Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting

Abstract

Background Healthy individuals and patients with cancer who are carriers of germline pathogenic variants in the BRCA1/2 genes face multiple reproductive challenges that require appropriate counseling and specific expertise. Main body On December 5th–7th, 2019, patient advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to “San Giuseppe Moscati” Hospital in Avellino (Italy) for a workshop on reproductive management of women with germline pathogenic variants in the BRCA1/2 genes. From the discussion regarding the current evidence and future prospective in the field, eight main research questions were formulated and eight recommendations were developed regarding fertility, fertility preservation, preimplantation genetic testing, and pregnancy in healthy carriers and patients with cancer. Conclusion Several misconceptions about the topic persist among health care providers and patients often resulting in a discontinuous and suboptimal management. With the aim to offer patient-tailored counseling about reproductive issues, both awareness of current evidences and research should be promoted.

The Lactobacillus Crispatus M247 oral administration: it really is an effective strategy in the management of papillomavirus-infected women?

“…Its defensive action has also been found against the human papillomavirus. Actually, a healthy vaginal ecosystem is characterized by Lactobacilli that could represent a local immune system and in ammation response modulation [31]with the capacity to control cell proliferation/apoptosis [32].Indeed, hydrogen peroxide, lactate and bacteriocins rreleased by Lactobacilli could inhibit pathogen overgrowth in the whole urogenital tract, being a vital support in achieving a good reproductive and general health in women [33][34][35].Therefore, the support of lactobacilli taken orally would allow to restore the endogenous balance and strengthen the defenses against HPV facilitating its clearance [35][36][37].Other study evaluated the role of oral probiotics in patients with HPV infection, but with an important bias that it was represents to enrolled only women with concomitant infection in progress. In fact, the execution of pap-smears in women with infection could be unreliable since the criteria for an optimal cytology valuation also include the absent of in ammation [37][38][39].…”

Contraception and Hormone Replacement Therapy in Healthy Carriers of Germline BRCA1/2 Genes Pathogenic Variants: Results from an Italian Survey

“…On 5–7 December 2019, patients’ advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to “San Giuseppe Moscati” Hospital in Avellino (Italy) to participate in a workshop on the reproductive management of women with germline pathogenic variants in the BRCA1/2 genes [ 5 ]. The invited experts represented different disciplines related to the topic, including oncologists, gynecologists, geneticists, and bioethicists.…”

“…At the time of these procedures, healthy BRCA carriers are usually young. Therefore, they face several decisions on gynecology-related issues, including contraception, fertility, and pregnancy [ 5 ]. Furthermore, undergoing risk-reducing salpingo-oophorectomy (RRSO) before the age of 40 for BRCA1 and 45 years for BRCA2 carriers is associated with premature iatrogenic menopause.…”

Fertility preservation techniques in cervical carcinoma

“…The inhibition of oocyte maturation during or just before a chemotherapy regimen with a concomitant treatment with gonadotropin-releasing hormone agonist (GnRHa), such as goserelin, triptorelin, buserelin, and leuprolide represents a well-established FP approach in cancer patients. Data from comprehensive literature highlight that, when other FP methods are not feasible, GnRHa administration may be offered to reduce chemotherapy-induced ovarian toxicity [36] . However, despite the fact that GnRHa utilization in FP programs is still debated, this therapeutic approach could equally be considered applicable for urgent cases [40]…”