Tulandi._subbed.qxp 21/4/09 05:17 Page 39
Fertility Preservation in Women with Gynaecological Cancer
The Role of the Reproductive Centre in pregnancies and live births following ovarian transplantation of
Preserving Fertility in Women with frozen-thawed ovarian tissue.
110, 111
Gynaecological Cancer
Besides modification in the surgical treatment, reproductive centres Ovarian Transposition
are now offering fertility preservation for young women undergoing In women undergoing pelvic radiation, one can offer ovarian
cancer treatment.
103
In fact, the American Society for Clinical suspension or transposition. This procedure can be performed by
Oncology (ASCO) recommends referral of all cancer patients with an laparoscopy. The ovaries are re-located at least 3cm from the upper
interest in future conception for fertility preservation.
104
margin of the radiation field. In our practice, we do not separate the
fallopian tubes from the uterus to allow the possibility of
Cryopreservation of Ovarian spontaneous conception at the same setting; we also perform
Tissue, Oocytes or Embryos ovarian wedge resection for cryopreservation.
112
In women less
Cryopreservation of ovarian tissue or oocytes is an option for than 40 years of age, ovarian transposition is associated with
women without partners who do not opt to use donor oocytes. One preservation of ovarian function in 88.6% of cases.
113
can freeze the oocytes at the mature or immature stages. A
promising alternative for fertility preservation is collection of Conclusion
immature oocytes followed by in vitro maturation (IVM) and Removal of the reproductive organs has been the treatment of
vitrification of the in vitro matured oocytes.
105–108
In any event, the choice for most gynaecological cancers. However, today one can
best established method for fertility preservation is in vitro offer conservative surgery to selected young women who wish to
fertilisation (IVF) followed by embryo cryopreservation.
109
preserve their fertility. It is a challenging decision to proceed with a
fertility- preserving surgery. One should first evaluate the type and
Ovarian Tissue Cryopreservation stage of the disease, the survival rate, quality of life and the
Compared with oocyte or embryo cryopreservation, ovarian tissue psychological impact of the treatment. A multidisciplinary team
cryopreservation has some advantages. These include the consisting of an infertility specialist, an oncologist and a psychologist
availability of thousands of oocytes in the ovarian cortex, and one must take part in the decision-making.
can excise the ovary at the time of cancer surgery. However, it
needs a surgical procedure for excision and another to transplant Patients should be advised that the fertility-preserving procedure
the frozen-thawed ovarian tissue. Furthermore, the transplant may not be the standard treatment for their cancer. Treatment should
recipients should undergo ovarian stimulation with gonadotropin to be individualised. Following treatment, patients should be followed
produce mature oocytes.
105
To date, there have been only a few up and carefully monitored. ■
1. Covens A, et al., Gynecologic Oncology, 2001;81:133–7. 37. Niwa K, et al., BJOG, 2005;112:317–20. 76. Gershenson DM, J Clin Oncol, 1988;6:270.
2. Averette H, et al., Cancer, 1993;71:1422–37. 38. Wang CB, et al., Cancer, 2002;94:2192–8. 77. Pui CH, et al., N Engl J Med, 1991; 325(24):1682–7.
3. Delgado G, et al., Gynecol Oncol, 1990;38: 352–7. 39. Imai M, et al., Eur J Gynaecol Oncol, 2001; 22:217–20. 78. Nishio S, et al., J Obstet Gynaecol Res, 2006;32:416–21.
4. Landoni F, et al., Lancet, 1997;350:535–40. 40. Randall TC, et al., Gynaecol Obstet 1997;90:434–40. 79. Tangir J, et al., Obstet Gynecol, 2003;101:251–7.
5. Lertsanguansinchai P, et al., Int J Radiat Oncol Biol Phys, 41. Kim YB, et al., Cancer, 1997; 79:320–27. 80. Gershenson DM, et al., Proc ASCO 2002;21(373a):1491.
2004;59:1424–31. 42. Duska LR, et al., Cancer 1999;85:2623-9. 81. Zanetta G, et al., J Clin Oncol, 2001; 19:1015.
