Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers

Zapardiel, Ignacio; Cruz, María; Diestro, María Dolores; Requena, A.; Garcia-Velasco, Juan A.

doi:10.1093/humupd/dmv066

Cited by 54 publications

(44 citation statements)

References 273 publications

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“…Fertility preservation in women with cervical, endometrial and ovarian cancers is provided by both, fertility-sparing surgery and ART [18]. According to the literature, prevention of fertility in women with gynecological cancers is possible without disturbing the oncological safety [19].…”

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confidence: 99%

Assisted reproductive technology in reproductive medicine — possibilities and limitations

Szamatowicz

2016

Ginekol Pol

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Infertility has become an increasingly common health problem and has been estimated to affect approximately 10% of women in the reproductive age. Due to its high prevalence, it has been deemed a social disease by the World Health Organization (WHO). The causes of infertility are numerous and vary from person to person. As for treatment, the three main therapeutic strategies include pharmacological therapy, surgical therapy -mostly endoscopy, and assisted reproductive technology (ART). Recent decades have witnessed great progress in ART, resulting in successful treatment of the previously untreatable cases, particularly in the field of fertility preservation, preimplantation screening for aneuploidy, uterine transplantations and mitochondrial replacement techniques as prevention against a number of severe diseases. Regardless, ART treatment does not guarantee pregnancy and live birth. The success rate is much smaller as compared to the failure rate, it being among its most important limitations. Embryo implantation is an extremely complex process and represents the most critical step of the reproduction process in humans. Attempts to evaluate endometrial receptivity and strategies for its correction have been discussed. The search for new effective predictors of an individual prognosis remains a crucial challenge for the contemporary reproductive medicine.

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confidence: 99%

Assisted reproductive technology in reproductive medicine — possibilities and limitations

Szamatowicz

2016

Ginekol Pol

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“…Even in instances in which ovaries are outside of a direct radiation path, scatter doses can still cause ovarian failure in up to 50-90% of cases [67]. Oophoropexy removes ovaries from the direct field of radiation treatment (laparoscopically or with the use of mini-laparatomy), using placement that varies according to the patient's anatomy and the planned treatment[68]. At the conclusion of treatment, the ovaries are returned to their original position to allow return of reproductive function.…”

Section: Established Fertility Preservation Methods For Femalesmentioning

confidence: 99%

New promising strategies in oncofertility

Hudson

Stanley

Nahata

et al. 2017

Expert Review of Quality of Life in Cancer Care

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Introduction Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments. Areas Covered Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies. Expert Commentary There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.

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“…Potential strategies for such women include embryo or oocyte cryopreservation (Gressel et al ., 2015; Zapardiel et al ., 2016). However, embryo cryopreservation is not suitable for children and unmarried women as it involves a male partner, unless sperm donation is acceptable (Zapardiel et al ., 2016). Embryo cryopreservation also requires superovulation, which is time consuming and not without side effects.…”

Section: Introductionmentioning

confidence: 99%

“…Ovulation induction does not appear to be associated with increased risk of relapse, and subsequent pregnancies do not worsen oncological outcomes (Matthews et al ., 2012; Fujimoto et al ., 2014; Zapardiel et al ., 2016). The impact of high serum estradiol levels on endometrial carcinoma is uncertain, although some data suggest an adverse effect of ovarian stimulation.…”

Section: Introductionmentioning

confidence: 99%

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Fertility-preservation in endometrial cancer: is it safe? Review of the literature

Carneiro

Lamaita

Ferreira

et al. 2016

JBRA Assisted Reproduction

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Almost 5% of women with endometrial cancer are under age 40, and they often have well-differentiated endometrioid estrogen-dependent tumors. Cancer survival rates have improved over the last decades so strategies to avoid or reduce the reproductive damage caused by oncologic treatment are needed. We reviewed the published literature to find evidence to answer the following questions: How should we manage women in reproductive age with endometrial cancer? How safe is fertility preservation in endometrial cancer? Can pregnancy influence endometrial cancer recurrence? What are the fertility sparing options available? Progestins may be prescribed after careful evaluation and counseling. Suitable patients should be selected using imaging methods and endometrial sampling since surgical staging will not be performed. Conservative treatment should only be offered to patients with grade 1 well-differentiated tumors, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease or suspicious adnexal masses, and expression of progesterone receptors in the endometrium. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and ruled out before the decision to preserve the ovaries. The availability of Assisted Reproductive Technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation techniques can be employed, although the latter remains experimental. Unfortunately, fertility preservation is rarely considered. Current recommendations for conservative management are based on the overall favorable prognosis of grade 1 minimally invasive tumors. Selected patients with endometrial cancer may be candidates to a safe fertility-preserving management.

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Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers

Abstract: After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.

Cited by 54 publications

References 273 publications

Assisted reproductive technology in reproductive medicine — possibilities and limitations

Assisted reproductive technology in reproductive medicine — possibilities and limitations

New promising strategies in oncofertility

Fertility-preservation in endometrial cancer: is it safe? Review of the literature

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