Fertility-sparing Techniques Research Articles

ESGO Quality Indicators for Surgical Management of Cervical Cancer: An Audit of Compliance of a Tertiary Care Center

Objective This article assesses the compliance of surgical management of carcinoma cervix, to the quality indicators for treatment put forth by the European Society of Gynaeacological Oncology (ESGO), at a tertiary care center. Methods This is a retrospective analysis and audit of data collected from electronic medical records of patients with carcinoma cervix who underwent surgical management in the department of gynecologic oncology from June 1, 2017 to May 31, 2020. Results Compliance to all 15 quality indicators under 5 categories was assessed. The first two structural indicators were met. The mean number of parametrectomies was 24 and all were operated by a specialist. With regard to targets addressing overall management, only 46% cases were preoperatively planned in multidisciplinary team meetings and 74% met the target of required preop investigations. There was deficiency in recording pertinent intraoperative details and postoperative pathological information. On assessing the quality of surgical care, there were no postoperative urological fistula, but 18% had involved surgical margins, 16% were upstaged postsurgery, and 15% had recurrence within 2 years. All were counseled about fertility-sparing technique when relevant but only 7% had undergone lymph node staging as per recommendations and 51% had received adjuvant chemoradiation. Conclusion This audit revealed that the department did not meet the ESGO quality standards published in 2020. The department has implemented structural and procedural changes to meet these standards and a plan to continuously assess compliance to the same.

(263) Sexuality and Fertility among Young Women Treated for Cervical Cancer

Abstract Introduction Cervical cancer is the fourth cancer in women. Its incidence is particularly high in developing countries. The increase in cases among young women in low- and middle-income countries may be due to changes in sexual behaviors and an increased risk of HPV infection and the absence of vaccination programs. The mortality and morbidity rates of cervical cancer are very high if diagnosed at an advanced stage. It is a preventable Human Papilloma Virus (HPV) related cancer. Cervical cancer patients are often stigmatized because of the idea that this cancer is associated with early-onset sexuality. Furthermore, the treatments for such cancer are mutilating for women often causing definitive infertility and sexual and/or couple dysfunctions. Objective This study aims to describe the changes in sexuality and fertility among young women diagnosed and treated for cervical cancer Methods It is a monocentric cross-sectional study based on a phone survey. We included and contacted all young women (under 40) when they were diagnosed with and/or treated for cervical cancer in our institution for 11 years from January 2010 to December 2020. We excluded all patients with a history of chronic disease other than cervical cancer. The study took place from January To May 2022. We developed an 8-item questionnaire in the local dialect and used the validated translation of the Female Sexual Function Index (FSFI) to evaluate the participants' sexual function. Results We included 23 cases of cervical cancer in young women, i.e. a response rate of 4.6%. The average age of our sample was 34.7 years (±4.7). The median age of first sexual intercourse was 21.5 years [20–25.25]. The abortion rate was 2 [0.25–2.75] per participant. The median age of the first pregnancy was 21 years [21–27]. The most common symptom leading to the cancer diagnosis was post-coital metrorrhagia in 12 (52.2%) of cases. The first Pap smear led to a cervical cancer diagnosis in 13 cases (56.5%). Five patients had a tumor size ≤ 40 mm and 4 patients were metastatic at the time of the diagnosis. Eighteen patients underwent surgical treatment of whom 5 had a fertility-sparing technique. All patients got radiation. The average duration of follow-up was 5.72 years ±0.3.247. The average survival is 9.7 years (±0.9 years; 95% CI 7.9 – 11.5 years). The 3-year survival rate is 82.6%, and the 5-year survival rate is 82.6%. Five patients expressed a desire for pregnancy after the treatment, one got pregnant after 5 years. Five patients expressed that there was an impact on their sexuality after the treatment with sexual disorders with pain, in particular dyspareunia and vulvodynia, and a decrease in female desire associated with a guilty feeling. All patients had pathological FSFI scores regarding all the domains of female sexual function Conclusions Sexuality and fertility are taboo among young cervical cancer survivors. The sexual stigma of cervical cancer as a sexually transmitted disease is present in our population. Fertility-sparing surgical techniques and less sexually harmful radiation techniques are still to be perfected. Disclosure No.

New boundaries for fertility sparing management in endometrial cancer.

