Fertility preservation in a female of reproductive age with ovarian cancer

AbstractFertility preservation is an important option to consider for young women with low-grade early ovarian cancer. Fertility-sparing surgery (“FSS”) permits the conservation of the uterus and one of the ovaries. This technique is considered safe for stages IA G1, G2 and probably safe for IC G1 epithelial and non-epithelial ovarian cancers. There are still uncertainties and FSS is not fully accepted for stage IC G1, G2 and clear cell carcinoma. The difficulty in choosing the best option lies in the fact that there is a lack of prospective randomized studies, due to ethical and organizational issues. Retrospective studies and reviews showed reassuring results for FSS in terms of relapse and long term survival. The spontaneous pregnancy rate seems to decrease after FSS, but chemotherapy does not seem to have an impact on fertility rates. Compared with the general population, assisted reproductive techniques are considered safe and with similar fertility results.

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FERTILITY PRESERVATION WITH IN VIVO OOCYTE RETRIEVAL AMONG YOUNG WOMEN WITH OVARIAN CANCER: A CASE SERIES

Fertility and Sterility ◽

10.1016/j.fertnstert.2020.10.024 ◽

2020 ◽

Vol 114 (3) ◽

pp. e257

Author(s):

Alex Robles ◽

Brittany Noel Robles ◽

Laura C. Gemmell ◽

Paula C. Brady

Keyword(s):

Ovarian Cancer ◽

Fertility Preservation ◽

Young Women ◽

Case Series ◽

Oocyte Retrieval

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Outcome of Reproductive Age Women With Stage IA or IC Invasive Epithelial Ovarian Cancer Treated With Fertility-Sparing Therapy

Obstetrical & Gynecological Survey ◽

10.1097/01.ogx.0000058684.18516.cf ◽

2003 ◽

Vol 58 (4) ◽

pp. 254-255

Author(s):

Jeanne M. Schilder ◽

Amy M. Thompson ◽

Paul D. DePriest ◽

Frederick R. Ueland ◽

Michael L. Cibull ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Reproductive Age ◽

Reproductive Age Women ◽

Fertility Sparing ◽

Stage Ia ◽

Invasive Epithelial Ovarian Cancer

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The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

Journal of Ovarian Research ◽

10.1186/s13048-021-00825-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Shizhuo Wang ◽

Jiahui Gu

Keyword(s):

Ovarian Cancer ◽

Ovarian Reserve ◽

Premenopausal Women ◽

Laparoscopic Hysterectomy ◽

Ovarian Tumors ◽

Reproductive Age ◽

Control Group ◽

Significant Difference ◽

Bilateral Salpingectomy ◽

The Impact

Abstract Background Bilateral salpingectomy has been proposed to reduce the risk of ovarian cancer, but it is not clear whether the surgery affects ovarian reserve. This study compares the impact of laparoscopic hysterectomy for benign disease with or without prophylactic bilateral salpingectomy on ovarian reserve. Methods Records were reviewed for 373 premenopausal women who underwent laparoscopic hysterectomy with ovarian reserve for benign uterine diseases. The serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and three-dimensional antral follicle count (AFC) were assessed before surgery and 3 and 9 months postoperatively to evaluate ovarian reserve. Patients were divided into two groups according to whether they underwent prophylactic bilateral salpingectomy. The incidence of pelvic diseases was monitored until the ninth month after surgery. Results There was no significant difference between the two surgery groups in terms of baseline AMH, E2, FSH, LH, and AFC (all P > 0.05). There was no difference in potential bias factors, including patient age, operative time, and blood loss (all P > 0.05). There was also no significant difference between the two groups 3 months after surgery with respect to AMH (P = 0.763), E2 (P = 0.264), FSH (P = 0.478), LH (P = 0.07), and AFC (P = 0.061). Similarly, there were no differences between groups 9 months after surgery for AMH (P = 0.939), E2 (P = 0.137), FSH (P = 0.276), LH (P = 0.07) and AFC (P = 0.066). At 9 months after the operation, no patients had malignant ovarian tumors. The incidences of benign ovarian tumors in the salpingectomy group were 0 and 2.68 % at 3 and 9 months after surgery, respectively, and the corresponding values in the control group were 0 and 5.36 %. The incidences of pelvic inflammatory disease in the salpingectomy group were 10.72 and 8.04 % at 3 and 9 months after surgery, respectively, while corresponding values in the control group were 24.13 and 16.09 %. Conclusions Prophylactic bilateral salpingectomy did not damage the ovarian reserve of reproductive-age women who underwent laparoscopic hysterectomy. Prophylactic bilateral salpingectomy might be a good method to prevent the development of ovarian cancer. Larger clinical trials with longer follow-up times are needed to further evaluate the risks and benefits.

