Ovarian Preservation Research Articles

Uterine Sarcomas: How to Navigate an Ever-Growing List of Subtypes.

Uterine sarcomas are rare mesenchymal tumors that are aggressive cancers. The rarity of these tumors, and consequently limited prospective data, has made surgical management of uterine sarcomas challenging. One major obstacle in the management of uterine sarcomas is establishing the diagnosis prior to surgery, which is crucial for appropriate intraoperative management. This paper serves to review aspects of surgical management of uterine sarcomas that remain unanswered. Distinguishing common benign myomas from rare uterine sarcomas is important for operative planning and subspecialty care because benign myomas are frequently managed with minimally invasive hysterectomy or myomectomy, whereas the mainstay of management of uterine sarcomas is hysterectomy without specimen fragmentation. Preoperative clinical presentation, serum studies, imaging, and histologic examination all have limitations in establishing a preoperative diagnosis. In addition, patients are often of reproductive age and desire fertility preservation. Although surgery remains the cornerstone for management, high-quality data guiding best practices are sparse. Morcellation should be avoided. Expert pathologic review, imaging to assess for metastatic disease, and consideration of hormone receptor testing are advisable. Recent data have further informed surgical approach and fertility preservation in early-stage disease, but controversy remains. Despite substantial advancement in the medical management of uterine sarcomas, surgical management of uterine sarcomas remain challenging. Larger studies with long-term follow-up are needed to guide fertility preservation surgery options, both local resection and ovarian preservation, further in young women. Development of novel methods to differentiate between benign and malignant uterine masses is needed.

Ovarian Auto-Transplantation of Cryopreserved Tissue on Muscle Surface Compared With Subrenal Capsular in Rats

Fertility protection and ovarian function preservation are important to those undergoing radiation therapy to fight female reproductive cancers. The aim of this study was to explore a new ovarian transplantation position, the surface of thigh muscle, which was biceps femoris muscle in rats. We hypothesized that this procedure was comparable to traditional subrenal capsular transplantation and realized a normal ovarian function. The ovarian tissue, after cryopreservation, were transplanted to surface of biceps femoris muscle by suturing. Histologic examination indicated that the transplanted tissues would survive and support a lower level of follicle growth compared with subrenal capsular (17 ± 2.6 vs 8.9 ± 4; P=.0018). According to weight gaining record, muscle surface transplantation supported appropriate weight gain although the β-estradiol levels did not completely recover. This new procedure could support a basic normal estrous cycle. Ovarian transplantation through this procedure partly rebuilt ovarian function, which was more likely to be an alternative way for those not suitable for subrenal capsular transplantation.

Hormone Therapy Reduces Recurrence in Stage II-IV Uterine Low-Grade Endometrial Stromal Sarcomas: A Retrospective Cohort Study.

Low-grade endometrial stromal sarcoma (LG-ESS) is a rare and indolent malignancy. Hormone therapy has been reported as an adjuvant treatment for LG-ESS, although its effectiveness is controversial. Here we aimed to investigate the effects of postoperative hormone therapy on recurrence in patients with uterine LG-ESS. Between January 2010 and December 2019, a total of 152 patients (23 with and 129 without fertility-sparing) with a diagnosis of primary uterine LG-ESS confirmed by pathologists were enrolled in this study. In the cohort without fertility-sparing, 22 (17.7%) patients had recurrence, and the median disease-free survival (DFS) was 47 (2-130) months; only one of these patients died of LG-ESS. No significant difference was found in recurrence between the groups with and without hormone therapy (p=0.802). However, subgroup analysis showed that hormone therapy decreased the recurrence rate in stage II-IV (p=0.001, HR 0.144, 95% CI: 0.038-0.548), but not in stage I disease (p=0.256). High-dose progestins notably reduced recurrence (p=0.012, HR 0.154, 95% CI: 0.036-0.660), whereas non-progestin therapy marginally influenced recurrence (p=0.054) compared with no hormone therapy in stage II-IV disease. Moreover, hormone therapy within 12 months was effective in reducing recurrence (p=0.038, HR 0.241, 95% CI: 0.063-0.922). Ovarian preservation (p=0.004, HR 6.250, 95% CI: 1.786-21.874) and negative expression of ER/PR (p=0.000, HR 23.249, 95% CI: 4.912-110.026) were high-risk factors for recurrence in patients without fertility-sparing. In the fertility-sparing cohort, 15 (65.2%) patients experienced recurrence, and the median DFS was 24 (3-107) months. Six patients successfully delivered healthy fetuses, and five received hormone therapy. Twelve patients finally accepted hysterectomy after repeated recurrence, and only two of them had given birth before surgery. Patients who received hormone therapy showed longer DFS, although this difference was not statistically significant (p=0.466). In conclusion, postoperative hormone therapy reduces recurrence in patients with stage II–IV uterine LG-ESS without fertility-sparing, and high-dose treatment with progestins within 12 months is recommended. Bilateral oophorectomy can also reduce the risk of recurrence. Patients with fertility-sparing have a high risk of recurrence and poor pregnancy outcomes, and hormone therapy may be a reasonable choice in postoperative management.