6. Morris M, et al., Gynecol Oncol, 1993;51:193–6. 43. Heintz APM, et al., Int J Gynaecol Obstet, 2003;83:135–66. 82. Low JJH, et al., Cancer, 2000;89:391–8.
7. Schorge JO, Gynecol Oncol, 2000;78:217–20. 44. Eisenkop SM, et al., Gynecol Oncol, 1998; 69:103–8. 83. Kanazawa K, et al., Am J Clin Oncol, 2000;23:244.
8. Ostor AG, et al., Int J Gynecol Cancer, 1994;4:257–64. 45. Ahmed FY, et al., J Clin Oncol, 1996;14:2968. 84. Cronje HS, et al., Am J Obstet Gynecol, 1999;180:323.
9. Gadducci A, et al., Eur J Gynaecol Oncol, 2003;24:513–16. 46. Allen DG, et al., Eur J Gynaecol Oncol, 1995;16:349–56. 85. Lack EE, et al., Cancer, 1981;48:1846–54.
10. Kyrgiou M, et al., Lancet, 2006;367:489–98. 47. Trimbos JB, et al., Curr Opin Obstet Gynecol, 2004;16:43. 86. Bognoni V, et al., Minerva Ginecol, 1997;49:283–7.
11. Dargent D, et al., JOBGYN, 1994;2:285–92. 48. Young RC, et al., N Engl J Med, 1990;322(15):1021–7. 87. Sasano H, et al., Pathol Int, 1997;47:325–8.
12. Plante M, et al., Oncology (Williston Park), 2006;20:479–88. 49. Pecorelli S, et al., J Epidemiol Biostat, 1998;3:75–102. 88. Calaminus G, et al., Gynecol Oncol, 1997;65:447–52.
13. Hertel H, et al., Gynecol Oncol, 2006;103: 506–11. 50. Sonoda Y, Oncology (Williston Park), 2004;18:343–56. 89. Schneider DT, et al., Klin Padiatr, 2002;214:173–8.
14. Shepherd JH, Best Pract Res Clin Obstet Gynaecol, 2005;19: 51. Thigpen JT, Semin Oncol, 1999;26:29–33. 90. Young RH, et al., Am J Surg Pathol, 1984;8:575–96.
577–90. 52. Brown CL, et al., Gynecol Oncol, 1998;76:240. 91. Evans AT, et al., Obstet Gynecol,1980;55:231–8.
15. Mathevet P, et al., Gynecol Obstet Fertil, 2003;31:706–12. 53. Colombo N, et al., Int J Gynecol Cancer, 2005;15:206. 92. Powell JL, et al., Gynecol Oncol, 2001;81:113–16.
16. Beiner ME, et al., Nat Clin Pract Oncol, 2007;4:353–61. 54. Schilder JM, et al., Obstet Gynecol Surv, 2003;58:254. 93. DiSaia, PJ, et al. In: Clinical Gynecologic Oncology,
17. Burnett AF, et al., Gynecol Oncol, 2003;88:419–23. 55. Morice P, et al., Cancer, 2001; 92:2412–18. Mosby-Yearbook, 1997;351.
18. Schlaerth JB, et al., Am J Obstet Gynecol, 2003;188:29. 56. Raspagliesi F, J Am Coll Surg, 1997;185:457–60. 94. Zhang M, et al., Obstet Gynecol Surv, 2007;62:381.
19. Bernardini M, et al., Am J Obstet Gynecol, 2003;189:1378. 57. Zanetta G, et al., BJOG, 1997;104:1030–35. 95. Klier E, Zentralbl Gynakol, 1980;102:628–30.
20. Plante M, et al., Gynecol Oncol, 2005;99:143–6. 58. Tinelli R, et al., Gynecol Oncol, 2006;100:185–91. 96. Malaga CYR, et al., Ginecol Obstet Mex, 2004;72:247–50.
21. Jolley J, et al., Am J Perinatol, 2007;24:531. 59. Trimble CL, et al., Gynecol Oncol, 2002;86:34–7. 97. Messerli ML, et al., Am J Obstet Gynecol, 1985;153:294–300.