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Fertility preservation in patients with early epithelial ovarian cancer

Journal of Gynecologic Oncology ◽

10.3802/jgo.2009.20.1.44 ◽

2009 ◽

Vol 20 (1) ◽

pp. 44 ◽

Cited By ~ 35

Author(s):

Yong-Soon Kwon ◽

Ho-Suap Hahn ◽

Tae-Jin Kim ◽

In-Ho Lee ◽

Kyung-Taek Lim ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Fertility Preservation

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Advances in Fertility Preservation for Young Women With Cancer

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_208301 ◽

2018 ◽

pp. 27-37 ◽

Cited By ~ 3

Author(s):

Karen Lisa Smith ◽

Clarisa Gracia ◽

Anna Sokalska ◽

Halle Moore

Keyword(s):

Fertility Preservation ◽

Young Female ◽

Current Data ◽

Reproductive Age ◽

Fertility Treatment ◽

Ovarian Suppression ◽

Female Patients ◽

Ovarian Protection ◽

Future Fertility ◽

Reproductive Techniques

Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.

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Fertility preservation with successful pregnancy outcome in a patient with transplanted heart and non-Hodgkin’s lymphoma – a case report

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2587-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ana Sofia Pais ◽

Nuno Guerra ◽

Daniela Couto ◽

Ana Paula Sousa ◽

Teresa Almeida-Santos

Keyword(s):

Fertility Preservation ◽

Heart Transplant ◽

Multidisciplinary Team ◽

Normal Pregnancy ◽

Reproductive Age ◽

Pelvic Irradiation ◽

Non Hodgkin Lymphoma ◽

Increased Risk ◽

Oncologic Treatment

Abstract Background: Fertility preservation must be discussed with reproductive age women before cancer treatment. Heart transplantation raises complex issues in pregnancy. Pregnancy in a heart transplant woman after pelvic irradiation involves close multidisciplinary follow-up to avoid complications in the mother and the foetus. We report the first live birth in a heart transplant woman after pelvic irradiation, chemotherapy and fertility preservation. Case presentation: A 36-year-old heart transplant woman with pelvic non-Hodgkin lymphoma spared her fertility, with cryopreservation of oocytes and embryos, before chemotherapy and pelvic irradiation. After multidisciplinary discussion and pre-conception evaluation, pregnancy was achieved. A close follow-up by a multidisciplinary team allowed a normal pregnancy without maternal or foetal complications and the delivery of a healthy infant. Conclusions Achieving pregnancy in heart transplant women with iatrogenic ovarian failure after oncologic treatment including pelvic irradiation is possible and can be successful. Careful and close surveillance by a multidisciplinary team is mandatory due to increased risk of maternal and foetal complications.

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Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity

International Journal of Molecular Sciences ◽

10.3390/ijms21207792 ◽

2020 ◽

Vol 21 (20) ◽

pp. 7792

Author(s):

Hyun-Woong Cho ◽

Sanghoon Lee ◽

Kyung-Jin Min ◽

Jin Hwa Hong ◽

Jae Yun Song ◽

...

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Ovarian Tissue ◽

Alkylating Agents ◽

Survival Rates ◽

Chemotherapeutic Agents ◽

Reproductive Age ◽

Experimental Techniques ◽

Ovarian Tissue Cryopreservation

Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility preservation options including established and experimental techniques that take into consideration the patient’s age, marital status, chemotherapy regimen, and the possibility of treatment delay should be provided. In addition, effective multidisciplinary oncofertility strategies that involve a highly skilled and experienced oncofertility team consisting of medical oncologists, gynecologists, reproductive biologists, surgical oncologists, patient care coordinators, and research scientists are necessary to provide cancer patients with high-quality care.

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Fertility‐sparing surgery and survival among reproductive‐age women with epithelial ovarian cancer in 2 cancer registries

Cancer ◽

10.1002/cncr.32620 ◽

2019 ◽

Vol 126 (6) ◽

pp. 1217-1224 ◽

Cited By ~ 4

Author(s):

Sarah M. Crafton ◽

David E. Cohn ◽

Elyse N. Llamocca ◽

Elaine Louden ◽

Jennifer Rhoades ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cancer Registries ◽

Reproductive Age ◽

Reproductive Age Women ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Ethics and Oncofertility: A Call for Religious Sensitivity

Journal of Oncology Practice ◽

10.1200/jop.2016.020487 ◽

2017 ◽

Vol 13 (7) ◽

pp. e582-e589 ◽

Cited By ~ 2

Author(s):

Michele R. Hanselin ◽

Deborah L. Roybal ◽

Thomas B. Leininger

Keyword(s):

Fertility Preservation ◽

Decision Process ◽

Treatment Plan ◽

Informed Consent Process ◽

Reproductive Age ◽

Spiritual Guidance ◽

Faith Based ◽

Hospital Chaplains ◽

Role Of Religion

For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient’s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient’s moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources.

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