Advances in Fertility Preservation for Young Women With Cancer

2018 ◽  
pp. 27-37 ◽  
Author(s):  
Karen Lisa Smith ◽  
Clarisa Gracia ◽  
Anna Sokalska ◽  
Halle Moore
Keyword(s):  
Fertility Preservation ◽  
Young Female ◽  
Current Data ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Ovarian Suppression ◽  
Female Patients ◽  
Ovarian Protection ◽  
Future Fertility ◽  
Reproductive Techniques

Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.

Assessment of contraception and fertility knowledge among female oncology patients of child bearing age and their providers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18270-e18270
Author(s):  
Samantha Betman ◽  
Jessica M Madrigal ◽  
Kelly Stempinski-Metoyer ◽  
Ruta D. Rao ◽  
Ashlesha Patel
Keyword(s):  
Fertility Preservation ◽  
Cancer Care ◽  
Safety Net ◽  
Cook County ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Oncology Patients ◽  
Female Patients ◽  
Future Fertility ◽  
Oncology Providers

e18270 Background: Understanding the implications for future fertility is a growing concern among young women diagnosed with cancer. Women are less likely than men to receive information regarding fertility preservation and possible infertility following cancer treatment. Our goal was to examine knowledge of contraception and cancer-related changes in fertility among women of childbearing age treated at John H. Stroger, Jr. Hospital of Cook County and to assess whether or not medical providers prioritized having these conversations with female patients. Methods: We interviewed 20 female oncology patients, and 14 completed an additional 12 question true/false question fertility knowledge survey. We administered a survey to providers in the Medical Oncology department to assess how they prioritize talking about contraception and fertility preservation with their female patients of childbearing age. Providers rated ten items using a five-item Likert scale ranging from strongly disagree to strongly agree. Data was summarized as frequencies and percentages. Results: Among the 20 patients interviewed, six (30%) were under age 35 and 14 (70%) had an income of under $30,000. Of these, only 50% had tried a tier 1 long acting reversible contraceptive method and 43% had tried a tier 2 method. Fertility knowledge scores ranged from 0 to 8, out of 12 (Table). The median score was 2 (IQR 3). Among the 17 oncology providers surveyed, only 24% (n = 4) agreed that they were confident educating their patients about fertility preservation, and only 35% (n = 6) prioritized talking to their female patients of reproductive age about different methods of contraception. Conclusions: Health disparities in cancer care are well-known. Low-income women who seek cancer care at a safety-net institution may have limited knowledge on contraception and fertility. A better understanding of how oncology providers can prioritize these topics when talking to patients about their cancer diagnosis is needed. [Table: see text]

scholarly journals Female Fertility Preservation through Stem Cell-based Ovarian Tissue Reconstitution In Vitro and Ovarian Regeneration In Vivo

2019 ◽  
Vol 13 ◽  
pp. 117955811984800 ◽  
Author(s):  
Taichi Akahori ◽  
Dori C Woods ◽  
Jonathan L Tilly
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Mammalian Species ◽  
Reproductive Age ◽  
Embryo Cryopreservation ◽  
Novel Approach ◽  
Future Fertility ◽  
Female Fertility Preservation

Historically, approaches designed to offer women diagnosed with cancer the prospects of having a genetically matched child after completion of their cytotoxic treatments focused on the existing oocyte population as the sole resource available for clinical management of infertility. In this regard, elective oocyte and embryo cryopreservation, as well as autologous ovarian cortical tissue grafting posttreatment, have gained widespread support as options for young girls and reproductive-age women who are faced with cancer to consider. In addition, the use of ovarian protective therapies, including gonadotropin-releasing hormone agonists and sphingosine-1-phosphate analogs, has been put forth as an alternative way to preserve fertility by shielding existing oocytes in the ovaries in vivo from the side-effect damage caused by radiotherapy and many chemotherapeutic regimens. This viewpoint changed with the publication of now numerous reports that adult ovaries of many mammalian species, including humans, contain a rare population of oocyte-producing germ cells—referred to as female germline or oogonial stem cells (OSCs). This new line of study has fueled research into the prospects of generating new oocytes, rather than working with existing oocytes, as a novel approach to sustain or restore fertility in female cancer survivors. Here, we overview the history of work from laboratories around the world focused on improving our understanding of the biology of OSCs and how these cells may be used to reconstitute “artificial” ovarian tissue in vitro or to regenerate damaged ovarian tissue in vivo as future fertility-preservation options.

