Desire Fertility Preservation Research Articles

Fertility-sparing surgical interventions for low-risk, non-metastatic gestational trophoblastic neoplasia.

The primary treatment approach for addressing low-risk nonmetastatic gestational trophoblastic neoplasia (LR-NMGTN) in women desiring fertility preservation involves chemotherapy. An alternative option for treatment is fertility-sparing surgical interventions, either alone or in combination with adjuvant chemotherapy. The hypothesised advantages of choosing fertility-sparing surgery in cases of LR-NMGTN include potential avoidance of adverse effects associated with chemotherapy, potential reduction in the number of chemotherapy cycles required to achieve complete remission, and potential reduction in time to remission. To measure the benefits and harms of fertility-sparing surgical interventions, with or without adjuvant chemotherapy, compared to primary chemotherapy alone, for the treatment of women with low-risk, non-metastatic gestational trophoblastic neoplasia (LR-NMGTN). We searched CENTRAL, MEDLINE, Embase, Web of Science, ClinicalTrials.gov and WHO ICTRP on 31 January 2024. We also searched abstracts of scientific meetings and reference lists of included studies. We included all randomised controlled trials (RCTs) comparing fertility-sparing surgical interventions, with or without subsequent adjuvant chemotherapy, versus primary chemotherapy as standard care for the treatment of women with LR-NMGTN. We employed standard Cochrane methodological procedures. We used the GRADE approach to assess the certainty of evidence for each outcome, if available. We focused on the following outcomes: treatment success rate, relapse, disease-specific mortality, death due to treatment, pregnancy rate, quality of life, and any adverse events. We included two RCTs, with a total of 151 participants contributing data to our analyses. Both studies used uterine curettage as the fertility-sparing surgical intervention. Fertility-sparing surgical intervention without subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 62 participants with varying hCG (human chorionic gonadotrophin) levels evaluated this comparison. Most of our outcomes of interest were not measured in this study. The relative risk of experiencing any adverse event could not be estimated as chemotherapy adverse effects were not reported. The study reported that there were no surgical complications. Chemotherapy was administered to 50% of participants in the intervention group after curettage because their hCG levels increased. Fertility-sparing surgical intervention with subsequent adjuvant chemotherapy versus primary chemotherapy alone One RCT involving 89 participants with hCG levels < 5000 IU/L evaluated this comparison. We judged the risk of bias in the study to be high. The evidence was very uncertain about the effect of uterine curettage with subsequent adjuvant chemotherapy on treatment success rate (RR 1.03, 95% CI 0.86 to1.23; 86 participants), relapse (RR 0.5, 95% CI 0.05 to 5.31; 86 participants), pregnancy rate (RR 0.86, 95% CI 0.31 to 2.34; 86 participants), and rate of adverse events (RR 1.15, 95% CI 0.63 to 2.13; 86 participants), all very low certainty evidence. The relative risks of disease-specific mortality and death due to treatment could not be estimated as there were no deaths in either group. There were no results for quality of life as this outcome was not reported. Uterine curettage is the only fertility-sparing surgical intervention for LR-NMGTN that has been evaluated in a randomised controlled trial. The evidence is very uncertain about the benefits and harms of uterine curettage, with or without subsequent adjuvant chemotherapy, compared to primary chemotherapy alone. The two available studies are small with a high risk of bias, and future research may find substantially different results for all reported outcomes. Larger RCTs, with appropriate clinical outcome measures, would be required to determine the benefits or harms of fertility-sparing surgical interventions for this population.

The intrauterine device: how to deploy this strategy in the molecular world?

Progestin-based therapy can safely be offered to a subset of patients with atypical endometrial hyperplasia or Grade 1 endometrioid endometrial cancer who desire fertility preservation. A recent study shows that levonorgestrel intrauterine device confers durable clinical benefit and identifies possible immune mechanisms of relapse and resistance.

