Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Urologia. 2022 Aug;89(3):444-450. doi: 10.1177/03915603211036426. Epub 2021 Aug 2.
The link between female infertility and gynecological cancer has always been a debated and challenging topic. Although cervical cancer has the worst impact on female fertility, as it is usually diagnosed in patients of reproductive age, endometrial and ovarian cancer are also diagnosed and treated often in relatively younger patients in which fertility preservation is a relevant issue. The aim of this review is to highlight the correlation between therapy for female infertility and the developing cancer's risk and to describe the fertility sparing treatments in gynecological oncology.
A systematic review of the literature through the main scientific search engines (PubMed and Google Scholar) was performed. We selected the most relevant articles based on the largest case series and the latest updates. All selected documents have been listed in the references.
Fifty-six relevant articles published between 1996 and 2019 were identified.Results from the available evidence report no significant increased risk of endometrial, cervical, and ovarian cancer in patients having infertility treatments.In young patients diagnosed with gynecological cancer, preservation of fertility is a personalized choice depending on several factors (type, stage, age and desire to conceive, safety of the treatment, and feasibility of fertility sparing surgery). For ovarian cancer FIGO stage IA G1, IA G2 (grade), and IC G1; for endometrial adenocarcinoma grade 1 with no lymphovascular space invasion (LVSI) or myometrial invasion and for early-stage cervical cancer (FIGO stage 2018: IA1-IB1), fertility sparing treatment is possible. The role of fertility sparing treatment with the increase of personalization of therapies therapy is always a theme of discussion and research.
At present data regarding the risk of gynecological cancers after infertility treatments are reassuring. Careful evaluation of female fertility-sparing options in young women interested by ovarian, endometrial, or cervical tumors should be carried out involving a multidisciplinary team and ensuring safety and efficacy.
女性不孕与妇科癌症之间的关联一直是一个备受争议和具有挑战性的话题。尽管宫颈癌对女性生育能力的影响最为严重，因为它通常在生育年龄的患者中诊断，但子宫内膜癌和卵巢癌也经常在相对年轻的患者中诊断和治疗，在这些患者中，保留生育能力是一个相关问题。本综述的目的是强调女性不孕治疗与发展中癌症风险之间的相关性，并描述妇科肿瘤学中的生育保留治疗。
通过主要的科学搜索引擎（PubMed 和 Google Scholar）进行了文献的系统回顾。我们根据最大的病例系列和最新的更新选择了最相关的文章。所有选定的文献都列在参考文献中。
共确定了 1996 年至 2019 年期间发表的 56 篇相关文章。现有证据表明，接受不孕治疗的患者患子宫内膜癌、宫颈癌和卵巢癌的风险没有显著增加。在被诊断患有妇科癌症的年轻患者中，保留生育能力是一个个性化的选择，取决于多个因素（类型、分期、年龄和受孕愿望、治疗的安全性以及生育保留手术的可行性）。对于卵巢癌FIGO 分期 IA G1、IA G2（分级）和 IC G1；对于无淋巴血管间隙浸润（LVSI）或肌层浸润的子宫内膜腺癌 1 级和早期宫颈癌（FIGO 2018 分期：IA1-IB1），可以进行生育保留治疗。随着治疗个性化的增加，生育保留治疗的作用始终是讨论和研究的主题。
目前，关于不孕治疗后妇科癌症风险的数据令人安心。在对有卵巢、子宫内膜或宫颈癌兴趣的年轻女性进行生育保留选择的评估时，应涉及多学科团队，并确保安全性和疗效。
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