scholarly journals Fertility preservation in reproductive-age women facing gonadotoxic treatments

2015 ◽  
Vol 22 (4) ◽  
pp. 294 ◽  
Author(s):  
J. Roberts ◽  
R. Ronn ◽  
N. Tallon ◽  
H. Holzer
Keyword(s):  
Fertility Preservation ◽  
Multidisciplinary Approach ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Future Fertility ◽  
Fertility Sparing ◽  
Cure Rates ◽  
Reproductive Consequences

BackgroundAdvancements in the treatments for cancer and autoimmune and other hematologic conditionscontinue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical reproductive technologies has helped to offset the reproductive consequences of the use of gonadotoxic therapies, and allows for future fertility and normal pregnancy.Methods A review of the literature was performed to outline the pathophysiology of gonadotoxicity from various treatments. The success of fertility preservation, fertility sparing, and cryopreservation options are reviewed. Barriers and facilitators to referral and oncofertility treatment in Canada are also outlined.ResultsAccording to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies.ConclusionsTo ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral. 

scholarly journals The Perspectives of Fertility Preservation in Women with Endometrial Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 602
Author(s):  
Jure Knez ◽  
Leyla Al Mahdawi ◽  
Iztok Takač ◽  
Monika Sobočan
Keyword(s):  
Endometrial Cancer ◽  
Fertility Preservation ◽  
Gynecological Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Reproductive Age ◽  
Younger Women ◽  
Future Fertility ◽  
Fertility Sparing

Endometrial cancer is the most common gynecological cancer in developed countries. The disease is diagnosed with increasing frequency in younger women, commonly also in their reproductive age. The standard treatment of endometrial cancer is surgical in the form of hysterectomy and bilateral salpingo-oophorectomy, and this precludes future fertility in younger women. The current challenge is to identify the group of women with endometrial cancer and low-risk features that would benefit from more conservative treatment options. More focus in management needs to be aimed towards the preservation of quality of life, without jeopardizing oncological outcomes. In this review, we analyze the current approaches to identification of women for conservative management and evaluate the success of different medical options for treatment and surgical techniques that are fertility sparing. We also elaborate on the future perspectives, focusing on the incorporation of molecular characterization of endometrial cancer to fertility preservation algorithms. Future studies should focus specifically on identifying reliable clinical and molecular predictive markers in this group of young women. With improved knowledge and better risk assessment, the precision medicine is the path towards improved understanding of the disease and possibly widening the group of women that could benefit from treatment methods preserving their fertility.

scholarly journals Spontaneous Pregnancy following Treatment of Symptomatic Uterine Myomatosis with Ulipristal Acetate without Surgery

2021 ◽  
Vol 5 (3) ◽  
pp. 01-05
Author(s):  
Vicente Spinoso Cruz ◽  
Marta Colechá Morales ◽  
Ligia Gil Melgosa ◽  
Aida Revuelta Lopez
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Benign Tumors ◽  
Women Of Reproductive Age ◽  
Ulipristal Acetate ◽  
Uterine Myomas ◽  
Spontaneous Pregnancy ◽  
Future Fertility ◽  
Effective Option

Uterine fibroids are the most frequent gynaecological benign tumors in women of reproductive age and can cause infertility. Their treatment may be medical, surgical or a combination of both, but they may compromise future fertility in patients in which their wish to conceive has not yet been fulfilled. In this report we present two patients with symptomatic uterine myomas and who wanted to preserve their fertility. Treatment with one or two 12-week courses of 5 mg of ulipristal acetate was prescribed. A decrease in the size of the fibroids was observed, along with adequate control of the symptoms. Spontaneous pregnancies led to two live births without significant complications. Treatment with Ulipristal Acetate may be an effective option to take into account in the management of patients with symptomatic uterine fibroids who refuse surgery or in those in which it is contraindicated and who wish to preserve their fertility.