Acquired uterine arteriovenous malformation after cesarean section

HIGHLIGHTS 1. Acquired uterine arteriovenous malformation (AVM) is an uncommon sequela of cesarean section, warranting consideration in instances of persistent uterine bleeding in the puerperium.2. Embolization represents a viable and well-established treatment modality for AVM, providing a safe and efficacious intervention that serves as an alternative, less invasive modality for patients desiring fertility preservation. ABSTRACT Objectives: To demonstrate that embolization is a viable and well-established treatment for acquired arteriovenous malformations (AVMs), offering a safe and effective, less invasive option for patients seeking to preserve fertility.Case Report: A 20-year-old female experiencing recurrent massive bleeding with a history of previous caesarean section and wound infection resuturing. The transvaginal color Doppler ultrasound showed a hypervascularity in the uterus around the surgical lesion, suggesting a uterine AVM and its confirmed by angiography. The patient underwent a series of uterine artery embolization interventions, which proved to be a successful therapeutic approach. As a result of this treatment modality, not only was the patient's condition effectively resolved, but her fertility was also preserved.Conclusion: Acquired uterine arteriovenous malformation (AVM) is an uncommon sequela of cesarean section, warranting consideration in instances of persistent uterine bleeding in the puerperium. Embolization represents a viable and well-established treatment modality for AVM, providing a safe and efficacious intervention that serves as an alternative, less invasive modality for patients desiring fertility preservation.

Investigations of the quality of fertility preservation education provided to patients with cancer at a large community hospital.

e23087 Background: Infertility is a challenge many young cancer patients face as a consequence of aggressive treatments. Moreover, many eligible patients do not receive discussion about their fertility, and even fewer obtain referrals to fertility specialists. The goal of the investigation was to examine the frequency and quality of fertility preservation education provided to eligible patients at the Windsor Regional Cancer Program (WRCP). Methods: The first part of the investigation involved a retrospective chart review which identified 203 patients that presented to the WRCP between January 15, 2018 to January 15, 2020 under the age of 40. Amongst these patients, we identified 54 patients that were eligible for fertility preservation. These 54 patients were contacted to participate in the survey and we received 11 responses. The survey data collected include demographics and experience with fertility preservation. The data were analyzed using University of Windsor RedCap. Windsor Regional Hospital REB approval number: 22-426. Results: The retrospective chart review revealed that 34% of the 54 eligible patients did not receive documented fertility preservation counseling. Amongst the survey respondents that had fertility preservation discussions, 86% (6 patients) cited that it was initiated by a healthcare provider. In addition, we found that only 27% (3 patients) of survey respondents were interested in pursuing fertility preservation. The reasoning cited most often included not wanting children, already had children, and barriers such as finances, time and effort to pursue fertility preservation and fear of delaying fertility preservation. Moreover, the 3 survey respondents successfully pursued fertility preservation in the form of sperm collection (2 patients) and freezing eggs/embryos (1 patient). Conclusions: We identified the need to improve standardization of fertility preservation education in eligible patients. Moreover, we found that few patients desired fertility preservation. Although this is a small number of patients, providing appropriate fertility education is essential in cancer survivorship. Our next steps include piloting and implementing an improved fertility education program.

Changing the Perspective on Fertility Preservation for Women with Metastatic or Advanced Stage Cancer.

In this Perspective we share the personal story of a 33-year-old patient diagnosed with metastatic breast cancer and her journey through fertility preservation, surrogacy, and eventually motherhood, highlighting misconceptions about fertility preservation in this population. There are nearly 1 million women under the age of 50 diagnosed and living with cancer in the USA. These patients are met with life-altering decisions, including those that may limit their reproductive ability. While there have been tremendous advances and advocacy in the field of oncofertility, there has been limited focus on patients with advanced stage or metastatic cancer. We describe five key misconceptions surrounding fertility preservation in patients with advanced stage cancer, offering a review of the literature and our approach to challenging topics like desiring fertility preservation in the face of Stage 4 disease, the safety and timing of ovarian stimulation during cancer treatment, and passing away following fertility preservation. We review the importance of assessing perceptions of fertility preservation in patients with metastatic cancer and highlight the lack of research in this area as a call to action.

