Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

Objective: Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged < 50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers. Tabulation, Integration, and Results: For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research. Conclusion: Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches. (C) 2021 AAGL. All rights reserved.

Automated summary

Fertility-sparing treatment is a viable option for women with gynecologic cancers, with different surgical and non-surgical approaches available depending on the type and stage of the cancer. Strategies such as progestin therapy, ovarian preservation, and assisted reproductive technology can help preserve fertility while ensuring effective cancer treatment. Ongoing research into methods such as oocyte or embryo cryopreservation provides promising possibilities for the future of fertility preservation in gynecologic oncology.