Fertility preservation in patients with gynaecologic malignancy: Response to ovarian stimulation and long-term outcomes

Tsonis, Orestis; Kopeika, Julia

doi:10.1016/j.ejogrb.2023.09.020

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…A study looking at the long-term reproductive outcome of controlled ovarian stimulation in patients with gynecologic malignancies found that 17 out of 68 patients (25%) returned to the clinic to claim their oocytes/embryos in a median time of 36 months. Out of this sample, the successful livebirth rate was 58.8% [66]. While oocyte and embryo cryopreservation are well-established techniques for fertility preservation, OTC is considered an innovative technique [67].…”

Section: Cryopreservation Of Oocytes Embryos and Ovarian Tissuementioning

confidence: 98%

Fertility Preservation in Cervical Cancer—Treatment Strategies and Indications

Salman,

Covens

2024

Current Oncology

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Cervical cancer is frequently diagnosed in women during their reproductive years, and fertility preservation is an essential part of their cancer treatment. In highly selected patients with early stage, low-risk cervical cancer and a tumor size ≤ 2 cm, several treatment strategies can be offered for patients wishing to preserve fertility, including radical/simple trachelectomy or conization with pelvic lymph node assessment. Trachelectomy can be performed through a vaginal, abdominal, or minimally invasive approach and has been shown to have an equivalent oncologic outcome compared to radical hysterectomy. All surgical approaches for radical trachelectomy seem to have excellent survival with comparable oncologic outcomes. Nevertheless, patients undergoing vaginal trachelectomy have better obstetric outcomes compared to the other routes. In patients with larger tumors (2–4 cm), neoadjuvant chemotherapy followed by fertility-sparing surgery is an alternative option. Several chemotherapy regimens have been used for this indication, with a pathologic complete response rate of 17–73%. For locally advanced diseases that require radical hysterectomy or primary chemoradiation, fertility preservation can be performed using oocyte, embryo, or ovarian tissue cryopreservation, as well as ovarian transposition. For these patients, future pregnancy is possible through surrogacy. In addition to fertility preservation, ovarian transposition, where the ovaries are repositioned outside of the radiation field, is performed to maintain ovarian hormonal function and prevent premature ovarian failure. In summary, fertility-preservation treatment strategies for patients with early stage cervical cancer are continuously evolving, and less radical surgeries are becoming more acceptable. Additional and ongoing evidence is helping determine the impact of conservative procedures on oncologic and obstetric outcomes in these patients.

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Section: Cryopreservation Of Oocytes Embryos and Ovarian Tissuementioning

confidence: 98%

Fertility Preservation in Cervical Cancer—Treatment Strategies and Indications

Salman,

Covens

2024

Current Oncology

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The complexity and challenges of fertility preservation in women with cervix cancer—A prospective cohort study reporting on reproductive outcome and overall survival

Marklund,

Jiang,

Röjlar

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionOur objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long‐term reproductive outcome, and overall survival.Material and MethodsProspective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a population‐based register. Trial registration number: ClinicalTrials.gov NTC04602962.ResultsIn total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility‐sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (N = 11), ovarian tissue (N = 54), or both (N = 3). After a mean follow‐up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During follow‐up, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients.ConclusionsOur findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve parenthood. While fertility‐sparing surgery can allow pregnancy, those who undergo a hysterectomy are limited to adoption, surrogacy, or the emerging possibility of uterus transplantation.

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Optimizing Reproductive Options for Young Women with Cervical Cancer

Mattei,

Iaculli,

Carbone

et al. 2024

Reprod. Med.

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Cervical cancer is one of the leading causes of mortality in women of reproductive age. In recent years, the development of preventive and therapeutic strategies has significantly increased survival rates. While this represents an important medical achievement, it has also raised a major social issue regarding the need to ensure an adequate quality of life for surviving patients. Many of these women are left without their reproductive capacity at an age when their desire for motherhood has not yet been fulfilled. Infertility or subfertility in cancer survivors is actually a growing problem, complicated by the current trend of increasingly delaying pregnancy. The psychological effects of this issue can be devastating, sometimes even more so than the cancer diagnosis itself. Although today fertility-sparing surgeries can ensure excellent reproductive outcomes with minimal oncological risk, obstetric sequelae remain significant, and affected women often require specialized care pathways. Additionally, adequate counselling is still not provided to all patients who cannot access fertility-sparing treatments and who find themselves without hope. Reproductive medicine is therefore facing the modern challenge of offering concrete options to help these patients realize their desire for motherhood. The aim of this article is to provide an overview of the therapeutic options available to young women facing an early- or later-stage diagnosis of cervical cancer.

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Fertility preservation in patients with gynaecologic malignancy: Response to ovarian stimulation and long-term outcomes

Cited by 3 publications

References 20 publications

Fertility Preservation in Cervical Cancer—Treatment Strategies and Indications

Fertility Preservation in Cervical Cancer—Treatment Strategies and Indications

The complexity and challenges of fertility preservation in women with cervix cancer—A prospective cohort study reporting on reproductive outcome and overall survival

Optimizing Reproductive Options for Young Women with Cervical Cancer

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