22. Hua LIU, et al.,Aust N Z J Obstet Gynaecol, 2008;48:517–8. 60. Morice P, et al., Fertil Steril, 2001;75:92–6. 98. Berkowitz RS, et al., Semin Oncol, 2000;27:678–85.
23. Plante M, et al., Gynecol Oncol, 2006;101:367–70. 61. Nayar R, et al., Hum Pathol, 1996;27:521–7. 99. Hammond CB, et al., Am J Obstet Gynecol, 1980;136:844–58.
24. Gallup DG, et al., Obstet Gynecol, 1984;64:417–20. 62. Suh-Burgmann E, Gynecol Oncol, 2006;103:841–7. 100. Rustin GJ, et al., Br Med J (Clin Res Ed), 1984;288:103.
25. Crissman JD, et al., Obstet Gynecol, 1981;57:699–704. 63. Swanton A, et al., Eur J Obstet Gynecol, 2007;135:3–7. 101. Blagden SP, et al., Br J Cancer, 2002;86:26–30.
26. Creasman WT, et al.,et al., Int J Gynaecol Obstet, 64. Fauvet R, et al., Fertil Steril, 2005;83:284–90. 102. Song HZ, et al., Am J Obstet Gynecol, 1988;158:538–45.
2003;83:79–118. 65. Boran N, et al., Gynecol Oncol, 2005;97:845–51. 103. Tulandi T, et al., Obstet Gynecol, 2008;112:1160.
27. Walsh C, et al., Obstet Gynecol, 2005;106:693–9. 66. Donnez J, Munschke A, et al., Fertil Steril, 2003;79:1216–21. 104. Lee SJ, et al., J Clin Oncol, 2006;24:2917.
28. Kaku T, et al., Cancer Lett, 2001;167:39–48. 67. Camatte S, et al., BJOG, 2002;109:376–80. 105. Oktay K, et al., N Engl J Med, 2000;342(25):1919.
29. Lowe MP, et al., Gynecol Oncol, 2003; 91:569–72. 68. Zanetta G, et al., J Clin Oncol, 2001;19:2658. 106. Sylvestre C, et al., Hum Reprod, 2005;20:i134.
30. Montz FJ, et al., Am J Obstet Gynecol, 2002;186:651. 69. Morris RT, et al., Obstet Gynecol, 2000;95:541–7. 107. Tucker M, et al., Hum Reprod, 1996;11:1513–15.
31. Kinkel K, et al., Radiology.; 1999;212(3):711–18. 70. Gotlieb WH, et al., Cancer, 1998;82:141–6. 108. Wu J, et al., Reproduction, 2001;121:389–93.
32. Macdonald RR, et al., Br J Obstet Gynaecol, 1988;95:166–74. 71. Zalel Y, et al., Int J Gynaecol Obstet, 1996; 55:1–10. 109. Huang JYJ, et al., Fertil Steril, 2008;89:567–72.
33. Ota T, et al., Int J Gynecol Cancer, 2005;15:657. 72. Gershenson DM, et al., Obstet Gynecol, 1987;70:765–9. 110. Kosasa TS, et al., Am J Obstet Gynecol, 2005;192:2035.
34. Gotlieb WH, et al., Gynaecol Obstet, 2003;102:718–25. 73. Taylir MH, et al., Cancer, 1985;56:1341. 111. Veeck LL, et al., Fertil Steril, 2004;82:1418–27.
35. Ushijima K, et al., J Clin Oncol, 2007;25:2798. 74. Williams S, et al., J Clin Oncol, 1994;12:701. 112. Tulandi T, et al., Fertil Steril, 1998;70:381–3.
36. Maltaris T, et al., Gynecol Oncol, 2006;103:1109–21. 75. Rogers PC, et al., J Clin Oncol, 2004; 22:3563. 113. Bisharah M, et al., Am J Obstet Gynecol, 2003;188:367.
EUROPEAN OBSTETRICS & GYNAECOLOGY 39
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84