocrinol (Oxf). 1989; 31(3): 363–373.
    CrossRefPubMed
  24. Green DM, Whitton JA, Stovall M, et al. Pregnancy outcome of female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Am J Obstet Gynecol. 2002; 187(4): 1070–1080.
    CrossRefPubMed
  25. Lambertini M, Peccatori FA, Demeestere I, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2020; 31(12): 1664–1678.
    CrossRefPubMed
  26. Perachino M, Massarotti C, Razeti MG, et al. Gender-specific aspects related to type of fertility preservation strategies and access to fertility care. ESMO Open. 2020; 5(Suppl 4): e000771.
    CrossRefPubMed
  27. Clemons M, Simmons C. Identifying menopause in breast cancer patients: considerations and implications. Breast Cancer Res Treat. 2007; 104(2): 115–120.
    CrossRefPubMed
  28. NCCN Clinical Practice Guidelines in Oncology. Adolescent and Young Adult (AYA) Oncology, version 1.2023. https://www.nccn.org/ (30.03.2023).
  29. Lambertini M, Campbell C, Bines J, et al. Adjuvant Anti-HER2 Therapy, Treatment-Related Amenorrhea, and Survival in Premenopausal HER2-Positive Early Breast Cancer Patients. J Natl Cancer Inst. 2019; 111(1): 86–94.
    CrossRefPubMed
  30. Ejlertsen B, Tuxen MK, Jakobsen EH, et al. Adjuvant Cyclophosphamide and Docetaxel With or Without Epirubicin for Early TOP2A-Normal Breast Cancer: DBCG 07-READ, an Open-Label, Phase III, Randomized Trial. J Clin Oncol. 2017; 35(23): 2639–2646.
    CrossRefPubMed
  31. Lambertini M, Ceppi M, Cognetti F, et al. MIG and GIM study groups. Dose-dense adjuvant chemotherapy in premenopausal breast cancer patients: A pooled analysis of the MIG1 and GIM2 phase III studies. Eur J Cancer. 2017; 71: 34–42.
    CrossRefPubMed
  32. van der Kaaij MAE, Heutte N, Meijnders P, et al. Premature ovarian failure and fertility in long-term survivors of Hodgkin's lymphoma: a European Organisation for Research and Treatment of Cancer Lymphoma Group and Groupe d'Etude des Lymphomes de l'Adulte Cohort Study. J Clin Oncol. 2012; 30(3): 291–299.
    CrossRefPubMed
  33. Meissner J, Tichy D, Katzke V, et al. Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma. Ann Oncol. 2015; 26(8): 1771–1776.
    CrossRefPubMed
  34. Sieniawski M, Reineke T, Josting A, et al. Assessment of male fertility in patients with Hodgkin's lymphoma treated in the German Hodgkin Study Group (GHSG) clinical trials. Ann Oncol. 2008; 19(10): 1795–1801.
    CrossRefPubMed
  35. Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr. 2005(34): 12–17.
    CrossRefPubMed
  36. Akhtar S, Youssef I, Soudy H, et al. Prevalence of menstrual cycles and outcome of 50 pregnancies after high-dose chemotherapy and auto-SCT in non-Hodgkin and Hodgkin lymphoma patients younger than 40 years. Bone Marrow Transplant. 2015; 50(12): 1551–1556.
    CrossRefPubMed
  37. Ceppi L, Galli F, Lamanna M, et al. Ovarian function, fertility, and menopause occurrence after fertility-sparing surgery and chemotherapy for ovarian neoplasms. Gynecol Oncol. 2019; 152(2): 346–352.
    CrossRefPubMed
  38. Zhao J, Liu J, Chen K, et al. What lies behind chemotherapy-induced amenorrhea for breast cancer patients: a meta-analysis. Breast Cancer Res Treat. 2014; 145(1): 113–128.
    CrossRefPubMed
  39. Anderson RA, Mansi J, Coleman RE, et al. The utility of anti-Müllerian hormone in the diagnosis and prediction of loss of ovarian function following chemotherapy for early breast cancer. Eur J Cancer. 2017; 87: 58–64.
    CrossRefPubMed
  40. Mourits MJ, de Vries EG, Willemse PH, et al. Ovarian cysts in women receiving tamoxifen for breast cancer. Br J Cancer. 1999; 79(11-12): 1761–1764.
    CrossRefPubMed
  41. Braems G, Denys H, De Wever O, et al. Use of tamoxifen before and during pregnancy. Oncologist. 2011; 16(11): 1547–1551.