The increasing rates of endometrial cancer in premenopausal women that accompanies modern lifestyle options that enhance the prevalence of obesity as well as the trend of delayed childbearing are expected to increase the need for fertility sparing techniques. Currently, the cornerstone of fertility sparing treatment is hormonal handling with progestin treatment and is reserved for women with well differentiated endometrioid lesions that are limited in the myometrial layer. Innovative approaches in the surgical treatment of patients with the use of operative hysteroscopy seem to offer decreased intervals to remission of lesions and longer progression free survival. Recent small case series also dictate that patients with endometrioid lesions of medium differentiation as well as those with superficial myometrial invasion may be adequately treated with the use of operative hysteroscopy. Moreover, the novel classification system may help better understand patients that will likely respond better to hormonal treatment. In the near future, further data from clinical trials will be available that will help optimize patient selection as well select surgical and medical options that will help establish a personalized approach of fertility preservation in endometrial cancer patients.

MP51-08 IS THE UROLIFT A FERTILITY SPARING TECHNIQUE IN PATIENTS SUFFERED FROM BPH?

You have accessJournal of UrologyCME1 Apr 2023MP51-08 IS THE UROLIFT A FERTILITY SPARING TECHNIQUE IN PATIENTS SUFFERED FROM BPH? Pasquale Annese, Nicola d'Altilia, Ugo G. Falagario, Vito Mancini, Antonella Ninivaggi, Edoardo Tocci, Mariano Bruno, Anna Ricapito, Gian M. Busetto, Carlo Bettocchi, and Giuseppe Carrieri Pasquale AnnesePasquale Annese More articles by this author , Nicola d'AltiliaNicola d'Altilia More articles by this author , Ugo G. FalagarioUgo G. Falagario More articles by this author , Vito ManciniVito Mancini More articles by this author , Antonella NinivaggiAntonella Ninivaggi More articles by this author , Edoardo TocciEdoardo Tocci More articles by this author , Mariano BrunoMariano Bruno More articles by this author , Anna RicapitoAnna Ricapito More articles by this author , Gian M. BusettoGian M. Busetto More articles by this author , Carlo BettocchiCarlo Bettocchi More articles by this author , and Giuseppe CarrieriGiuseppe Carrieri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hypertrophy (BPH) is a common disease in aging males. Although less common, some patients under 50 years of age reported lower urinary tract disorders (LUTS) due to BPH. If desirous of paternity, pharmacological treatment remains the only one due to the risk of anejaculation after surgery. The first aim of the study was to report functional outcomes related to fertility preservation evaluatet by sperm test in a population under 50 years of age who underwent UroLift in a single Center. METHODS: We included 20 young men with symptomatic BPH assessed by the International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) assessed by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF).Semen analysis was performed before surgery and repeated at 3 months with evaluation of pH, volume, sperm concentration, total motility, vitality and morphology of sperms. All patients, preoperatively underwent, uroflowmetry (UFM), digital rectal examination, transrectal prostate ultrasound to measure prostate volume, PSA, cystoscopy and urodynamics test if necessary. Urinary function was scheduled at 1, 3, 6, 12 months with UFM, IPSS, IIEF-5, and MSHQ-EjD-SF. First PSA and cistoscopy were repeated at 6 month. RESULTS: The mean age of the patients was 44.5 (36.5, 48) years. Mean operative time was 15 (10, 20) min and 2.5 (2, 4) implats per patients were used. At 3 months there were no difference in terms of total sperm count, volume, pH, motility, vitality, morphology, liquefaction, leucocytes (p=0.9; p=0.8; p=0.7; p=1; p=1; p=1; p=0,2; p=0.5). No patient presented retrograde ejaculation. Q-max increased by 64.4% (p=0.001), PVR decreased by 66.6% (p=0.016), and IPSS decreased by 60% (p<0.001). IIEF and MSHQ-EjD-SF were similarly preserved (p=0.14, p=0.4). CONCLUSIONS: From the results obtained, we can conclude new findings regarding sparing of sperm test parameters following UroLift, furthermore, no one reported retroejaculation or volume alteration. UroLift was confirmed to be effective as a technique in improving urinary functional disorders secondary to BPH. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e695 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pasquale Annese More articles by this author Nicola d'Altilia More articles by this author Ugo G. Falagario More articles by this author Vito Mancini More articles by this author Antonella Ninivaggi More articles by this author Edoardo Tocci More articles by this author Mariano Bruno More articles by this author Anna Ricapito More articles by this author Gian M. Busetto More articles by this author Carlo Bettocchi More articles by this author Giuseppe Carrieri More articles by this author Expand All Advertisement PDF downloadLoading ...

Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions

Cervical cancer is one of the leading causes of cancer-related death in women of reproductive age. The established fertility-sparing approaches for the management of early-stage cervical cancer for women who plan pregnancy are associated with a decline in fecundity and an increased risk of pregnancy complications. This article aims to offer an overview of fertility-sparing approaches and the management of potential subfertility and pregnancy complications after these treatments. An extensive search for the available data about infertility and cervical cancer, fertility-sparing techniques in patients with cervical cancer, fertility treatment, obstetrical complications, and pregnancy outcomes in cervical cancer patients was completed. Fertility-preserving procedures such as loop electrosurgical excision procedure (LEEP), cold-knife conization, and trachelectomy in women diagnosed with cervical cancer can be considered as safe and effective treatments that preserve reproductive potential. Current fertility-preserving procedures, based on the balance of the oncological characteristics of patients as well as their desire for reproduction, allow one to obtain acceptable reproductive and obstetric outcomes in women treated for cervical cancer. Nevertheless, careful monitoring of pregnancies obtained after fertility-preserving procedures is recommended, since this cohort of patients should be considered at higher risk compared with a healthy population.

Is the Urolift a fertility sparing technique in patients suffered from BPH?

Is the Urolift a fertility sparing technique in patients suffered from BPH?

SC157 - Is the urolift a fertility sparing technique?

SC157 - Is the urolift a fertility sparing technique?

Fever and Abdominal Pain in a 10-year-old with Autism.

Fever and Abdominal Pain in a 10-year-old with Autism.

Efficacy of Hayman Suture in the Treatment of Atonic Postpartum Hemorrhage

Purpose: The study aims to investigate the effectiveness of Hayman’s suture in the management of Atonic postpartum hemorrhage. Subjects and Method: The study includes 37 patients who developed severe atonic PPH not responsive to pharmacological measures at the Department of Obstetrics and Gynecology at Aswan University hospital, in the period between Mars 2018 and December 2019. This is a case series study of 37 patients upon whom Hayman suture is applied when failed to respond to medical management, step-wise devascularization of the uterus is attempted when the suture cannot control the bleeding alone, reserving hysterectomy as a last resort when all measures are failed. Results: Results of the research None of the 37 patients of our study required hysterectomy to control the bleeding, Hayman suture succeeded solely to arrest the hemorrhage in 30 patients (81.1%), while 7 patients(18.9%) required step-wise devascularization of the uterus with Hayman suture to stop the bleeding. It is not uncommon for complications to be described with the use of uterine compression sutures. In our study, we did not report any complications. Conclusion: The application of Hayman’s suture is a fast, efficient, non-complex, lifesaving and fertility-sparing technique to control atonic postpartum hemorrhage.

Case Report: Young Nulligravid with Chronic Non-Puerperal Uterine Inversion Secondary to a Prolapsed Myoma with Malignant Histopathology

<h3>Study Objective</h3> To present an interesting case report of a 23-year-oldnulligravid with a 5-month history of heavy and prolonged vaginal bleeding with intermittent hypogastric pain. Examination showed a necrotic mass measuring 7 × 8 × 5 cm occupying the vaginal vault with no palpable cervix and uterus. Ultrasound confirmed a prolapsed submucous myoma with uterine inversion. Admitting diagnosis was chronic and complete non-puerperaluterine inversion secondary to prolapsed infected submucous myoma with secondary anemia. The patient was anemic with leukocytosis and she was given intravenous antibiotic and transfused with packed RBC, properly typed and crossmatched. Biopsy of the prolapsed mass revealed an infarcted polyp. Surgical plan was to preserve fertility and perform a hysteroscopic- and laparoscopic- guided vaginal myomectomy followed by uterine repositioning. On diagnostic hysteroscopy, there was no identifiable cervix, the prolapsed mass was too large and surgical landmarks were not identified. Concurrent laparoscopy revealed the uterus was inverted into a constricted "flower-pot" cervical ring towards the vaginal canal at the level of the round ligaments and bilateral ovaries and fallopian tubes were grossly normal. Proceeded with amputation of the prolapsed mass in a piecemeal fashion followed by attempts at uterine repositioning by Huntington's and Hultain's maneuvers but were not successful. The remaining vaginal mass was too large to pass through the cervix hence decision was to proceed with laparoscopic total hysterectomy with bilateral salpingectomy. Histopathology revealed Malignant Spindle Cell Neoplasm. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Uterine inversion is rare in the non-puerperal period and is often difficult to diagnose and manage. There should be high index of suspicion in the setting of a mass protruding from the vagina, non-palpable uterus, and pelvic organs not visualized on ultrasound. When inversion is chronic, reverting maneuvers may prove difficult rendering fertility-sparing techniques implausible. In the setting of fertility preservation, malignancy must be ruled out.

Minimizing Fertility-sparing Treatment for Low Volume Early Stage Cervical Cancer; Is Less the (R)Evolution?