Ovarian transposition in order to preserve fertility before irradiation in a young patient with cervical cancer

Ovarian transposition has been imagined for young women diagnosed with pelvic malignancies who are submitted to surgery, who are further candidates for irradiation and who deserve fertility preservation. The most commonly indication for this procedure are represented by rectal and hematological malignancies; in certain cases diagnosed with gynecological malignancies in early stages such as cervical cancer ovarian preservation can be also taken in consideration in order to preserve fertility; however, ovarian transposition should be taken in consideration in order to remove the ovaries from the radiation field. The aim of the current paper is to report the case of a 31 year old patient diagnosed with a stage IIA cervical cancer in whom a total radical hysterectomy en bloc with right adnexectomy and pelvic lymph node dissection was performed; meanwhile the left ovary was transposed at the level of the left lumbar area, 2 cm above the left iliac crest and metallic clips were placed at the inferior margins in order to be easily identified when performing adjuvant radiation therapy.

Ovarian conservation in a patient with a large ovarian cyst and adnexal torsion – a confirmatory video with intravenous indocyanine green

To share our experience of intravenous indocyanine green (ICG) application during conservative ovarian surgery in a young patient with adnexal torsion, a large ovarian cyst, and apparent ovarian necrosis. This confirmatory video of ovarian reperfusion uses footage from the laparoscopic treatment and ICG application in a young patient with adnexal torsion and apparent necrosis. Academic, multisite medical center. A 24-year-old patient with a 12-cm dermoid cyst, adnexal torsion, and apparent tissue necrosis. Five milligrams intravenous ICG, de-torsion, ovarian cystectomy, and ovarian reconstruction. The patient approved the ICG off-label use. Ovarian preservation and perioperative morbidity. This video demonstrates the surgical treatment of a patient with adnexal torsion. The perfusion patterns before and after the surgical treatment, i.e., cyst de-torsion and cyst removal are documented using intravenous ICG. The perfusion patterns guided the surgeon to perform ovarian conservation despite apparent initial ischemia. The patient recovered well, and no postoperative 30-day morbidity occurred. Intraoperative subjective overestimation of the true ovarian ischemia may lead to unnecessary oophorectomy. Per the American College of Obstetrics and Gynecology recommendation, patients with adnexal torsion should be treated surgically with ovarian conservation regardless of the appearance of the ovary. As demonstrated, ovaries reperfuse despite multiple twists along the infundibulopelvic pedicle, apparent necrosis, and large cysts. Unilateral salpingo-oophorectomies are avoidable even in these cases.

Prognosis for Young Females with Pseudomyxoma Peritonei of Appendiceal Origin and Unilateral or Bilateral Ovaries Preserved During Cytoreductive Surgery.