    CrossRefPubMed
  42. Schuurman TN, Witteveen PO, van der Wall E, et al. Tamoxifen and pregnancy: an absolute contraindication? Breast Cancer Res Treat. 2019; 175(1): 17–25.
    CrossRefPubMed
  43. Buonomo B, Brunello A, Noli S, et al. Tamoxifen Exposure during Pregnancy: A Systematic Review and Three More Cases. Breast Care (Basel). 2020; 15(2): 148–156.
    CrossRefPubMed
  44. Bellet M, Gray KP, Francis PA, et al. Twelve-Month Estrogen Levels in Premenopausal Women With Hormone Receptor-Positive Breast Cancer Receiving Adjuvant Triptorelin Plus Exemestane or Tamoxifen in the Suppression of Ovarian Function Trial (SOFT): The SOFT-EST Substudy. J Clin Oncol. 2016; 34(14): 1584–1593.
    CrossRefPubMed
  45. Bernhard J, Zahrieh D, Castiglione-Gertsch M, et al. International Breast Cancer Study Group Trial VIII. Adjuvant chemotherapy followed by goserelin compared with either modality alone: the impact on amenorrhea, hot flashes, and quality of life in premenopausal patients--the International Breast Cancer Study Group Trial VIII. J Clin Oncol. 2007; 25(3): 263–270.
    CrossRefPubMed
  46. Partridge AH, Niman SM, Ruggeri M, et al. International Breast Cancer Study Group, POSITIVE Trial Collaborators. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med. 2023; 388(18): 1645–1656.
    CrossRefPubMed
  47. Lambertini M, Martel S, Campbell C, et al. Pregnancies during and after trastuzumab and/or lapatinib in patients with human epidermal growth factor receptor 2-positive early breast cancer: Analysis from the NeoALTTO (BIG 1-06) and ALTTO (BIG 2-06) trials. Cancer. 2019; 125(2): 307–316.
    CrossRefPubMed
  48. Ruddy KJ, Guo H, Barry W, et al. Chemotherapy-related amenorrhea after adjuvant paclitaxel-trastuzumab (APT trial). Breast Cancer Res Treat. 2015; 151(3): 589–596.
    CrossRefPubMed
  49. Ruddy KJ, Zheng Y, Tayob N, et al. Chemotherapy-related amenorrhea (CRA) after adjuvant ado-trastuzumab emtansine (T-DM1) compared to paclitaxel in combination with trastuzumab (TH) (TBCRC033: ATEMPT Trial). Breast Cancer Res Treat. 2021; 189(1): 103–110.
    CrossRefPubMed
  50. Hassel JC, Livingstone E, Allam JP, et al. Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy. ESMO Open. 2021; 6(5): 100248.
    CrossRefPubMed
  51. Rambhatla A, Strug MR, De Paredes JG, et al. Fertility considerations in targeted biologic therapy with tyrosine kinase inhibitors: a review. J Assist Reprod Genet. 2021; 38(8): 1897–1908.
    CrossRefPubMed
  52. Clement SC, Peeters RP, Ronckers CM, et al. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma--a systematic review. Cancer Treat Rev. 2015; 41(10): 925–934.
    CrossRefPubMed
  53. Evranos B, Faki S, Polat SB, et al. Effects of Radioactive Iodine Therapy on Ovarian Reserve: A Prospective Pilot Study. Thyroid. 2018; 28(12): 1702–1707.
    CrossRefPubMed
  54. Garutti M, Lambertini M, Puglisi F. Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review. ESMO Open. 2021; 6(5): 100276.
    CrossRefPubMed
  55. Salzmann M, Tosev G, Heck M, et al. Male fertility during and after immune checkpoint inhibitor therapy: A cross-sectional pilot study. Eur J Cancer. 2021; 152: 41–48.
    CrossRefPubMed
  56. Lambertini M, Horicks F, Del Mastro L, et al. Ovarian protection with gonadotropin-releasing hormone agonists during chemotherapy in cancer patients: From biological evidence to clinical application. Cancer Treat Rev. 2019; 72: 65–77.
    CrossRefPubMed
  57. Sofiyeva N, Siepmann T, Barlinn K, et al. Gonadotropin-Releasing Hormone Analogs for Gonadal Protection During Gonadotoxic Chemotherapy: A Systematic Review and Meta-Analysis. Reprod Sci. 2019; 26(7): 939–953.
    CrossRefPubMed
  58. Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient-Level Data. J Clin Oncol. 2018; 36(19): 1981–1990.
    CrossRefPubMed
  59. Senra JC, Roque M, Talim MCT, et al. Gonadotropin-releasing hormone agonists for ovarian protection during cancer chemotherapy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 51(1): 77–86.
    CrossRefPubMed
  60. GILANI M, HASANZADEH M, GHAEMMAGHAMI F, et al. Ovarian preservation with gonadotropin-releasing hormone analog during chemotherapy. Asia Pac J Clin Oncol. 2007; 3(2): 79–83.
    CrossRef
  61. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019; 112(6): 1022–1033.
    CrossRefPubMed
  62. Dohle GR. Male infertility in cancer patients: Review of the literature. Int J Urol. 2010; 17(4): 327–331.
    CrossRefPubMed
  63. Delessard M, Saulnier J, Rives A, et al. Exposure to Chemotherapy During Childhood or Adulthood and Consequences on Spermatogenesis and Male Fertility. Int J Mol Sci. 2020; 21(4).
    CrossRefPubMed
  64. Santaballa A, Márquez-Vega C, Rodríguez-Lescure Á, et al. Multidisciplinary consensus on the criteria for fertility preservation in cancer patients. Clin Transl Oncol. 2022; 24(2): 227–243.
    CrossRefPubMed
  65. Oktay K, Harvey BE, Partridge AH, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2018; 36(19): 1994–2001.
    CrossRefPubMed
  66. Jedrzejczak P, Taszarek-Hauke G, Korman M, et al. [The sperm quality in young patients before cancer therapy]. Przegl Lek. 2004; 61(3): 141–145.
    PubMed
  67. Brannigan RE, Fantus RJ, Halpern JA. Fertility preservation in men: a contemporary overview and a look toward emerging technologies. Fertil Steril. 2021; 115(5): 1126–1139.
    CrossRefPubMed
  68. Tur-Kaspa I, Segal S, Moffa F, et al. Viagra for temporary erectile dysfunction during treatments with assisted reproductive technologies. Hum Reprod. 1999; 14(7): 1783–1784.
    CrossRefPubMed
  69. Mehta A, Sigman M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril. 2015; 104(5): 1074–1081.
    CrossRefPubMed
  70. Meng X, Fan L, Wang T, et al. Electroejaculation combined with assisted reproductive technology in psychogenic anejaculation patients refractory to penile vibratory stimulation. Transl Androl Urol. 2018; 7(Suppl 1): S17–S22.
    CrossRefPubMed
  71. Ohl DA, Quallich SA, Sønksen J, et al. Anejaculation and retrograde ejaculation. Urol Clin North Am. 2008; 35(2): 211–20, viii.
    CrossRefPubMed
  72. Furuhashi K, Ishikawa T, Hashimoto H, et al. Onco-testicular sperm extraction: testicular sperm extraction in azoospermic and very severely oligozoospermic cancer patients. Andrologia. 2013; 45(2): 107–110.
    CrossRefPubMed
  73. Grin L, Girsh E, Harlev A. Male fertility preservation-Methods, indications and challenges. Andrologia. 2021; 53(2): e13635.
    CrossRefPubMed
  74. Del-Pozo-Lérida S, Salvador C, Martínez-Soler F, et al. Preservation of fertility in patients with cancer (Review). Oncol Rep. 2019; 41(5): 2607–2614.
    CrossRefPubMed
  75. Dolmans MM, Marinescu C, Saussoy P, et al. Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe. Blood. 2010; 116(16): 2908–2914.
    CrossRefPubMed
  76. De Rycke M, Belva F, Goossens V, et al. ESHRE PGD Consortium data collection XIII: cycles from January to December 2010 with pregnancy follow-up to October 2011. Hum Reprod. 2015; 30(8): 1763–1789.
    CrossRefPubMed
  77. Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org, Ethics Committee of the American Society for Reproductive Medicine. Use of preimplantation genetic testing for monogenic defects (PGT-M) for adult-onset conditions: an Ethics Committee opinion. Fertil Steril. 2018; 109(6): 989–992.
    CrossRefPubMed