The aim of this study was to conduct a review on less radical fertility-sparing surgical treatment for early-stage cervical cancer. We conducted a Medline search from 2014 to 2018 regarding less radical fertility-sparing techniques, such as simple trachelectomy or cervical conization, with pelvic lymphadenectomy. We also assessed the impact of the removal of the parametrium on the obstetric and oncologic outcome, in women who desire to preserve their fertility. We analyzed studies about cervical conization and simple trachelectomy, together with pelvic lymphadenectomy in early-stage cervical cancer. We also assessed the importance of parametrial involvement in reducing morbidity, without jeopardizing the oncologic outcome of these patients. Studies demonstrate that in tumors ≤2 cm, without lymphovascular Space Invasion and without evidence of parametrial involvement, a less radical fertility-sparing surgical approach could increase pregnancy rates and have a positive effect on the quality of life of these patients. Standard fertility-sparing treatment for early-stage cervical cancer is still radical trachelectomy with pelvic lymphadenectomy. However, studies suggest that the omission of parametrectomy is a feasible and safe option. Simple trachelectomy or cervical conization, both combined with pelvic lymphadenectomy are acceptable approaches in a selected group of patients with early-stage cervical cancer.

Placenta accreta spectrum disorder: a comparison between fertility-sparing techniques and hysterectomy

This study aimed to compare fertility-sparing interventions and hysterectomy among women with placenta accreta spectrum disorder (PAS) who underwent caesarean deliveries. We retrospectively reviewed the data, and classified 148 patients as follows: group B: Bakri balloon without resection (n = 83); group R: segmental uterine resection (n = 23); and group H: hysterectomy (n = 42). The groups differed significantly with respect to operative time, transfused blood products, and post-operative intensive care unit and hospital stays. Morbidity was the highest in group H. The aforementioned parameters did not differ between Groups B and R. Groups R and H differed regarding the operative time, post-operative hospital stay, and transfused blood products. Although the treatment modality and PAS severity differed between the groups of patients with preserved fertility, the surgical outcome parameters did not differ. Hence, the effectiveness of these approaches may be similar without foregoing patient safety. IMPACT STATEMENT What is already known on this subject? As caesarean delivery rates have increased worldwide, the incidence of placenta accreta spectrum disorder (PAS), which has high morbidity and mortality rates, has also risen. Planned caesarean hysterectomy is recommended to reduce mortality and morbidity, but fertility is lost. What do the results of this study add? The severity of PAS can range from mild to severe. A patient-tailored approach, which was based on the intra-operative findings and used either a Bakri balloon tamponade or segmental uterine resection, reduced morbidity and preserved fertility. What are the implications of these findings for clinical practice and/or further research? Instead of adhering to the conventional approach that involves an elective caesarean hysterectomy based on antenatal imaging, more suitable approaches should be considered from the spectrum of haemostatic and fertility-preserving options available, while considering a surgeon’s experience, the intra-operative findings, and patients’ needs.

Fertility-sparing Surgery (FSS) in Epithelial Ovarian Cancer (EOC): A Case Report

Background: Epithelial ovarian cancer is the most common and lethal ovarian cancer. Now a days Fertility preservation is an important issue because of the constant shifting of childbearing age towards higher ages. The increasing incidence of epithelial ovarian cancer in women with active childbearing potential constitutes a therapeutic dilemma. Fertility sparing techniques are being increasingly incorporated in the therapeutic strategies in early stages of the disease. Established organ-preserving techniques in early stage epithelial ovarian cancer includes preservation of the contralateral ovary and uterus.&#x0D; Aim: To report the case of a Epithelial Ovarian Cancer, who had conservative surgery followed by chemotherapy with a good fertility outcome.&#x0D; Case presentation: A 31-year-old nulliparous woman with a right sided ovarian mucinous cystadenocarcinoma was treated by right adnexectomy and omentectomy followed by chemotherapy. A 3years follow-up showed no signs of relapse, and she completed a fullterm natural pregnancy which was delivered by caesarean section.&#x0D; Conclusion: Fertility sparing surgery in early stage Epithelial Ovarian Cancer has good prognosis. However, due to the rarity of the disease in early stages, the fertility outcome of this group of patients has not been established.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 46-48

Fertility sparing technique during pelvic exenteration for recurrent vaginal rhabdomyosarcoma