ObjectiveTo determine prognosis for young female patients with peritoneal pseudomyxoma (PMP) of appendiceal origin and unilateral or bilateral ovaries preserved during cytoreductive surgery (CRS).MethodsClinical data of female patients treated with CRS with or without hyperthermic intraperitoneal chemotherapy (HIPEC) at the Aerospace Center Hospital, Beijing between January, 2009 and December, 2019 were retrospectively reviewed. Patients had no changes in the bilateral ovaries on gross pathological observations or biopsy during CRS, and normal ovarian function. The demographic and clinical characteristics and prognosis of women with ovaries preserved (ovarian preservation group) or resected (ovarian resection group) during CRS were compared. Independent prognostic factors for survival were identified using univariate and multivariate analysis.Results40 patients were included in the final analysis. 19 patients chose ovarian preservation while 21 patients underwent ovarian resection. Completeness of cytoreduction (CCR) scores were CCR-0/1. There were significant differences in age (<40 vs. ≥40), symptoms, intraoperative HIPEC (Y vs. N), and histopathologic subtype of PMP (low-grade vs. high-grade) (p < 0.001) between patients in the ovarian preservation and ovarian resection groups. In the ovarian preservation group, median overall survival (OS) was 59 months (range, 53–65 months), and the 5-year survival rate was 37.9%. Median disease-free survival (DFS) was 13 months (range, 9–17 months), and the 5-year recurrence rate was 87.4%. In the ovarian resection group, the 5-year survival rate was 87.7%, and the 5-year recurrence rate was 18.3%. Median OS and median DFS were not reached. In patients with low-grade PMP, median DFS was significantly longer in patients with ovarian resection compared to ovarian preservation (p < 0.001). Univariate analysis showed histopathologic subtype of PMP (low-grade vs. high-grade, p < 0.001) was significantly associated with OS and DFS. On multivariate analysis, high-grade histopathologic subtype of PMP was an independent predictor of poor prognosis (OS and DFS).ConclusionHistopathologic subtype of PMP represents an independent predictor of prognosis in female patients with PMP of appendiceal origin and unilateral or bilateral ovaries preserved during CRS. These findings imply that ovarian preservation is a more suitable option for young females with low-grade PMP compared to high-grade PMP. Further prospective studies should be done investigating the role of resection of uninvolved ovaries in PMP.

Cryopreservation Competence of Chicken Oocytes as a Model of Endangered Wild Birds: Effects of Storage Time and Temperature on the Ovarian Follicle Survival.

Simple SummaryMany avian species are classified as endangered, and the development of the gamete preservation technique is essential to preserve their genetic diversity. Since cryopreservation and transplantation of ovarian tissues are currently the only methods of female fertility preservation in birds after birth, transporting the ovary to the laboratory in good condition is key for successful female fertility preservation. Here, we report using chickens as a model of wild birds for which storage at low temperature (4 °C), but not room temperature, can maintain the ovary, ensuring oocyte survival, morphology and protein expression of germ cell markers for at least 3 days. Furthermore, a vitrification study confirmed that oocytes after ovary storage at a low temperature can be preserved by ovarian tissue cryopreservation. On the other hand, ovaries stored at room temperature decreased oocyte survival, while increasing gene expression of apoptosis and oxidation stress markers. Our study not only verifies the fact that the storage of hen ovaries at low temperatures protects oocytes, which can be preserved by vitrification, but it also contributes to understanding the effect of ovary storage on the integrity and cryotolerance of immature follicles within the hen ovary.For the conservation of endangered avian species, developing gamete preservation technologies is essential. However, studies in oocytes have not been widely conducted. In this study, assuming that the ovaries are transported to a research facility after death, we investigated the effect of ovary storage on oocytes for the purpose of cryopreserving avian female gametes by using a chicken as a model of endangered avian species. After excision, the ovaries were stored at either a low temperature (4 °C) or room temperature for 1–3 days. Ovarian follicles stored under different conditions for each period were examined by neutral red staining, histology, and gene and protein expression analysis. In addition, the pH of the storage medium after preserving the ovaries was measured. Then, ovarian tissues were vitrified to determine the cryopreservation competence. Storing the ovarian tissues at 4 °C kept the follicles viable and morphologically normal for 3 days with slow decline. In contrast, although different storage temperature did not influence follicle viability and morphology after only 1 day of storage, ovarian tissues stored at room temperature rapidly declined in structurally normal follicles, and viable follicles were rarely seen after 3 days of storage. Gene and protein expression analysis showed that apoptosis had already started on the first day, as shown by the higher expression of CASP9 under room temperature conditions. Furthermore, high expression of SOD1 and a rapid decline of pH in the storage medium under room temperature storage suggested the influence of oxidative stress associated with low pH in this condition on the follicle survivability in hen ovarian tissues. Our cryopreservation study also showed that ovarian tissues stored at 4 °C could recover after cryopreservation even after 3 days of storage. The described storage conditions and cryopreservation methods, which preserve chicken follicle survival, will lay the foundation of ovarian tissue preservation to preserve the fertility of wild female birds.

