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Assisted reproductive technology (ART) has developed in Japan, and advanced reproductive technology was involved in 1.8% of all offspring 1). However, such therapy does not suit infertility caused by a problem in the uterus. This type of infertility can be divided into the congenital (dysplasia such as Müllerian duct hypoplasia and aplasia and Mayer-Rokitansky-Küster involves deficits of the uterus and the vagina) and acquired (hysterectomy as a treatment for uterus myoma, endometrial adhesion, uterine body cancer, and uterine cervix cancer) types 2). This paper specifically discusses infertility resulting from hysterectomy as a treatment for uterine cancer and ethical problems with regard to uterus transplants and surrogate mothers. There is a recent report arguing that uterine cervix cancer is caused by a sexually transmitted disease associated with human papillomavirus (HPV) 3) , and the importance of preventative medical examination for uterine cervix cancer has been proposed. The testing of HPV has become available recently due to the advances in testing technology. The diagnosis of uterine cervix cancer can maintain a significantly high accuracy with HPV testing and cytodiagnosis to find in the stage prior to canceration (severe dysplasia). Treatment of the disease may be relatively simple at such an early disease stage, which involves a treatment called conization to remove only uterine cervix by electrocautery or laser. Most cases of uterine cervical cancer can be completely cured with this single treatment without removing the uterus. In addition, this treatment does not influence pregnancy and childbirth. Patients with advanced stage female genital cancer, however, cannot use this treatment because cancer therapy should be prioritized and requires other therapies, such as radical hysterectomy or bilateral ovariectomy. We h a v e b e e n c o n d u c t i n g r e s e a r c h o n t i s s u e cryopreservation of a removed ovary from the standpoint of the future fertility reconstruction (Figure 2). We have also started working on the basic research of uterus transplants under immune tolerance with the aim of reconstructing the uterus. Ovarian cryopreservation after hysterectomy has not been performed so far because of its association with surrogate mothers in Japan. Surrogate mothers, in principle, are not legally recognized in Japan, and the Science Council of Japan proposes the following, see the website for details (http://www. scj.go.jp/ja/info/kohyo/pdf/kohyo-20-t56-1e.pdf). Propositions have been put forward regarding the issues Uterus transplantation and ovarian cryopreservation for fertility reconstruction in female genital cancer patients Collaboration Reconstructive surgery * Transplantation surgery QOL after childhood cancer therapy-Cutting-edge researches on fertility preservation
Assisted reproductive technology (ART) has developed in Japan, and advanced reproductive technology was involved in 1.8% of all offspring 1). However, such therapy does not suit infertility caused by a problem in the uterus. This type of infertility can be divided into the congenital (dysplasia such as Müllerian duct hypoplasia and aplasia and Mayer-Rokitansky-Küster involves deficits of the uterus and the vagina) and acquired (hysterectomy as a treatment for uterus myoma, endometrial adhesion, uterine body cancer, and uterine cervix cancer) types 2). This paper specifically discusses infertility resulting from hysterectomy as a treatment for uterine cancer and ethical problems with regard to uterus transplants and surrogate mothers. There is a recent report arguing that uterine cervix cancer is caused by a sexually transmitted disease associated with human papillomavirus (HPV) 3) , and the importance of preventative medical examination for uterine cervix cancer has been proposed. The testing of HPV has become available recently due to the advances in testing technology. The diagnosis of uterine cervix cancer can maintain a significantly high accuracy with HPV testing and cytodiagnosis to find in the stage prior to canceration (severe dysplasia). Treatment of the disease may be relatively simple at such an early disease stage, which involves a treatment called conization to remove only uterine cervix by electrocautery or laser. Most cases of uterine cervical cancer can be completely cured with this single treatment without removing the uterus. In addition, this treatment does not influence pregnancy and childbirth. Patients with advanced stage female genital cancer, however, cannot use this treatment because cancer therapy should be prioritized and requires other therapies, such as radical hysterectomy or bilateral ovariectomy. We h a v e b e e n c o n d u c t i n g r e s e a r c h o n t i s s u e cryopreservation of a removed ovary from the standpoint of the future fertility reconstruction (Figure 2). We have also started working on the basic research of uterus transplants under immune tolerance with the aim of reconstructing the uterus. Ovarian cryopreservation after hysterectomy has not been performed so far because of its association with surrogate mothers in Japan. Surrogate mothers, in principle, are not legally recognized in Japan, and the Science Council of Japan proposes the following, see the website for details (http://www. scj.go.jp/ja/info/kohyo/pdf/kohyo-20-t56-1e.pdf). Propositions have been put forward regarding the issues Uterus transplantation and ovarian cryopreservation for fertility reconstruction in female genital cancer patients Collaboration Reconstructive surgery * Transplantation surgery QOL after childhood cancer therapy-Cutting-edge researches on fertility preservation
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