Fertility Preservation in Young Patients with Endometrial Cancer

Abstract Background Endometrial cancer combining uterus didelphys is quite rare clinically which partially explains that there is no discussion about young patients’ fertility preservation and follow up of tumor outcome. Case presentation In this article, we report a case of unilateral endometrial carcinoma found in a young patient with uterus didelphys who was treated with high-efficiency progesterone due to unfinished child-bearing. During the follow-up, the affected uterine endometrium was not reversed by progesterone. So, the patient underwent the abdominal surgery with the left uterus and left fallopian tube resection. We performed three consecutive immunohistochemical studies of the contralateral uterine endometrium to verify the safety of preserving the contralateral uterus and its appendages which preserved her fertility. Conclusions Endometrial cancer occurring in patients with uterus didelphys is quite rare in child-bearing age. In this case report, we preserved the patient’s contralateral uterus based on patient’s strong needs and negative IHC analysis of the preserved side uterine endometrium. However, the tumor and fertility outcome require more follow-up.

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Genomic Consideration in Chemotherapy-Induced Ovarian Damage and Fertility Preservation

Genes ◽

10.3390/genes12101525 ◽

2021 ◽

Vol 12 (10) ◽

pp. 1525

Author(s):

Seongmin Kim ◽

Sanghoon Lee ◽

Hyun-Tae Park ◽

Jae-Yun Song ◽

Tak Kim

Keyword(s):

Fertility Preservation ◽

Quality Care ◽

Young Patients ◽

Young Female ◽

Patients With Cancer ◽

Female Cancer Patients ◽

Ovarian Damage ◽

Prevention Methods ◽

Gonadal Damage ◽

Gene Alterations

Chemotherapy-induced ovarian damage and fertility preservation in young patients with cancer are emerging disciplines. The mechanism of treatment-related gonadal damage provides important information for targeting prevention methods. The genomic aspects of ovarian damage after chemotherapy are not fully understood. Several studies have demonstrated that gene alterations related to follicular apoptosis or accelerated follicle activation are related to ovarian insufficiency and susceptibility to ovarian damage following chemotherapy. This may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions after chemotherapy. This review highlights the importance of genomic considerations in chemotherapy-induced ovarian damage and multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.

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Evaluation of Reproductive Concerns and Biographical Impact of Breast Cancer in Young Patients

Breast Care ◽

10.1159/000481340 ◽

2018 ◽

Vol 13 (2) ◽

pp. 124-128 ◽

Cited By ~ 1

Author(s):

Maximiliane Burgmann ◽

Kerstin Hermelink ◽

Alex Farr ◽

Friederike van Meegen ◽

Annika Heiduschk ◽

...

Keyword(s):

Breast Cancer ◽

Genetic Testing ◽

Fertility Preservation ◽

Young Patients ◽

Initial Decision ◽

Time Period ◽

Partnership Status ◽

Reproductive Concerns ◽

Young Breast Cancer ◽

Testing And Counseling

Background: This study evaluates interventions offered to young breast cancer (BC) patients, including fertility preservation, genetic testing, and counseling for parenthood concerns, and analyzes the effect of BC on biographical issues. Methods: Women who were diagnosed with BC at the age of 18-40 years and who underwent treatment at the Breast Center, Ludwig-Maximilian University (LMU) in Munich between 2006 and 2013, were eligible for this study. Patients received a self-developed questionnaire which covered the following topics: fertility preservation, family planning, genetic testing, parenthood concerns and children's needs, partnership status, and employment situation. Results: Re-evaluating their initial decision on fertility preservation, 76.4% of patients reported satisfaction with their decision. After BC diagnosis, 45.8% reported to have maternal desire, but only 21.7% actually planned to have children. 41.7% of patients missed sufficient counseling regarding parenthood concerns. Analysis of individual employment situations showed that the time period until the return to work was longer in patients who received chemotherapy. The majority of patients (71.6%) did not report changes in their partnership status. Conclusion: Young BC survivors report a lack of communication related to parenthood concerns and future conception, but are satisfied with counseling regarding fertility preservation and genetics.

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O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

Human Reproduction ◽

10.1093/humrep/deab127.081 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Sellami ◽

M Grynberg ◽

A Benoit ◽

C Sifer ◽

A Mayeur ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Fertility Preservation ◽

Cancer Diagnosis ◽

Ovarian Tissue ◽

Young Patients ◽

Oocyte Retrieval ◽

Breast Cancer Patients ◽

Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

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New Variant Of Hormonal Treatment For Atypical Endometrial Hyperplasia And An Early Endometrial Cancer With Fertility Preservation

Онкогинекология ◽

10.52313/22278710_2019_1_36 ◽

2019 ◽

pp. 36-45

Author(s):

Olga V. Novikova ◽

Cholpon A. Avasova ◽

Elena G. Novikova ◽

Ksenia V. Krasnopolskaya ◽

Yulia A. Lozovaya ◽

...

Keyword(s):

Endometrial Cancer ◽

Fertility Preservation ◽

Endometrial Hyperplasia ◽

Hormonal Treatment ◽

Atypical Endometrial Hyperplasia ◽

New Variant

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Fertility preservation for young patients with cancer: who is at risk and what can be offered?