Robotic-assisted uterine transposition followed by anatomic pelvic repositioning for a patient with intramural fibroids and rectal cancer

To report the first described case of robotic-assisted utero-ovarian transposition followed by anatomic repositioning in the pelvis and cervicovaginal anastomosis in a woman with uterine fibroids, which was performed for fertility preservation in the context of pelvic radiation for rectal cancer. Description of technique and live-action narrated surgical footage showing uterine transposition and repositioning. University hospital. A 36-year-old woman with a new diagnosis of cT3N2M0 rectal adenocarcinoma planned for neoadjuvant chemotherapy and pelvic radiation and desired fertility preservation permissive of future pregnancy. A transvaginal ultrasound revealed a 5-cm posterior leiomyoma and a normal endometrial cavity. The patient elected for utero-ovarian transposition before chemoradiation. The patient included in this video gave consent for publication and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. Per institutional guidelines, an Institutional Review Board review was not required. Robotic-assisted utero-ovarian transposition was performed in an inpatient setting 2 weeks after ovarian stimulation and oocyte retrieval. She was given a gonadotropin-releasing hormone agonist for menstrual suppression after oocyte retrieval. The uterus and adnexa were transposed en bloc to the upper abdomen, with perfusion via retroflected infundibulopelvic ligaments. Intravenous indocyanine green was administered intraoperatively to visualize uterine perfusion. Three weeks postoperatively, the patient underwent surgical management of small bowel obstruction, which was successfully managed with laparoscopic adhesiolysis. The patient subsequently completed chemoradiation and had a complete response to the rectal tumor. She therefore elected for surveillance. Seven months after transposition and 2 months after completion of treatment, the patient underwent uncomplicated robotic-assisted utero-ovarian anatomic repositioning in the pelvis with cervicovaginal anastomosis. Chromopertubation confirmed tubal patency. Restoration of normal pelvic anatomy and resumption of reproductive physiology. At her 4-month postoperative visit, the cervix and vagina were normal in appearance. The patient reported the return of spontaneous menses and sexual activity without complications. This case is unique because of the presence of bulky intramural uterine fibroids. The described technique may be useful for selected cancer patients who desire to carry a pregnancy after pelvic radiation for cancer treatment, and demonstrates that patients considering utero-ovarian transposition need not be excluded solely on the basis of the presence of uterine fibroids.

First pregnancy and live birth from ex vivo-retrieved metaphase II oocytes from a woman with bilateral ovarian carcinoma: a case report

ObjectiveTo report pregnancy and live birth resulting from intracytoplasmic sperm injection of ex vivo retrieved mature oocytes from a woman with bilateral ovarian carcinoma. DesignCase report. Subject(s)A 34-year-old nulliparous woman with bilateral ovarian tumor, with a risk of malignancy at 96.1% according to IOTA-ADNEX, who desired fertility preservation before definitive surgical treatment. Intervention(s)Cryopreservation of ex vivo retrieved mature (MII) oocytes followed by fertilization with donor sperm, and embryo transfer to a gestational carrier. Main outcome measure(s)Fertility preservation. ResultsAfter controlled ovarian stimulation, 12 MII oocytes were retrieved from oophorectomized specimens, and vitrified. ICSI with donor sperm was performed in remission, resulting in 9 cleavage-stage embryos, two of which were transferred to a gestational carrier, resulting in a normal healthy singleton pregnancy, and the live birth of a healthy baby. Conclusion(s): Ex vivo oocyte retrieval after oophorectomy may be a safe alternative to standard oocyte retrieval for fertility preservation in women with ovarian malignancies.

Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review.

Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.

Oocytes on ice: Exploring the advancements in elective egg freezing for women.

