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Fertility considerations prior to conservative management of gynecologic cancers
  1. Katherine Stewart1,
  2. Sukhkamal Campbell2,
  3. Michael Frumovitz1,
  4. Pedro T Ramirez1 and
  5. Laurie J McKenzie1,2
  1. 1 Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Laurie J McKenzie, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; ljmckenzie{at}mdanderson.org

Abstract

Fertility-sparing management of early-stage gynecologic cancers is becoming more prevalent as increasing evidence demonstrates acceptable oncologic and reproductive outcomes in appropriately selected patients. However, in the absence of randomized controlled trials, most of the commonly used treatment algorithms are based only on observational studies. As women are increasingly postponing childbearing, the need for evidence-based guidance on the optimal selection of appropriate candidates for fertility-sparing therapies is paramount. It is imperative to seriously consider the fertility potential of a given individual prior to making major oncologic treatment decisions that may deviate from the accepted standard of care. It is a disservice to patients to undergo a fertility-sparing procedure in hopes of ultimately achieving a live birth, only to determine later they have poor baseline fertility potential or other substantial barriers to conception including excess financial toxicity. Many women with oncologic diagnoses are of advanced maternal age and their obstetric and neonatal risks must be considered. In the era of advanced assisted reproductive technologies, patients should be provided realistic expectations regarding success rates while understanding the potential oncologic perils. A multidisciplinary approach to the conservative treatment of early-stage gynecologic cancers with early referral to reproductive specialists as well as maternal-fetal medicine specialists is warranted. In this review, we discuss the recommended fertility evaluation for patients with newly diagnosed, early-stage gynecologic cancers who are considering fertility-sparing management.

  • cervical cancer
  • endometrial neoplasms
  • ovarian cancer

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Footnotes

  • Twitter @frumovitz, @pedroramirezMD

  • Contributors All authors contributed to the planning, development, and approval of the final manuscript.

  • Funding MF reports research support from AstraZeneca and consultant/speaker fees from Stryker.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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