Influence of ovarian-sparing surgery and ovariectomy on prognosis in early cervical adenocarcinoma: a systematic review and meta-analysis.

The effect of ovarian-sparing surgery versus ovariectomy on prognosis in early cervical adenocarcinoma is controversial. The aim of this study was to compare the effect of ovary preservation versus ovariectomy on the prognosis of patients with cervical adenocarcinoma. A literature search was conducted of the PubMed, Excerpta Medica Database, Medline, Central, China National Knowledge Infrastructure databases, and China Science Periodical Database. The subjects of the literature study were patients with cervical adenocarcinoma. The literature compared the prognostic impact of ovary-sparing versus ovariectomy surgery. The Newcastle-Ottawa Scale was used to evaluate the quality of the articles. The Chi-square test was used to test the heterogeneity of the articles, and the random-effects model was used if the results indicated heterogeneity. A subgroup analysis and sensitivity analysis were used to examine the source of heterogeneity. If there was no heterogeneity among the articles, a fixed-effects model was used. Publication bias was evaluated using funnel plots and Egger test. A total of 3,467 patients with stage IA-IB cervical adenocarcinoma from 5 articles were included in the meta-analysis, of whom 995 had ovarian preservation and 1,895 had ovariectomy. There was no statistically significant difference in the 5-year overall survival (OS) between the stage IA-IIB cervical adenocarcinoma patients in the ovariectomy group and the ovarian preservation group (P=0.14). Additionally, there was no heterogeneity among these articles, and no publication bias (P>0.05). There was no significant difference in the 5-year progression free survival (PFS) between the stage IA-IIB cervical adenocarcinoma patients in the ovariectomy group and the ovarian preservation group (P=0.11). Additionally, there was no heterogeneity among these articles, and no publication bias (P>0.05). There was no significant difference in the 5-year disease specific survival (DSS) between the stage IA-IIB cervical adenocarcinoma patients in the ovariectomy group and the ovarian preservation group (P=0.48). Additionally, there was no heterogeneity among these articles, and no publication bias (P>0.05). There was no statistically significant difference in 5-year OS, PFS and DSS between ovarian-sparing surgery and oophorectomy for early-stage cervical adenocarcinoma. High-quality randomized controlled trials are still needed to verify this conclusion.

Characteristics and clinicopathological features of patients with ovarian metastasis of endometrial cancer: a retrospective study

There are no criteria for patient selection for ovarian-preserving surgery for endometrial cancer (EC). In this study, intraoperative findings of ovarian swelling (OvS) and the clinicopathological features of patients with EC with or without ovarian metastasis were analysed to identify risk factors for ovarian metastasis. Patients who underwent surgery for EC between 2012 and 2019 at our hospital were enrolled. In univariate analysis, all features were significantly higher in metastasis(+) cases. In multivariate analysis, lymphatic space invasion (LSI), cervical stromal involvement (CSI), peritoneal dissemination, and OvS were significant risk factors. In univariate analysis in stage I and II cases classified without adnexal pathological factors, type 2 histologic type, LSI, CSI, and OvS were significantly higher in metastasis(+) cases. LSI, CSI, and OvS were significant risk factors in multivariate analysis. Patients with type 1 histologic type EC without myometrial invasion ≥1/2, CSI and extrauterine lesions are appropriate for ovarian preservation. IMPACT STATEMENT What is already known on this subject? The number of premenopausal patients with endometrial cancer (EC) is increasing. Bilateral oophorectomy for EC results in surgical primary ovarian insufficiency, and thus, surgery with ovarian preservation has been examined. However, there are few reports on risk factors for ovarian metastasis of EC and no established criteria for patient background or pathological factors to determine suitability for ovarian preservation surgery. What do the results of this study add? In univariate analysis, all pathological findings suggestive of disease progression were more frequent in cases with ovarian metastases. In multivariate analysis, lymphatic space invasion (LSI), cervical stromal involvement (CSI), peritoneal dissemination, and ovarian swelling (OvS) were identified as significant risk factors for ovarian metastasis. In an analysis of stage I and II cases classified without adnexal pathological factors, type 2 histologic type, LSI, CSI, and OvS were significantly more common in cases with ovarian metastasis, and LSI, CSI, and OvS emerged as significant risk factors for ovarian metastasis in multivariate analysis. What are the implications of these findings for clinical practice and/or further research? Patients with type 1 histologic type EC without depth of myometrial invasion ≥1/2, CSI, or extrauterine lesions may be appropriate cases for ovarian preservation.

Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights.

Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.

Effect of hysterectomy on the function of saved ovaries and correction of hormonal imbalance

The objective: to assess the hormonal disorders in patients after the radical treatment for leiomyoma and to develop the therapeutic options for correction.Materials and methods. The clinical and laboratory assessment of postoperative course after leiomyoma surgery in 160 women of reproductive age was carried out. The following groups of patients were formed: I group – 90 patients after vaginal hysterectomy (HE) with opportunistic salpingectomy and ovarian preservation, II group – 70 patients after abdominal HE with opportunistic salpingectomy and ovarian preservation. The control group included 50 women of reproductive age with asymptomatic leiomyoma.Then the following groups were formed to assess the effectiveness of the proposed medical correction program: the main group – 46 patients after vaginal HE with fallopian tubes and 36 persons after abdominal HE with fallopian tubes – received the proposed medical correction program, and the comparison group – 44 and 34 individuals after vaginal and abdominal HE with opportunistic salpingectomy and ovarian preservation, respectively, with standard approach for postoperative and rehabilitative periods.The diagnostic program included the assessment of hormonal level, post-hysterectomy syndrome degree by modified menopausal index using survey, urogenital and sexual dysfunction, and the indicators of vulvovaginal atrophy according to the Barlow scale.Results. Neurovegetative symptoms were observed in 36,7 % patients in the I group and 48.6 % - II group, vegetative-vascular symptoms – 46.7 % and 62.3 %, respectively. Insomnia was characterized by the sleep process disorders, the preservation of the feeling of fatigue after waking up. It is necessary to mention that an increase in the proportion of cardiovascular diseases up to 36 months after surgery (hypertension, dyshormonal cardiomyopathy and their combinations, 23.1 % were diagnosed with dyshormonal mastopathy, the women complained on arthralgia, morning joint stiffness, ostealgia twice more.The assessment of sexual disorders and manifestations of urogenital tract dysfunction allowed to indicate the most significant rate of dysuria complains in 72.9 % of cases in the II group after classical abdominal HE. Up to 36 months after surgery the subclinical hypothyroidism was found in 62.2 % of women in the I group and 31.4 % – II group, clinically significant hypothyroidism – in 21.1 % and 55.7 %, respectively.In the half of the cases the hormonal imbalance like hypoesrogenia was determined up to 36 months of monitoring without statistically significant differences between groups of different HE methodic. The main factor was patient’s age in which endocrine, vegetative-vascular disorders and the clinical manifestations of psychosomatic are developed in a larger percentage of significantly earlier in women of late reproductive age.The use of proposed program of therapeutic options after HE with ovarian preservation allowed to provide a tendency of the estradiol, progesterone and testosterone levels normalization, prolactin and cortisol concentrations were close to the reference values. Estradiol concentration in the women in main group increased, although it remained significantly below the age normal indices, and the most significant normalization of theses parameters were determined in women who received hormonal replacement therapy. Clinically positive effect in patients on the severity of neurovegetative and psychoemotional manifestations on the background of differentiated treatment was observed after 3 months from the beginning of therapy.Conclusions. The obtained results suggest that the optimization of the treatment program with the the proposed drugs in women in the groups leads to relative optimization of hormonal status and initiation of compensatory-adaptive responses of the organism, which improves the quality of life and eliminates symptoms of hypoestrogenism.

Management and prognosis comparison between incidental and nonincidental intravenous leiomyomatosis: a retrospective single-center real-life experience.

