Fertility considerations prior to conservative management of gynecologic cancers

Abstract

Fertility-sparing management of early-stage gynecologic cancers is becoming more prevalent as increasing evidence demonstrates acceptable oncologic and reproductive outcomes in appropriately selected patients. However, in the absence of randomized controlled trials, most of the commonly used treatment algorithms are based only on observational studies. As women are increasingly postponing childbearing, the need for evidence-based guidance on the optimal selection of appropriate candidates for fertility-sparing therapies is paramount. It is imperative to seriously consider the fertility potential of a given individual prior to making major oncologic treatment decisions that may deviate from the accepted standard of care. It is a disservice to patients to undergo a fertility-sparing procedure in hopes of ultimately achieving a live birth, only to determine later they have poor baseline fertility potential or other substantial barriers to conception including excess financial toxicity. Many women with oncologic diagnoses are of advanced maternal age and their obstetric and neonatal risks must be considered. In the era of advanced assisted reproductive technologies, patients should be provided realistic expectations regarding success rates while understanding the potential oncologic perils. A multidisciplinary approach to the conservative treatment of early-stage gynecologic cancers with early referral to reproductive specialists as well as maternal-fetal medicine specialists is warranted. In this review, we discuss the recommended fertility evaluation for patients with newly diagnosed, early-stage gynecologic cancers who are considering fertility-sparing management.

Assessing gaps in motherhood after cancer: development and psychometric testing of the Survivorship Oncofertility Barriers Scale

“…Table 1 summarizes the participants, materials, and findings of each scale development step. Literature review indicated that oncofertility decision making is multifactorial, depending on cancer characteristics and treatment, sociodemographic characteristics, decision-making characteristics, reproductive histories, self-care and lifestyle factors, and psychosocial factors 25–33. Nine papers focused specifically on survivors’ fertility needs, concerns, and experiences.…”

Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions

“…The selection of patients with EC for fertility-sparing treatment is important in order to achieve the best outcomes. Current guidelines recommend progestin therapy in stage IA, grade 1 (well-differentiated) endometrioid-type endometrial cancer [ 24 , 25 ].…”

“…The 2018 National Comprehensive Cancer Network (NCCN) includes the following criteria to consider fertility-sparing management of endometrial cancer: well-differentiated (grade 1) endometrioid endometrial carcinoma [ 19 ]; disease thought to be limited to the endometrium on magnetic resonance imaging (preferred) or ultrasound; absence of suspicious or metastatic disease on imaging [ 19 , 25 , 26 , 27 ]. Table 1 shows the optimal indications for fertility-sparing treatment.…”

“…There must not be any contraindications to medical therapy or pregnancy. Patients must be informed that the fertility-sparing option is not the standard of care for the treatment of endometrial carcinoma [ 19 , 25 ].…”

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

“…Majority of the type I tumours respond to progestins. 5,[9][10][11][12] The national comprehensive cancer network (NCCN) guidelines were followed in most of the cases except a few patients with myometrial invasion who were not willing for definitive surgery. 5 Patients were thoroughly informed that fertility sparing treatment is not the standard of care for endometrial carcinoma management.…”