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Bortoletto P, Romanski PA, Petrozza JC, Pfeifer SM. Reproductive surgery: revisiting its origins and role in the modern management of fertility. Fertil Steril 2023; 120:539-550. [PMID: 36870592 DOI: 10.1016/j.fertnstert.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
For years, reproductive surgery was the mainstay of reproductive care. With the evolution and ultimate success of in vitro fertilization (IVF), reproductive surgery became an adjuvant therapy, indicated mainly for severe symptoms or to enhance success rates with assisted reproductive technologies. As success rates for IVF have plateaued, and emerging data rekindles the enormous benefits of surgically correcting reproductive pathologies, there is renewed interest among reproductive surgeons in reviving research and surgical expertise in this area. In addition, new instrumentation and surgical techniques to preserve fertility have gained traction and will solidify the need to have skilled reproductive endocrinology and infertility surgeons in our practice.
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Affiliation(s)
- Pietro Bortoletto
- Boston IVF, Waltham, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | - John C Petrozza
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Decision of Reproductive Medicine & IVF, Massachusetts General Hospital, Boston, Massachusetts
| | - Samantha M Pfeifer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
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Suzuki Y, Huang Y, Ferris J, Kulkarni A, Hershman D, Wright JD. Prescription of hormone replacement therapy among cervical cancer patients with treatment-induced premature menopause. Int J Gynecol Cancer 2023; 33:26-34. [PMID: 36543392 DOI: 10.1136/ijgc-2022-003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the utilization of hormone replacement therapy (HRT) among newly diagnosed cervical cancer patients who experienced premature menopause due to primary treatment. METHODS The MarketScan Databases were used to identify newly diagnosed cervical cancer patients <50 years of age with premature menopause after hysterectomy with bilateral salpingo-oophorectomy (primary surgery) or primary external beam pelvic radiation (primary radiotherapy). We examined the cumulative utilization of HRT until 24 months after the loss of ovarian function. Fine-Gray subdistribution hazard models were developed to examine the factors associated with cumulative HRT use. The duration of HRT use was analyzed by Kaplan-Meier curves. RESULTS A total of 1826 patients, including 352 (19.3%) who underwent primary surgery and 1474 (80.7%) who received primary radiotherapy, were identified. Overall, 39.0% of patients received HRT within 24 months of primary treatment. HRT was used in 49.4% of those who underwent primary surgery and in 36.6% of those who received primary radiotherapy (p<0.0001). The median duration of HRT use was 60 days among the entire cohort and was significantly shorter for the primary radiotherapy group than the primary surgery group (35 vs 90 days, p<0.0001). Primary radiotherapy, older age, residency in the Northeastern USA, and Black race were associated with a lower likelihood of HRT use. CONCLUSIONS HRT was prescribed to less than half of patients with newly diagnosed cervical cancer under the age of 50 who experienced premature menopause due to primary treatment. Among those who used HRT the duration of use was short.
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Affiliation(s)
- Yukio Suzuki
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Yongmei Huang
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Jennifer Ferris
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Amita Kulkarni
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Dawn Hershman
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Jason D Wright
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
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Laios A, Otify M, Papadopoulou A, Gallos ID, Ind T. Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis. BMC Womens Health 2022; 22:305. [PMID: 35869476 PMCID: PMC9308360 DOI: 10.1186/s12905-022-01887-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice. Methods A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy. Results There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83–100), 89% (95% CI 80–99) of women who did not develop ovarian cysts, and 99% (95% CI 1–5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76–113), 84% (95% CI 69–103) of women who did not develop ovarian cysts, and 99% (95% CI 82–120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55–69), and 95% (95% CI 85–107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group. Conclusions In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
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Laios A, Duarte Portela S, Papadopoulou A, Gallos ID, Otify M, Ind T. Ovarian transposition and cervical cancer. Best Pract Res Clin Obstet Gynaecol 2021; 75:37-53. [PMID: 33715965 DOI: 10.1016/j.bpobgyn.2021.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
Cervical cancer is the fourth most common female malignancy worldwide. As the focus of treatment is shifting towards balancing oncological outcomes with reproductive benefit, women are becoming increasingly aware of their fertility options. Cervical cancer is one of the primary malignancies where transposition of the ovaries may be indicated. Ovarian transposition should be performed in pre-menopausal women, undergoing pelvic irradiation to preserve ovarian function and prevent early menopause. The review discusses the available literature and synthesises a concise summary for gynaecologic oncology surgeons to counsel affected women. The paradoxical controversy, leading to its under use is acknowledged, due to the scarcity of published data with regard to functional outcomes, and the lack of clinical trials. In cervical cancer, ovarian transposition remains a safe fertility preservation (FP) option, which is associated with high ovarian function preservation, an acceptable rate of ovarian cysts and a negligible risk for metastases in the transposed ovaries.