BackgroundIntravenous leiomyomatosis (IVL) is a rare, difficult-to-treat type of smooth muscle tumor that originates from the uterine myoma. However, its clinical characteristics, management, and prognosis are not clearly understood. Moreover, the 2 different methods used to diagnose IVL—incidental and nonincidental—result in completely different treatments.MethodsWe conducted a single-center, retrospective study. Our real-life case series included patients pathologically diagnosed with IVL between July 2011 and December 2020. All patients with IVL were divided into 2 groups: an incidental group and a nonincidental group. Medical records of patients, including clinical characteristics, primary treatment, treatment after recurrence, and prognosis, were reviewed.ResultsA total of 39 patients were included in the study, with a median patient age of 47 years. Of the 39 cases, 15 (38.5%) were incidentally diagnosed with only intrapelvic tumors. Among the 24 patients with IVL in the nonincidental group, tumor spread in the inferior vena cava, right heart, and pulmonary artery was identified in 4, 17, and 3 patients, respectively. The most common symptoms were abnormal uterine bleeding in the incidental group and chest distress and dyspnea in the nonincidental group. Among the 15 patients in the incidental group, ovary-preserving surgery was performed in 6 young women (≤40 years old), of whom 3 underwent myomectomy. All 24 patients with IVL in the nonincidental group underwent thrombectomy without uterine or ovary preservation by multidisciplinary surgical treatment. Only 1 patient in each group underwent postoperative adjuvant therapy. During the median follow-up of 36.0 months, recurrence was recorded in 5 (12.8%) cases in the incidental group, with no deaths recorded. Only 1 patient was lost to follow-up. No recurrence was noted in the cases in the nonincidental group. Among the 5 patients who experienced recurrence, 4 received secondary surgical treatment and 1 received hormone therapy. All patients were alive as of this report.ConclusionsPatients with IVL who are diagnosed incidentally have a higher recurrence risk than those who are diagnosed nonincidentally and undergo complete tumor resection. However, patients incidentally diagnosed with IVL can still experience long disease-free survival rates following secondary surgical treatment after recurrence.

Surgical management of BRCA-mutation carriers: A single institution experience

IntroductionThe optimal surgical management of BRCA-mutation carriers remains a subject of debate. To evaluate the appropriateness of breast cancer (BC) treatment, the oncological outcomes of BRCA-mutation carriers treated either with breast-conserving therapy (BCT) or mastectomy were compared. Additionally, the role of bilateral salpingo-oophorectomy (BSO) and potential independent predictive factors for BC treatment were analyzed. Materials and methodsWe retrospectively reviewed all the consecutive patients with a pathogenic germline mutation in the BRCA1/2 genes tested at our Institution between July 2008 and October 2018. Primary end-points were disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS). ResultsThe characteristics and outcomes of 124 BRCA-associated BC patients were analyzed. Overall, 69 (55.7%) and 55 (44.3%) patients underwent BCT and mastectomy, respectively; 72 (58.1%) patients underwent BSO. After a median interval of 13.3 months, 24 patients underwent mastectomy after primary BCT. There was no significant difference in terms of DFS, DDFS, and OS between patients treated with BCT or mastectomy (p = 0.39,p = 0.27,p = 0.265, respectively). Patients treated with BSO had significantly better DDFS and OS compared to ovarian conservation (p = 0.033,p = 0.040, respectively). Three independent predictive factors for BCT were identified: age ≤41 years, genetic testing performed post-operatively, and breast tumors ≤21 mm. ConclusionsOur data suggest that BRCA-mutation carriers treated with BCT present similar oncological outcomes compared to mastectomy. Ovarian preservation decreases survival. Young BRCA-mutated patients with small BCs may not need up-front mastectomy, and BSO might be performed when ovarian cancer risk epidemiologically rises and potential reproductive desire is fulfilled.

Comparison of the Effect on the Ovarian Reserve of Modern Methods of Treatment of Endometrioid Cysts

ObjectiveTo compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve. MethodsThe study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound. ResultsIn the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns. ConclusionIn this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.

OPEC study: An international multicenter study of ovarian preservation in endometrial cancers.

To evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below. A total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged ≤40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed. The median duration of follow-up after EC diagnosis was 59 months (4-187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P =0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan-Meier analysis revealed no difference in either the overall survival (P =0.955) or recurrence-free survival (P =0.068) among patients who underwent OPS, and BSO. OPS appears to be safe without having any adverse impact on survival in women aged ≤40 years with FIGO Stage I EC.

Reproductive Considerations for Patients with Early-Onset Breast Cancer.

