FERTILITY PRESERVATION IN GYNECOLOGICAL CANCER

Abstract

Infertility is one of the most impacting sequelae for women with a diagnosis of cancer before the completion of family planning. Enhancement of chemotherapy and radiotherapy efficacy significantly improved oncological outcomes. However, their use in young women can compromise the reproductive function. Chemotherapeutic agents are related to the subsequent risk of ovarian insufficiency and early menopause. Radiotherapy of the pelvis can both determine ovarian follicles atresia and damage the uterus, inducing fibrosis and reducing the vascular supply. On that basis, The American Society of Clinical Oncology (ASCO 2018) and the American Society for Reproductive Medicine (ASRM 2019) released practice guidelines specifically focused on fertility preservation in cancer patients. These guidelines stress the importance of an appropriate counseling including the discussion of both the long-term consequences of the different treatments option on fertility and the possibility of fertility preservation. Different fertility-sparing management options are available, and the choice is based on the type and stage of the malignancy, age at diagnosis, ovarian reserve status, time available from diagnosis to treatment, and the type of planned treatment. All these considerations are applicable in gynecological cancer, but we have to add the consequences of a therapeutic and staging surgery that almost always include both hysterectomy and oophorectomy to the concerns related to the effect of chemotherapy and radiation therapy. On that basis, the fertility sparing in gynecological cancer is more challenging. Particularly, the standard approach is usually not performed or delayed. For all these reasons, fertility sparing in women with a diagnosis of gynecological cancer requires a dedicated approach.