scholarly journals Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
S van Wessel ◽  
T Hamerlynck ◽  
V Schutyser ◽  
C Tomassetti ◽  
C Wyns ◽  
...  
Keyword(s):  
Live Birth ◽  
Financial Support ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Operative Hysteroscopy ◽  
Randomised Controlled

Abstract STUDY QUESTIONS Does the application of anti-adhesion gel, compared to no gel, following operative hysteroscopy to treat intrauterine pathology in women wishing to conceive increase the chance of conception leading to live birth? WHAT IS KNOWN ALREADY Intrauterine adhesions (IUAs) following operative hysteroscopy may impair reproductive success in women of reproductive age. Anti-adhesion barrier gels may decrease the occurrence of IUAs, but the evidence on their effectiveness to improve reproductive outcomes is sparse and of low quality. STUDY DESIGN, SIZE, DURATION This multicentre, parallel group, superiority, blinded and pragmatic randomised controlled trial is being carried out in seven participating centres in Belgium. Recruitment started in April 2019. Women will be randomly allocated to treatment with anti-adhesion gel (intervention group) or no gel (control group). Sterile ultrasound gel will be applied into the vagina as a mock-procedure in both treatment arms. The patient, fertility physician and gynaecologist performing the second-look hysteroscopy are unaware of the allocated treatment. Power analysis, based on a target improvement of 15% in conception leading to live birth using anti-adhesion gel, a power of 85%, a significance level of 5%, and a drop-out rate of 10%, yielded a number of 444 patients to be randomised. The baseline rate of conception leading to live birth in the control group is expected to be 45%. PARTICIPANTS/MATERIALS, SETTING, METHODS Women of reproductive age (18–47 years), wishing to conceive (spontaneously or by fertility treatment) and scheduled for operative hysteroscopy to treat intrauterine pathology (endometrial polyps, myomas with uterine cavity deformation, uterine septa, IUAs or retained products of conception) are eligible for recruitment. Women may try to conceive from 3 to 6 weeks after receiving allocated treatment with follow-up ending at 30 weeks after treatment. If the woman fails to conceive within this timeframe, a second-look hysteroscopy will be scheduled within 2–6 weeks to check for IUAs. The primary endpoint is conception leading to live birth, measured at 30 weeks after randomisation. The secondary endpoints are time to conception, clinical pregnancy, miscarriage and ectopic pregnancy rates, measured at 30 weeks after receiving allocated treatment. The long-term follow-up starts when the patient is pregnant and she will be contacted every trimester. STUDY FUNDING/COMPETING INTEREST(S) This work is funded by the Belgian Healthcare Knowledge Centre (KCE). The anti-adhesion gel is supplied at no cost by Nordic Pharma and without conditions. Dr. Tomassetti reports grants and non-financial support from Merck SA, non-financial support from Ferring SA, personal fees and non-financial support from Gedeon-Richter, outside the submitted work. None of the other authors have a conflict of interest.

scholarly journals TMD in Females with Menstrual Disorders

2021 ◽  
Vol 18 (14) ◽  
pp. 7263
Author(s):  
Bożena Jedynak ◽  
Marta Jaworska-Zaremba ◽  
Barbara Grzechocińska ◽  
Magdalena Chmurska ◽  
Justyna Janicka ◽  
...  
Keyword(s):  
Temporomandibular Disorders ◽  
Reproductive Age ◽  
Estrogen Metabolism ◽  
Menstrual Disorders ◽  
Female Patients ◽  
University Center ◽  
Dental Offices ◽  
Cycle Disorders ◽  
Masticatory Muscle Pain ◽  
The University