Early-onset breast cancer presents various challenges in regard to reproductive health. This review examines the current data pertaining to issues such as fertility preservation, preimplantation genetics, the impact of chemotherapy and endocrine therapy, contraception, and pregnancy in the young breast cancer population. Many breast cancer treatments such as chemotherapy and endocrine therapy can be gonadotoxic or teratogenic. Multiple fertility preservation options are now available to young breast cancer patients, including embryo and oocyte preservation, ovarian tissue preservation, and ovarian suppression with GnRH agonists. In patients with known cancer germline mutations, preimplantation genetic testing is an option. Fertility preservation and other reproductive services are expanding and offer great promise to the early-onset breast cancer community. Providers must be knowledgeable about the various options in order to better empower patients.

Melatonin rescues the development and quality of oocytes and cumulus cells after prolonged ovary preservation: An ovine in vitro model

The preservation of ovaries beyond 7 h dramatically decreases the developmental potential of oocytes to reach the blastocyst stage during in vitro embryo production. Here we investigated the protective effects of melatonin in the ovarian preservation solution after prolonged storage (7 h) in ovine as an animal model. Slaughterhouse adult sheep ovaries were preserved in saline solution for 2 h (Control) and 7 h (Control stress), and with melatonin for 7 h and at different concentrations (Melatonin 10−3, 10−5, 10−7, 10−9, and 10−11 M). First, the fertilizing ability, embryo development rates, and blastocyst quality were investigated. Notably, a concentration of 10−9 M melatonin showed the greatest number (p < 0.05) of blastocysts produced after 7 h of ovary storage (24.75 ± 1.57%) and was comparable (p > 0.05) to that obtained after just 2 h of storage in the untreated Control (30.77 ± 1.57%). Then, oocyte quality parameters showed that, compared to Control stress, Melatonin actively reduced intracellular ROS content, caspase-3 activity, DNA fragmentation, and the abundance of pro-apoptotic transcripts BAX and CASP3, while increasing that of GDF9 and GPX1. In cumulus cells, flow cytometry results showed that melatonin decreased apoptosis and increased mitochondrial activity (p < 0.05). In addition, there was a greater (p < 0.05) abundance of HAS2, STAR, and PTGS mRNA transcripts in Melatonin compared to Control stress. These findings reveal a melatonin-mediated developmental rescue of oocytes against ischemic damage during ovary preservation which represents a promising strategy for successfully producing embryos when prolonged ovarian transport times are required.

Why are women considering ovarian tissue cryopreservation to preserve reproductive and hormonal ovarian function? A qualitative study protocol

IntroductionCurrent fertility preservation options available to women are oocyte cryopreservation (egg freezing) or embryo cryopreservation. A newer procedure, ovarian tissue cryopreservation (OTC), has become available in some centres, which offers...

Postoperative outcomes of Ovarian preserving surgery in reproductive aged women with adnexal torsion.

Background: Adnexal torsion can occur in women of all ages, and delayed diagnosis and treatment leads to decreased blood supply, resulting in necrosis. Especially in children and adolescent, adnexal torsion occurs often due to their anatomy. Although ovarian preserving surgery is recommended for adnexal torsion, oophorectomy has been done because of non-viable ovary, concern of thromboembolism, etc. The purpose of our study was to determine whether ovarian preserving surgery in adnexal torsion is useful in preserving ovarian function without increasing any risk of postoperative complications.

Role of NRF2 in Ovarian Cancer.

Among gynaecologic malignancies, ovarian cancer is one of the most dangerous, with a high fatality rate and relapse due to the occurrence of chemoresistance. Many researchers demonstrated that oxidative stress is involved in tumour occurrence, growth and development. Nuclear factor erythroid 2-related factor 2 (NRF2) is an important transcription factor, playing an important role in protecting against oxidative damage. Increased levels of Reactive Oxygen Species (ROS) activate NRF2 signalling, inducing the expression of antioxidant enzymes, such as haem oxygenase (HO-1), catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD), that protect cells against oxidative stress. However, NRF2 activation in cancer cells is responsible for the development of chemoresistance, inactivating drug-mediated oxidative stress that normally leads to cancer cells’ death. In this review, we report evidence from the literature describing the effect of NRF2 on ovarian cancer, with a focus on its function in drug resistance, NRF2 natural and synthetic modulators and its protective function in normal ovarian preservation.