Female fecundity decreases significantly after the age of 32, and rapidly so after age 37. There is no treatment to prevent this decline. Furthermore, globally, women are getting married later and the age at which they have their first child is increasing. As of July 2023, elective egg freezing (EEF) or oocyte cryopreservation (OC) for age-related fertility decline, commenced in Singapore. With medical advancements in OC, EEF is no longer considered experimental. The aim of this review is to examine the existing literature around EEF with regard to reproductive outcomes and its safety, to better guide clinicians in counselling young single women. Published studies were examined to increase understanding on optimal age for EEF, ideal number of oocytes for a live birth, recommended OC protocols, cryopreservation techniques affecting thaw survival or fertilisation, oocyte storage and pregnancy risks. Models predict that EEF should be performed at age <37 years and to achieve a 70% chance of live birth, women would need 14, 15 and 26 mature oocytes at ages 30-34, 35-37 and >38 years, respec-tively. An antagonist stimulation protocol with an agonist trigger would minimise ovarian hyper-stimulation syndrome and duration of stimulation without affecting outcomes. Oocyte vitrification in comparison to slow freezing increases thaw survival, fertilisation and clinical pregnancy rates. No increased risks exist for the woman, future pregnancy or child when compared with conventional IVF. EEF is a viable option for single women desiring fertility preservation. Financial costs are significant, but returns are worthwhile if oocytes are utilised.

Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

Adenomyosis is a common gynecological problem characterized by the growth of endometrial glands and stroma within the myometrium. Previously, the definitive diagnosis of adenomyosis was made through histopathology after a hysterectomy. However, in the last two decades, several uterine-sparing treatment options have emerged, including High-Intensity Focused Ultrasound (HIFU), which has become a promising option. HIFU is a non-invasive local thermal ablation technique that can be performed via ultrasound or MRI guidance. Additionally, “Laparoscopic uterine artery occlusion with uterus sparing pelvic plexus block and partial adenectomy for adenomyosis” has become a popular option. While conventional adenomyomectomy carries a high risk of recurrence and uterine rupture, some novel surgical techniques have been described to mitigate these complications and preserve future fertility. There are also “new surgical techniques of laparoscopic resection of adenomyoma under real-time intraoperative ultrasound elastography guidance”. Diagnostic imaging techniques such as transvaginal ultrasound, MRI, and hysteroscopic evaluation have revolutionized the diagnosis of adenomyosis and opened up possibilities for conservative treatment options. Hysteroscopy can be used for direct visualization and biopsy collection, though it is not the first-line treatment option. With the increasing incidence of adenomyosis and the desire for fertility preservation among younger patients, there is a growing need for effective uterine-sparing treatments. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 55-58

The role of the junctional zone in the management of adenomyosis with infertility.

The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as "adenomyosis", "junctional zone", and "infertility" to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.

Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study.

Our study aimed to analyze the prognosis and reproductive outcomes of patients with advanced-stage serous borderline ovarian tumors (SBOTs) who underwent fertility-sparing surgery (FSS). This study included patients aged ≤ 45 years diagnosed with advanced-stage (International Federation of Gynecology and Obstetrics II and III) SBOTs who were treated with FSS. Conservative surgeries were performed in 65 patients with advanced-stage SBOT with a median age of 28 years (range, 16-44 years). Nine patients had invasive implants. The median follow-up was 81.7 months. Forty-six patients (70.8%) had a relapse (median time to first recurrence, 22.8 months). Thirteen patients subsequently developed recurrence as an invasive disease, and two died due to disease progression. After multivariate analysis, age < 30 years and incomplete cytoreduction were independent risk factors for recurrence. Invasive implants and postoperative residual tumors were significantly associated with shorter disease-free survival. Of 35 patients attempting to conceive, 12 underwent assisted reproductive technology. Additionally, 19 pregnancies, including 15 full-term births, were documented. FSS provides a good chance of reproductive success in women with advanced-stage SBOT who desire fertility preservation, but it has a high recurrence rate and risk of malignancy transformation. Patients with invasive implants should be strictly selected for FSS.

