Fertility considerations in the management of gynecologic malignancies

Nicole Noyes, Jaime M. Knopman, Kara Long, Jaclyn M. Coletta, Nadeem R. Abu-Rustum

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)326-333
Number of pages8
JournalGynecologic Oncology
Volume120
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Fertility
Fertility Preservation
Neoplasms
Cryopreservation
Oocytes
Antineoplastic Protocols
Aptitude
Triage
Clinical Protocols
Germ Cells
Mental Competency
Therapeutics
Embryonic Structures
Quality of Life
Tissue Donors
Survival

Keywords

  • Cancer
  • Fertility preservation
  • Oocyte cryopreservation
  • Parenthood
  • Quality-of-life

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Noyes, N., Knopman, J. M., Long, K., Coletta, J. M., & Abu-Rustum, N. R. (2011). Fertility considerations in the management of gynecologic malignancies. Gynecologic Oncology, 120(3), 326-333. https://doi.org/10.1016/j.ygyno.2010.09.012

Fertility considerations in the management of gynecologic malignancies. / Noyes, Nicole; Knopman, Jaime M.; Long, Kara; Coletta, Jaclyn M.; Abu-Rustum, Nadeem R.

In: Gynecologic Oncology, Vol. 120, No. 3, 03.2011, p. 326-333.

Research output: Contribution to journalArticle

Noyes, N, Knopman, JM, Long, K, Coletta, JM & Abu-Rustum, NR 2011, 'Fertility considerations in the management of gynecologic malignancies', Gynecologic Oncology, vol. 120, no. 3, pp. 326-333. https://doi.org/10.1016/j.ygyno.2010.09.012
Noyes, Nicole ; Knopman, Jaime M. ; Long, Kara ; Coletta, Jaclyn M. ; Abu-Rustum, Nadeem R. / Fertility considerations in the management of gynecologic malignancies. In: Gynecologic Oncology. 2011 ; Vol. 120, No. 3. pp. 326-333.
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