Background: Temporomandibular disorders (TMD) are a common reason for patients to present at dental offices. The majority of people with TMD are women between the age of 20 and 40 years. The purpose of this study was to assess the types and prevalence of temporomandibular disorders in female patients of reproductive age with menstrual disorders. Materials and methods: The study involved 65 females of reproductive age (18–40 years, an average of 28.00 ± 6.27 years). The women who qualified for the study were patients of the University Center for Maternal and Newborn’s Health hospitalized because of infertility or menstrual cycle disorders. Women with confirmed estrogen metabolism disorders participated in a clinical study with the use of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Results: In the studied female patients with menstrual disorders, temporomandibular disorders (92.3%) were frequent occurrences. The most common type was intra-articular joint disorders (68%). Other reported complaints included masticatory muscle pain (44.62%), and degenerative joint diseases (12.3%). Conclusions: 1. In women with menstrual disorders, TMD may exist. 2. In women with TMD symptoms, their medical history should be extended to include the diagnosis of female hormone disorders.

scholarly journals Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

2021 ◽  
Author(s):  
Panagiotis Thomaidis ◽  
Niklas J. Weltermann ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
Axel Sauerwald ◽  
...  
Keyword(s):  
Negative Impact ◽  
Male Partner ◽  
Current Data ◽  
Reproductive Age ◽  
Negative Effects ◽  
Desire For Children ◽  
Pregnancy And Delivery ◽  
Hybrid Notes ◽  
Type Of Delivery

Abstract Purpose We conducted a retrospective observational study in order to identify negative effects of NOTES procedures (Natural Orifice Transluminal Endoscopic Surgery) with transvaginal specimen removal on pregnancy and delivery. Methods From the total population of 299 patients in our NOTES registry, we tried to contact the 121 patients who were of reproductive age (≤ 45 years) at the time of a transvaginal NOTES procedure. They were interviewed by telephone regarding their desire for children, post NOTES-operation pregnancies, and type of delivery using a structured questionnaire. The collected data was analyzed and compared with current data. Results We were able to contact 76 patients (follow-up rate: 62.8%) with a median follow-up of 77 months after surgery (33–129 months). Twenty of 74 participating patients had a desire for children (27.0%). One of them and another's male partner were diagnosed as infertile. Regarding the remaining 18 patients, 14 became pregnant, and three of them became pregnant twice. Considering these 17 pregnancies, there was one miscarriage (5.9%) and one twin birth (5.9%). On average, childbirth occurred 44 months after the NOTES procedure. With regard to the type of delivery, 10 vaginal births (58.8%) and 7 caesarean sections (41.2%) occurred. Thus, the rate of fulfilled desire for children was 77.8%. Compared with the literature, no difference to the normal course could be detected. Conclusion There is no sign that the transvaginal approach in Hybrid-NOTES, with removal of the specimen through the vagina, has a negative effect on conception, the course during pregnancy, or the type of delivery.

Fertility preservation in women with early ovarian cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Daniel Necula ◽  
Daria Istrate ◽  
Jérôme Mathis
Keyword(s):  
Ovarian Cancer ◽  
Fertility Preservation ◽  
Low Grade ◽  
Term Survival ◽  
Organizational Issues ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Early Ovarian Cancer ◽  
Reproductive Techniques

AbstractFertility preservation is an important option to consider for young women with low-grade early ovarian cancer. Fertility-sparing surgery (“FSS”) permits the conservation of the uterus and one of the ovaries. This technique is considered safe for stages IA G1, G2 and probably safe for IC G1 epithelial and non-epithelial ovarian cancers. There are still uncertainties and FSS is not fully accepted for stage IC G1, G2 and clear cell carcinoma. The difficulty in choosing the best option lies in the fact that there is a lack of prospective randomized studies, due to ethical and organizational issues. Retrospective studies and reviews showed reassuring results for FSS in terms of relapse and long term survival. The spontaneous pregnancy rate seems to decrease after FSS, but chemotherapy does not seem to have an impact on fertility rates. Compared with the general population, assisted reproductive techniques are considered safe and with similar fertility results.

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