Psychometric properties of the Korean version of the oncofertility barriers scales among nurses: A methodological study

ObjectiveThis study aimed to examine the psychometric properties of the Korean version of the Oncofertility Barrier Scale (K-OBS). MethodsThis methodological study investigated the validity and reliability of the K-OBS for measuring barriers to oncofertility care among nurses. A total of 270 nurses who had experience in rendering nursing care to cancer survivors were recruited, and the instrument was translated, assessed for content validity, and tested using a preliminary survey. Construct validity was established through explanatory factor analysis. Convergent validity and discriminant validity were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was assessed using Cronbach's alpha and McDonald's omega. ResultsThe K-OBS demonstrated satisfactory validity and reliability, with seven factors, including 27 items explaining 60.42% of the total variance, a Cronbach's alpha of 0.86, and a McDonald's omega of 0.83. The seven factors were labeled, “Lack of information and education” (8 items), “Rigid thinking toward oncofertility care” (5 items), “Cancer patient stereotypes” (4 items), “Insufficient support” (4 items), “Desire for fertility preservation” (2 items), “Interrupted oncofertility care” (2 items), and “Fertility risk” (2 items). ConclusionsThe results of this study indicate that the K-OBS may be a suitable instrument with acceptable validity and reliability for evaluating barriers to oncofertility among Korean nurses. This instrument can be used to identify obstacles that make oncofertility care difficult, thereby contributing to new insights for improving the future quality of oncofertility care in Korea.

P-401 Is cancer type associated with semen quality and infertility among men who desire fertility preservation?

Abstract Study question To investigate the association between cancer-types and semen-parameters before gonadotoxic-treatments, and to evaluate which patients have the highest risk of diminished spermatogenesis prior to therapy. Summary answer sperm quality among cancer patients before gonadotoxic treatment can differ according to the type of cancer. What is known already Many studies have reported impaired sperm quality at cancer diagnosis before any given gonadotoxic regiments. Except for testicular cancer and Hodgkin’s Lymphoma, baseline data on semen quality in case of different types of malignancies among male cancer patients are limited or based on low sample size Study design, size, duration A retrospective population-based cohort analysis was performed, 237 oncological male patients who were referred for fertility preservation between 1995-2020 within 90 days of cancer diagnosis and prior to cancer treatment Participants/materials, setting, methods The study population included 237oncological male patients who were referred to the Sperm Bank, Fertility, and IVF unit for the purpose of fertility preservation. Sperm analysis was performed within 90 days of cancer diagnosis and prior to therapy. The pre-treatment sperm analyses were based on the World Health Organization (WHO) guidelines Main results and the role of chance Histological examination of malignant diseases demonstrated 20 subtypes of cancers, the major groups included 49 patients with testicular cancer (TC), 72 patients with Hodgkin lymphoma (HD), 35 patients with other lymphoma, 29 patients with other hematological cancer, 16 with sarcoma and 36 with other solid malignant tumors. Our results show significant difference in sperm concentration between the different cancer groups (P value 0.007), the lowest median concentration of spermatozoa was found in the testicular cancer and sarcoma cancer patients 10 million per ml compared to the other cancer groups (other hematologic, Hodgkin lymphoma, other lymphoma and other solid tumors). Oligospermia was observed in 59% of testicular cancer patients and 50% of the sarcoma patients. Fertility outcomes were analyzed as a secondary objective. We found that only 37 patients' partners conceived and delivered offspring. Only 16.2% of those patients used their banked sperm and conceived via IVF-ICSI. We found that 20% of testicular cancer patients and other lymphoma patients including NHL conceived spontaneously after cancer diagnosis and treatment. Limitations, reasons for caution This is a retrospective cohort study and the oncology patients sample size is relatively small. Wider implications of the findings Our study emphasizes that sperm quality among cancer-patients before gonadotoxic-treatment can differ according to the cancer type. Significant reduction in sperm quality in testicular cancer patients was demonstrated, with a significant association was found between sperm concentration and various cancer-type. Further studies are warranted to confirm our results. Trial registration number not applicable

Atypical Polypoid Adenoma – A Histopathological Enigma

Atypical polypoid adenomyoma is an infrequent intrauterine polypoidal lesion. As per WHO classification of female genital tumors published in 2020, APA is classified as a mixed epithelial and mesenchymal tumor. The epithelial component comprises endometrioid-type glands with complex architecture, mild cytological atypia and fibromyomatous stroma with morular metaplasia. We present a case of a 32-year-old female with primary infertility; hysteroscopy showed a smooth polypoidal lesion over anterior wall of uterus. Complete transcervical resection of the lesion was done. Histopathology showed all the prementioned features of atypical polypoid adenomyoma and there was no other associated pathology. Since the patient desired fertility preservation, a conservative management plan with follow up was done. This lesion mostly involves women of fertile age group, hence differentiation from pre-malignant/malignant lesions is of utmost importance as fertility preservation can be done for this lesion. In older patients where fertility preservation is not required hysterectomy is advised in view of risk of recurrence.

