Fertility preservation techniques in cervical carcinoma

Abstract

Astract The usefulness of this review is to highlight how a fertility preservation (FP) approach is currently feasible for patients diagnosed with uterine cervical cancer. To this regard, a fertility sparing surgery has just overcome its traditional limits, gained acceptance within the major gynecologic oncology societies thanks to the ability to identify the “ideal” candidates to this conservative treatment. On the other hand, the use of other FPs for oocyte and ovarian cortex cryopreservation is still extremely debated. In fact, the existing risk of tumor spreading during oocyte retrieval necessary for oocyte cryostorage for patients’ candidates for neo-adjuvant therapy, as well as the potential hazard of cancer cell dissemination after ovarian tissue replacement in cases of non-squamous type cervical carcinomas should not be underestimated. Therefore, in consideration of the encountered limitations and the need to ensure adequate reproductive health for young uterine cervical cancer survivors, translational research regarding the FP has progressively collected innovative insights into the employment of stemness technology. In this context, the property of ovarian stem cells obtained from the ovarian cortex to generate functional oocytes in women could represent a promising therapeutic alternative to the current procedures for a novel and safer FP approach in cancer survivors.

Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions

“…Early diagnosis of cervical cancer allows conservative surgical management, especially in young patients considering pregnancy in the future [ 16 ]. Considering that cervical cancer metastasizes to pelvic and para-aortic lymph nodes, their evaluation is imperative during fertility-sparing surgical procedures [ 16 ].…”

“…Early diagnosis of cervical cancer allows conservative surgical management, especially in young patients considering pregnancy in the future [ 16 ]. Considering that cervical cancer metastasizes to pelvic and para-aortic lymph nodes, their evaluation is imperative during fertility-sparing surgical procedures [ 16 ]. The loop electrosurgical excision procedure (LEEP) or cold-knife conization combined with endocervical curettage with negative surgical margins is a recommended fertility-sparing procedure for the management of stage IA1 of cervical cancer without lymphovascular space invasion ( Figure 1 ) [ 17 ].…”

“…Although still debated [ 16 ], oocyte cryopreservation is a well-established procedure that allows a predictable opportunity for future pregnancy based on the number of oocytes retrieved and stored [ 38 ]. Controlled ovarian stimulation (COS) with gonadotropin is required as an important step for this approach [ 16 , 38 , 39 , 40 ]. Currently, the probability of success in oocyte cryopreservation is related to the viability of oocytes after they are refrozen [ 16 ].…”

“…Controlled ovarian stimulation (COS) with gonadotropin is required as an important step for this approach [ 16 , 38 , 39 , 40 ]. Currently, the probability of success in oocyte cryopreservation is related to the viability of oocytes after they are refrozen [ 16 ].…”

“…Such fertility-sparing approaches are only offered to women with cancer in the early stages, according to the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) staging system of cervical cancer, who plan pregnancy in the future [ 15 ]. Of note, fertility-sparing surgery offers similar overall and disease-free survival compared to radical hysterectomy [ 16 ]. At the same time, the fertility-sparing surgery applied for the management of cervical cancer is linked to an increased risk of pregnancy complications such as preterm deliveries, preterm premature rupture of membranes (PPROM), and low-birth-weight infants [ 15 ].…”