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Affiliation(s)
- Alexandros Laios
- Department of Gynaecologic Oncology, Leeds Teaching Hospitals NHS Trust, Beckett Street, Harehills, Leeds, LS97TF, UK.
| | - Sara Duarte Portela
- Department of Gynaecologic Oncology, Leeds Teaching Hospitals NHS Trust, Beckett Street, Harehills, Leeds, LS97TF, UK.
| | - Argyro Papadopoulou
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham Women's Foundation NHS Trust, Heritage Building, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Ioannis D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham Women's Foundation NHS Trust, Heritage Building, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Mohamed Otify
- Department of Gynaecologic Oncology, Leeds Teaching Hospitals NHS Trust, Beckett Street, Harehills, Leeds, LS97TF, UK.
| | - Thomas Ind
- Department of Gynaecologic Oncology, Royal Marsden Hospital, Fulham Road, SW36JJ, London, UK; St Georges's University of London, Blackshaw Road, SW170QT, London, UK.
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Haimeur Y, Canlorbe G, Gonthier C, Belghiti J, Uzan C, Azaïs H. [How I do… a laparoscopic lateral ovarian transposition with uterine fixation before pelvic radiation therapy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:204-207. [PMID: 32919089 DOI: 10.1016/j.gofs.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Y Haimeur
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France.
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Hussein RS, Khan Z, Zhao Y. Fertility Preservation in Women: Indications and Options for Therapy. Mayo Clin Proc 2020; 95:770-783. [PMID: 32247351 DOI: 10.1016/j.mayocp.2019.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 01/21/2023]
Abstract
Fertility preservation (FP) is a vital issue for individuals in either reproductive or prepubescent stage of life when future fertility may be compromised. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure maintaining or preserving reproductive health. Fertility potential can be affected by cancer therapy and numerous other factors, including advancing age, metabolic conditions, autoimmune diseases, specific surgical interventions, and sex affirmation procedures. A paradigm shift focusing on quality-of-life issues and long-term survivorship has emerged, especially because of advances in cancer diagnostics and treatment. Several FP techniques have been widely distributed, while others are still in the research stage. In addition, specific procedures and some potentially fertoprotective agents are being developed, aiming to minimize the hazards of gonadal damage caused by cancer therapy and decrease the need for more costly, invasive, and time-consuming FP methods. This review highlights the advances, indications, and options for FP, both experimental and well-established, in females of various age groups. An electronic search in PubMed, Embase, and Google Scholar databases was conducted, including retrospective studies, prospective clinical trials, meta-analyses, original reviews, and online abstracts published up to June 30, 2019. The search terms used included fertility preservation, oncofertility, embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. The meeting proceedings of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology were also hand searched.
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Affiliation(s)
- Reda S Hussein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Advances in fertility-preservation surgery: navigating new frontiers. Fertil Steril 2019; 112:438-445. [DOI: 10.1016/j.fertnstert.2019.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 11/21/2022]
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Khiat S, Bottin P, Saïas-Magnan J, Gasmi M, Orsoni P, Courbiere B. Fertility preservation strategies for rectal cancer in reproductive-age women. Future Oncol 2019; 15:2635-2643. [PMID: 31339047 DOI: 10.2217/fon-2019-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Despite rectal cancer being unusual before 40, fertility preservation (FP) remains a major concern for these reproductive-age women. Treatment usually involves pelvic radiotherapy, neoadjuvant chemotherapy, and surgery of rectum and mesorectum resection, at high risk of impairing fertility in women with risks of premature ovarian failure and radio-induced uterus damage. To date, there is no consensus on FP strategy for rectal cancer. We shared experiences between oncofertility experts from a French research network Groupe de Recherche et d'Etude en Cryoconservation Ovarienne et Testiculaire about a case of rectal cancer in a young woman. Indications, advantages and disadvantages of different FP strategies were discussed: ovarian transposition, cryopreservation of ovarian cortex and oocyte vitrification. This case was the starting point that led to the development of a French multidisciplinary e-meeting for sharing experiences and for suggesting the best strategy when faced with a complex oncofertility case.
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Affiliation(s)
- Samuel Khiat
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, AP-HM La Conception, 147 bd Baille, 13005 Marseille, France
| | - Pauline Bottin
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, AP-HM La Conception, 147 bd Baille, 13005 Marseille, France
| | - Jacqueline Saïas-Magnan
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, AP-HM La Conception, 147 bd Baille, 13005 Marseille, France
| | - Mohamed Gasmi
- Department of Gastroenterology, AP-HM, Aix Marseille Univ, Hôpital Nord, Marseille, France
| | - Pierre Orsoni
- Department of Digestive Surgery, AP-HM, Aix Marseille Univ, Hôpital Nord, Marseille, France
| | - Blandine Courbiere
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP-CECOS, Plateforme Cancer et Fertilité ONCOPACA-Corse, AP-HM La Conception, 147 bd Baille, 13005 Marseille, France.,Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 13397, Marseille, France
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