Neoadjuvant chemotherapy followed by radical trachelectomy versus upfront abdominal radical trachelectomy for patients with FIGO 2018 stage IB2 cervical cancer

ObjectiveTo explore the optimal fertility-sparing treatment for stage IB2 cervical cancer. We compared the outcomes of neoadjuvant chemotherapy (NACT) followed by radical trachelectomy (RT) with those of upfront abdominal RT (ART). MethodsThis is a retrospective study with prospectively collected data between August 2015 and July 2019. Patients with IB2 cervical cancer who desired fertility preservation underwent NACT followed by RT, or upfront ART, per their choice. ResultsThis study included 51 patients, of which, 16 patients underwent NACT followed by RT and 35 patients chose upfront ART. Fertility was preserved in 12 (75.0%) and 27 (77.1%) patients from the NACT and upfront ART groups, respectively. Incidence rates of intraoperative (0% versus 3.7%) and postoperative complications (25.0% versus 48.1%) of the NACT group were lower compared to the upfront ART group (P=NS). Eleven (91.7%) patients in NACT group and 17 (63.0%) patients in upfront ART groups received adjuvant chemotherapy after surgery. The median follow-up, and 5-year recurrence-free survival rates of the NACT-RT and upfront ART groups were 56 and 61 months, and 83.3% and 96.3%, respectively (P=NS). The recurrence rate was higher in patients with tumor reduction <50% after NACT than that in patients with tumor reduction >50% (66.7% versus 0%, P < 0.05). Tumor reduction <50% was the only independent predictor of recurrence in patients who underwent NACT before RT. ConclusionsNACT followed by RT could be a feasible fertility-sparing option for selected patients with 1B2 cervical cancer. The NACT group had a relatively higher recurrence rate and fewer complications compared to the upfront ART group, albeit without statistical significance. Patients with tumor regression >50% after NACT could be ideal candidates for RT after NACT.

Contemporary Use of Hormonal Therapy in Endometrial Cancer: a Literature Review.

Most endometrial cancers are estrogen receptor and progesterone receptor positive. Hormonal therapy in endometrial cancer is best used in patients with low-grade disease and hormone receptor positivity. Though not standard of care, hormonal treatment can be considered in endometrial cancer treatment in both the early-stage upfront setting for patients who are not surgical candidates and in advanced and recurrent endometrial cancer. In patients who desire fertility preservation or who are not surgical candidates, levonorgestrel intrauterine device and oral progesterone are preferred treatment options. In patients with advanced and metastatic disease, there is no standard-of-care second-line treatment, and hormonal treatment is a widely accepted option for low-grade disease. Beyond progesterone, selective estrogen receptor modulators, aromatase inhibitors, gonadotropin-releasing hormone agonists, and fulvestrant are hormonal treatment options. New therapies, such as MTOR inhibitors and CDK 4/6 inhibitors, have been extensively studied in breast cancer and are shown to be useful in conjunction with hormonal therapies particularly when there is suspected resistance to anti-estrogen treatment. Hormonal therapies also tend to be better tolerated than chemotherapy agents, making them a desirable option particularly in patients with lower performance status. Results from ongoing clinical trials will hopefully help shed light on the use of combination treatment in patients with hormone receptor-positive, low-grade metastatic, and recurrent endometrial cancer.

