Division of Reproductive Endocrinology, New York University School of Medicine, New York, NY 10016, USA.
Gynecol Oncol. 2011 Mar;120(3):326-33. doi: 10.1016/j.ygyno.2010.09.012. Epub 2010 Oct 13.
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.
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.
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.
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.
妇科癌症是女性恶性肿瘤的重要组成部分。历史上，癌症的治疗主要侧重于消除疾病，而不考虑对生育能力的影响。早期检测方案和先进的治疗方案的实施，改善了妇科癌症患者的预后。随着这种改善，人们现在更加关注生活质量问题。生育力保存（FP）已成为妇科癌症管理选择和实施的一个组成部分。在本报告中，我们讨论了与未来生育潜力相关的妇科恶性肿瘤。
我们回顾了生殖原则，如卵巢储备、子宫功能、宫颈功能和早期产科管理，以及可用的 FP 方法。此外，我们还讨论了癌症及其治疗方法对女性生殖系统可能造成的潜在损害。我们提出了关于评估 FP 可行性的基线筛查测试的一般建议。最后，提出了特定于癌症的 FP 方法。
卵子数量和质量随着年龄的增长而自然下降。在大多数患者中，在 35 岁以后，下降的斜率显著加剧。存在可靠的卵巢储备测量方法，应利用这些方法来评估和筛选潜在的 FP 候选者。FP 的进步，特别是卵母细胞冷冻保存（OC），提高了与癌症患者可用技术相关的成功率。目前，OC 在成功应用的情况下，似乎是诊断为妇科恶性肿瘤的单身女性的首选方法，因为它提供了生殖自主权，而使用供体配子进行胚胎冷冻保存仍然是一种替代方法。
在妇科肿瘤学中，为了实现癌症生存而进行的有效治疗可能会损害随后怀孕和/或生育孩子的能力。因此，随着肿瘤生育力领域的不断扩展，在制定癌症治疗方案时，应就 FP 进行讨论。