  78. Practice Committee of Society for Assisted Reproductive Technology, Practice Committee of American Society for Reproductive Medicine. Preimplantation genetic testing: a Practice Committee opinion. Fertil Steril. 2008; 90(5 Suppl): S136–S143.
    CrossRefPubMed
  79. Ustawa z dnia 25 czerwca 2015 roku o leczeniu niepłodności, Dz. U. 2020 poz. 442 t.j.
  80. Haberko J. Komentarz do ustawy o leczeniu niepłodności. https://sip.lex.pl/komentarze-i-publikacje/komentarze/ustawa-o-leczeniu-nieplodnosci-komentarz-587696505 (30.03.2023).
  81. Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty, Dz. U. 2021 poz. 790 t.j.
  82. Kanafek K. Rozwodowa niezgoda – dysponowanie niewykorzystanymi embrionami. Internetowy Przegląd Prawniczy. 2017; 2: 62.
  83. Speller B, Sissons A, Daly C, et al. An evaluation of oncofertility decision support resources among breast cancer patients and health care providers. BMC Health Serv Res. 2019; 19(1): 101.
    CrossRefPubMed
  84. Gardino SL, Jeruss JS, Woodruff TK. Using decision trees to enhance interdisciplinary team work: the case of oncofertility. J Assist Reprod Genet. 2010; 27(5): 227–231.
    CrossRefPubMed
  85. van der Kooi ALLF, Kelsey TW, van den Heuvel-Eibrink MM, et al. Perinatal complications in female survivors of cancer: a systematic review and meta-analysis. Eur J Cancer. 2019; 111: 126–137.
    CrossRefPubMed
  86. Buonomo B, Brunello A, Noli S, et al. Tamoxifen Exposure during Pregnancy: A Systematic Review and Three More Cases. Breast Care (Basel). 2020; 15(2): 148–156.
    CrossRefPubMed
  87. Partridge AH, Pagani O, Niman SM, et al. Pregnancy outcomes and safety of interrupting therapy for women with endocrine responsive breast cancer: Primary results from the POSITIVE trial (IBCSG 48-14/BIG 8-13). Presented at SABCS 2022. December 6-10, 2022. Abstract GS4-09.
  88. Pereg D, Koren G, Lishner M. Cancer in pregnancy: gaps, challenges and solutions. Cancer Treat Rev. 2008; 34(4): 302–312.
    CrossRefPubMed
  89. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004; 5(5): 283–291.
    CrossRefPubMed
  90. Nicholson HO. Cytotoxic drugs in pregnancy. Review of reported cases. J Obstet Gynaecol Br Commonw. 1968; 75(3): 307–312.
    CrossRefPubMed
  91. Esposito S, Tenconi R, Preti V, et al. Chemotherapy against cancer during pregnancy: A systematic review on neonatal outcomes. Medicine (Baltimore). 2016; 95(38): e4899.
    CrossRefPubMed
  92. Avilés A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001; 2(3): 173–177.
    CrossRefPubMed
  93. Amant F, Van Calsteren K, Halaska MJ, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol. 2012; 13(3): 256–264.
    CrossRefPubMed
  94. Vandenbroucke T, Verheecke M, van Gerwen M, et al. International Network on Cancer, Infertility and Pregnancy (INCIP). Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Eur J Cancer. 2020; 138: 57–67.
    CrossRefPubMed

About cookies

Necessary cookies

Allways active

These cookies are necessary for the proper display and operation of the website. Blocking them may cause the website to malfunction.

Analytical cookies

As part of our website, we use analytical tools, such as Google Analytics, that allow us to verify website traffic. These tools may require the use of cookies.

Community cookies

These are cookies associated with the social networks we use. Accepting them will allow us to associate your visit to the site with our social media profiles.

Marketing cookies

These are cookies responsible for carrying out advertising and marketing activities - consenting to their use will allow us to target you with advertisements based on your previous activities within our website.

Oncology in Clinical Practice

About Via Medica Advertising
Bookstore (Ikamed) TVMed
News
Copyright © 2023 Via Medica Regulations Cookie policy Privacy policy Legal Notice