7884 Laparoscopic Ovarian Transposition for Fertility Preservation

<h3>Study Objective</h3> To review the role of ovarian transposition in fertility preservation technologies, describe laparoscopic ovarian transposition performed for fertility preservation in a patient undergoing pelvic radiation, and to discuss the feasibility of this procedure for the general obstetrician gynecologist for cancer patients desiring fertility preservation. <h3>Design</h3> We present a case report of a patient who undergoes laparoscopic ovarian transposition performed for fertility preservation prior to planned pelvic radiation therapy for melanoma metastatic to the sacrum. <h3>Setting</h3> Ambulatory operating room setting with patient in dorsal lithotomy position. <h3>Patients or Participants</h3> Case report of a patient selected from our institution. <h3>Interventions</h3> Laparoscopic ovarian transposition affixes the ovaries out of the pelvis, preventing their irradiation during planned radiation therapy for cancers involving the pelvis. <h3>Measurements and Main Results</h3> A laparoscopic ovarian transposition performed for fertility preservation was successfully performed prior to planned pelvic radiation therapy. <h3>Conclusion</h3> Women undergoing planned pelvic radiation therapy should be offered ovarian transposition prior to starting therapy. Laparoscopic ovarian transposition is an option for fertility preservation that is within the scope of the general obstetrician gynecologist.

Current Approaches to the Management of Patients with Endometrial Cancer.

Simple SummaryNew data, the development of new methods of treatment and management and the rising incidence of endometrial cancer require constant reviewing, in order to inform healthcare professionals about the current approaches to endometrial cancer. This review aims to present old, new and emerging perspectives in the management of endometrial cancer and evaluate the existing therapeutic strategies, by assessing the different surgical routes, the position of adjuvant therapies in the treatment of endometrial cancer and the implementation of SLNB. Upon reviewing literature data, it became clear that minimally invasive surgery is becoming gradually the preferred route of surgery, whereas SLNB is gaining more ground and could yield important information about the management needed in low-risk and high-risk endometrial cancer.The incidence of endometrial cancer (EC) is rising and healthcare professionals need to be informed about the latest data on the constant developments in the field of its management. With particular interest in the classification and management of EC, we surveyed current literature, national and international data, and guidelines, as well as the latest studies to present the most recent data regarding the management of EC. It became evident that despite the consensus on low-risk EC, there are still controversies surrounding the management of high-risk EC, especially regarding the role of sentinel lymph node biopsy (SLNB). Our aim is to present the old and new perspectives in the management of EC, the different available surgical routes, the possible desire for fertility preservation, the role of adjuvant therapies and the focus on the advantages and the limitations of the implementation of SLNB in therapeutic strategies. It became evident throughout our search and based on literature data that minimally invasive surgery (MIS) leads to satisfying outcomes, thus becoming gradually the preferred route of surgery, while SLNB could provide essential information and guidance about the overall management needed in cases of both low-risk and high-risk EC.

Safety and efficacy of levonorgestrel-releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer.

To investigate the recurrence rate, live-birth rate, and treatment outcomes of levonorgestrel-releasing intrauterine device (LNG-IUD) for the management of atypical endometrial hyperplasia (AEH) or Grade-1 endometrial cancer (EC) in patients who desire fertility-sparing treatment and those seeking conservative treatment without fertility preservation. We prospectively enrolled nine patients from a single institution between April 2009 and September 2013 who were followed up for 60 months after LNG-IUD insertion. The median patient age was 35 (range: 29-39) years. The overall recurrence rate was 56% (5/9). The median interval between removal of the LNG-IUD and recurrence was 20.5 (range: 2-30) months. Three of the nine patients had Grade-1 EC, and six had AEH. The response rates to the LNG-IUD in patients with Grade-1 EC and AEH were 66% and 100%, respectively. Four patients (three with AEH, one with Grade-1 EC) experienced recurrence 6 months after MPA treatment and all 4 (100%) had complete response. Eight patients desired fertility preservation, of which 37% (3/8) conceived after receiving fertility treatment and 25% (2/8) had a live birth; the remaining three had previously received MPA for 6 months and had a recurrence; of these, 1 had a live birth. LNG-IUD is effective for the management of AEH and EC in young patients who desire fertility-sparing treatment, including those ineligible for MPA owing to the presence of comorbidities and those with recurrence after MPA treatment (6-month treatment), and patients seeking conservative treatment without fertility preservation.