Abstract We present the first case and describe the surgical technique of anterior pelvic exenteration with uterine preservation in a 17-year-old patient with a recurrent vaginal rhabdomyosarcoma. Surgical technique included a skeletonization of uterine pedicles and ligation of superior vesical and vaginal arteries, adapting abdominal radical trachelectomy technique. Cervix was transected to avoid vaginal opening and tumor spillage. Uterus was reimplanted to a vaginal reconstruction, created with a DIEP, and a continent urinary diversion was performed. Pelvic filling was completed with an omental J-flap. Postoperative course was uneventful and the patient was discharged at day 17th. The last days of her stay were dedicated to self-catheterization education and learning the management of Miami pouch. Her menstrual cycle resumed two months after the surgery. Cervix exhibited a normal appearance during clinical examination eight weeks after surgery and postoperative MRI did not show signs of local recurrence. Unfortunately, distant metastatic relapse occurred three months after surgery and the patient died two months later. Fertility preservation at the time of anterior pelvic exenteration is technically feasible in selected young patients. Further cases are needed to assess the reproducibility of this surgical procedure, the reproductive function of the uterus and the rate of uterine recurrences.

21. Total laparoscopic radical trachelectomy as a fertility sparing technique in early cervical cancer in a ‘Buddy’ operating institute: Demonstration of technique and review of outcomes

21. Total laparoscopic radical trachelectomy as a fertility sparing technique in early cervical cancer in a ‘Buddy’ operating institute: Demonstration of technique and review of outcomes

Fertility preservation in women with cervical, endometrial or ovarian cancers.

BackgroundAlthough cancer in general affects an aged population, a significant number of women develop cancer at childbearing age. Long-term survival rates after gynecological cancer, especially in young patients are increasing and all quality-of-life aspects, including preservation of fertility have become of major relevance.OutcomesSurgical techniques aimed at sparing reproductive organs and preserving fertility have been developed for women presenting with gynecological cancer found at early stages. Indications for fertility-sparing surgery are in general restricted to women presenting with a well-differentiated low-grade tumor in its early stages or with low malignant potential. Up to now, use of fertility-sparing techniques in well-selected patients has not been shown to affect overall survival negatively and fertility outcomes reported have been favorable. Still larger amounts of data and longer follow-up periods are needed. Several current fertility-sparing cancer treatments may result in sub-fertility and in those cases assisted reproductive techniques are indicated. Overall quality of life has been satisfactory in cancer patients after fertility-sparing surgery.ConclusionsFertility-sparing surgery is a viable tool to enable gynecological cancer patients of young age to fulfill their family building without impairment of oncological outcome. Cancer patients of reproductive age should undergo fertility counseling to analyze this sensitive subject. Further studies are needed to investigate the role of fertility-sparing treatment and combined adjuvant therapy in higher-grade cancers.

Efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment. Key words: Placenta previa; Placenta percreta; Tourniquets; Ligation; Suture techniques; Gynecologic surgical procedures

PPO.47 Radical Vaginal Trachelectomy for Cervical Cancer during pregnancy and subsequent obstetric outcome

Radical Vaginal Trachelectomy (RVT) is a fertility sparing technique first described by D’Argent in 1994.1 This involves removal of the cervix and parametrial tissue, laparoscopic bilateral pelvic lymph node dissection...

Demonstration of Laparoscopic Resection of Uterine Sacculation (Niche) With Uterine Reconstruction

Study ObjectiveTo demonstrate a technique of laparoscopic excision of uterine sacculation (niche) with uterine reconstruction. DesignNarrated video presenting a step-by-step explanation of a laparoscopic technique for excision of uterine sacculation (niche) with uterine reconstruction using a narrated video (Canadian Task Force classification III). SettingLaparoscopic excision of uterine sacculation (niche) is a fertility-sparing technique for use in a selected group of patients who do not respond to medical treatment and in whom definitive treatment via hysterectomy is not an option. InterventionsLaparoscopic excision of uterine sacculation (niche) is performed by excising the uterine defect after initial reflection of the uterovesical fold. The area of uterine defect is identified preoperatively using flexible hysteroscopy. Once the margins of the defect are identified laparoscopically, it is circumferentially excised. The uterine manipulator helps to identify the cervical canal. Reconstruction is performed using interrupted 1 Vicryl sutures using an extracorporeal technique for secure tissue apposition. An adhesion barrier is then applied around the reconstructed area. ConclusionExcision of uterine sacculation (niche) with uterine reconstruction is a conservative surgical laparoscopic technique that should be considered in a selected group of patients in whom fertility sparing is desired and after medical therapy including progestogens, combined contraceptive pills, or the Mirena coil has failed to resolve symptoms.

Methods and conditions of fertility preservation in early-stage ovarian tumors

The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1-2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be of primary importance. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended.