Fertility considerations in the management of gynecologic malignancies Journal Article


Authors: Noyes, N.; Knopman, J. M.; Long, K.; Coletta, J. M.; Abu-Rustum, N. R.
Article Title: Fertility considerations in the management of gynecologic malignancies
Abstract: Goals: Gynecologic cancers represent a significant proportion of malignancies affecting women. Historically, cancer treatment focused primarily on eradicating disease, irrespective of the impact on fertility. The implementation of early detection protocols and advanced treatment regimens has resulted in improved prognosis for gynecologic cancer patients. With this improvement, more attention is now paid to quality-of-life issues. Fertility preservation (FP) has become an integral component in the selection and execution of gynecological cancer management. In this report we address gynecologic malignancies as they relate to future fertility potential. Methods: We review reproductive principles such as ovarian reserve, uterine function, cervical competence, and early obstetrical management, as well as available FP methods. In addition, we discuss the potential damage that cancer and cancer treatments can impart on the female reproductive system. We offer general recommendations regarding baseline screening tests useful in assessing the feasibility of FP. Lastly, cancer-specific FP methods are presented. Results: Oocyte quantity and quality naturally decline with advancing age. In most patients, the slope of decline steepens significantly after the age of 35. Reliable ovarian reserve measures exist and should be utilized to assess and triage potential candidates for FP. Advancements in FP, particularly in oocyte cryopreservation (OC), have improved the success rates associated with the techniques available to cancer patients. Currently, where successfully available, OC appears to be the preferred method for single women diagnosed with a gynecologic malignancy as it affords reproductive autonomy, whereas embryo cryopreservation using a donor gamete remains an alternative. Conclusions: In gynecologic oncology, effective treatments to achieve cancer survival can compromise the ability to subsequently conceive and/or carry a child. Therefore, as the field of oncofertility continues to expand, a discussion regarding FP should be initiated when tailoring a cancer treatment protocol. © 2010 Elsevier Inc. All rights reserved.
Keywords: fertility preservation; quality-of-life; parenthood; oocyte cryopreservation
Journal Title: Gynecologic Oncology
Volume: 120
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2011-03-01
Start Page: 326
End Page: 333
Language: English
DOI: 10.1016/j.ygyno.2010.09.012
PROVIDER: scopus
PUBMED: 20943258
DOI/URL:
Notes: --- - "Export Date: 4 March 2011" - "CODEN: GYNOA" - "Source: Scopus"
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