The Lancet Oncology ◽

10.1016/s1470-2045(05)70092-9 ◽

2005 ◽

Vol 6 (4) ◽

pp. 209-218 ◽

Cited By ~ 508

Author(s):

W Hamish B Wallace ◽

Richard A Anderson ◽

D Stewart Irvine

Keyword(s):

At Risk ◽

Fertility Preservation ◽

Young Patients ◽

Patients With Cancer

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Fertility Preservation in Female Cancer Patients

ISRN Obstetrics and Gynecology ◽

10.5402/2012/807302 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Chung-Hoon Kim ◽

Gyun-Ho Jeon

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Survival Rates ◽

Young Patients ◽

Gynecologic Surgery ◽

Embryo Cryopreservation ◽

Future Fertility ◽

Female Cancer Patients ◽

Gestational Surrogacy

With improved survival rates among cancer patients, fertility preservation is now being recognized as an issue of great importance. There are currently several methods of fertility preservation available in female cancer patients and the options and techniques via assisted reproduction and cryopreservation are increasing, but some are still experimental and continues to be evaluated. The established means of preserving fertility include embryo cryopreservation, gonadal shielding during radiation therapy, ovarian transposition, conservative gynecologic surgery such as radical trachelectomy, donor embryos/oocytes, gestational surrogacy, and adoption. The experimental methods include oocyte cryopreservation, ovarian cryopreservation and transplantation, in vitro maturation, and ovarian suppression. With advances in methods for the preservation of fertility, providing information about risk of infertility and possible options of fertility preservation to all young patients with cancer, and discussing future fertility with them should be also considered as one of the important parts of consultation at the time of cancer diagnosis.

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Spontaneous Pregnancy and Fertility Preservation Program in Women Undergoing High Dose Chemotherapy for Hematological Malignancies.

Blood ◽

10.1182/blood.v106.11.1114.1114 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1114-1114

Author(s):

Izhar Hardan ◽

Dror Meirow ◽

Avichai Shimoni ◽

Jacob Levron ◽

Noga Shemtov ◽

...

Keyword(s):

Fertility Preservation ◽

Young Women ◽

Ovarian Tissue ◽

Young Patients ◽

High Dose Chemotherapy ◽

Ovarian Failure ◽

Ovarian Tissue Cryopreservation ◽

High Dose ◽

Cryopreserved Ovarian Tissue ◽

Tissue Cryopreservation

Abstract Loss of fertility is a major concern in young women undergoing high dose chemotherapy (HDT). Although it is generally accepted that therapy of the myeloabelative range is related with a high rate of fertility loss, we observed during the last years eight spontaneous pregnancies with normal deliveries in young women after bone marrow transplantation. Seven patients (pt’s) were with lymphoma and MM and were conditioned with BEAM regimen (n=6) and melphalan 200mg/sm (n=1) prior to an autologous SCT, while one patient had a secondary AML and underwent BEAM primed autologous SCT and Busulfex/FA primed allogeneic BMT. The median age at transplant of this group was 28y and median time from transplant to pregnancy was 25 months. More than 100 women of 18–40y.o were transplanted in our center during this period; however, obviously the fertility rate cannot be calculated as it is related with additional parameters including survival, post transplant complications and mainly patient’s preferences. Naturally we observed during the same period many young patients with ovarian failure post transplant, as well as one successful pregnancy from a cryopreserved embryo. Methods. We Therefore initiated in October 2000 a fertility preservation program in which all women of 18 – 40y.o were offered a pretransplant IVF with embryo preservation, and/or ovarian tissue cryopreservation (OTC), according to their clinical status. 651 pt’s were transplanted in our center in the last 44 months, of which 81 were women of 18–41y.o that were all enrolled in this program. Results. Seven pt’s of this group (8.6%) underwent IVF. The major causes of denying IVF were the need to delay BMT for more than clinically accepted, prolonged preexisting ovarian failure, lack of a suitable partner and patient’s preference. Seventeen pt’s (21%) underwent OTC. The major causes of denying OTC were patient’s preference (mainly due to no evidence of success with this method) and thrombocytopenia/neutropenia. During this period: One patient of this group was fertilized with her cryopreserved embryos 32 months after transplant and is at her 16 week of pregnancy. One patient underwent a successful transplantation of her cryopreserved ovarian tissue 2.5 years after HDC while in a documented ovarian failure, and gave birth to a healthy baby on June 2005. The OTC of this patient was performed after cis-platinum containing salvage therapy for relapsing NHL, prior to BEAM primed SCT, and immediately after a failure of hormonal stimulation for IVF. One patient underwent a cryopreserved ovarian tissue transplantation on July 2005 Conclusions: 1. Spontanous pregnancy after HDT, mainly at the younger age, is not a rare phenomenon. 2. Most young patients prior to HDT are not eligible for IVF. 3. Pretransplant ovarian tissue cryopreservation is a feasible tool in this set-up. The first success with this method is promising.

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