Seminars in reproductive medicine最新文献

Borderline ovarian tumors (BOTs) are commonly diagnosed in women of reproductive age, raising concerns about the impact of surgical management on fertility. This review explores the role of fertility-sparing surgery (FSS) and fertility preservation (FP) strategies in young women diagnosed with BOTs. While FSS carries a slightly higher risk of recurrence compared to bilateral salpingo-oophorectomy, there is growing evidence supporting the safety of FSS, with no adverse effects on 10-year overall survival. In light of this, recent multidisciplinary guidelines recommend FSS for BOT at all stages. A significant proportion of women with BOTs report infertility prior to diagnosis, suggesting a possible pathophysiological link between reduced reproductive fitness and the development of BOT. The potential association between ovarian stimulation (OS) and an increased risk of BOT remains controversial, with current evidence failing to establish a definitive causal link. For women with recurrent stage I BOT and no evidence of peritoneal disease on imaging, OS followed by oocyte retrieval is a viable option before definitive surgery. Notably, a history of BOT does not significantly affect pregnancy outcomes following IVF. FP counseling is essential to tailor treatment plans that address both oncological and reproductive needs in patients undergoing FSS for BOT.

Radical trachelectomy has become an accepted fertility-sparing treatment for patients with early-stage cervical cancer. Despite its oncological safety, radical trachelectomy is associated with persistent sexual dysfunction and voiding issues, complicating long-term quality of life. Fertility outcomes demonstrate overall pregnancy rates ranging from 25.7-73%, with less radical procedures such as conization and simple trachelectomy reporting higher pregnancy rates compared with radical trachelectomy. Assisted reproductive treatments might be necessary due to complications such as cervical stenosis. During pregnancy, there is an elevated risk of miscarriage, preterm delivery, and premature rupture of membranes due to cervical shortening. However, less radical fertility-sparing procedures such as conization and simple trachelectomy demonstrate lower preterm delivery rates. Prophylactic cerclage, as well as close monitoring of cervical length during pregnancy, is essential, and cesarean section remains the recommended method of delivery. Recent studies suggest that less radical fertility-sparing procedures may provide comparable oncological safety while reducing complications, highlighting the need to reevaluate surgical approaches. This review provides an overview of reproductive and obstetrical outcomes in patients after treatment for early-stage cervical cancer with trachelectomy. This review additionally emphasizes the need for further research to refine fertility-sparing strategies.

Ovarian cancer, a leading cause of gynecological cancer mortality, often affects women of reproductive age. Fertility-sparing surgery (FSS) has emerged as a viable option for selected patients with early-stage ovarian cancer who wish to preserve fertility. Patient and tumor selection criteria focus on preserving ovarian function and reproductive potential without compromising oncological safety. Optimal candidates are young, premenopausal women with disease confined to one ovary and favorable prognostic factors such as early FIGO stage, specific histologic subtypes, and good overall health. FSS typically involves unilateral salpingo-oophorectomy while preserving the uterus and contralateral ovary, achieving survival outcomes comparable to radical surgery in early-stage low-grade tumors. However, its application in higher-risk cases requires cautious evaluation. Multidisciplinary management, involving gynecologic oncologists and reproductive specialists, is essential for successful implementation of FSS, ensuring both oncological safety and preservation of reproductive potential. Long-term follow-up is critical to monitor recurrence and assess reproductive outcomes. Pregnancy after FSS is feasible, with timing guided by cancer type, stage, and individual circumstances. This review summarizes the current knowledge on FSS in ovarian cancer, emphasizing its relevance and the need for further research to refine patient selection and ensure optimal outcomes.

Treatment of gynecological cancers often induces a premature menopause. Plus advancing treatments mean more gynecological cancer survivors are living to physiological menopause. Hormone replacement therapy (HRT) has proven substantial long-term benefits in physiological menopause and premature menopause particularly. We aimed to evaluate the current evidence on the safety of HRT in gynecological cancer survivors to help clinicians counsel these patients. HRT is not contraindicated in most gynecological cancer survivors, as evidence available often shows safety or even benefit with HRT use. However, HRT is contraindicated in a few cancers-in low-grade serous ovarian carcinoma, high-risk endometrial carcinoma, and some uterine sarcomas. Caution is advised in high-grade serous, late-stage endometrioid, and granulosa ovarian carcinomas when there is substandard evidence demonstrating safety, but also a theoretical harm present. Due to deficient large randomized controlled trials and methodological biases being present in most studies, HRT use needs to be individualized in most cancers-ovarian carcinomas, endometrial carcinomas, and cervical adenocarcinomas. Justification for HRT use is strong, and HRT is not contraindicated in most gynecological cancers due to largely reassuring evidence. More robust long-term data are needed for further reliable guidance for clinicians and patients.

Cervical cancer (CC) is one of the most common malignancies affecting young women of childbearing age, making fertility preservation (FP) a pivotal consideration in its management. The feasibility of FP techniques depends on the cancer stage and oncological treatments. In early-stage CC, fertility-sparing surgery can be offered for young patients wishing to preserve fertility without compromising oncological safety. Neoadjuvant chemotherapy followed by fertility-sparing surgery is an alternative for patients with nonmetastatic locally advanced disease and negative lymph node status. Nevertheless, for patients with locally advanced disease requiring radical hysterectomy or pelvic radiotherapy, FP can be performed using oocyte, embryo, or ovarian tissue cryopreservation. For these patients, future pregnancy is possible through surrogacy. Recently, uterine transposition has been proposed as an alternative to preserve uterine anatomy to prevent uterine radio-induced damage and avoid surrogacy. This review provides a comprehensive overview of the FP options available for young patients with CC.

Radiotherapy is an effective treatment for various cancers, but it can cause significant side effects on various organ systems, including the reproductive organs, which is a major concern for women of reproductive age. A well-known long-term effect of oncological treatment is premature ovarian insufficiency. Another critical but sometimes overlooked organ at risk in female cancer survivors is the uterus. This review focuses on the impact of radiotherapy on uterine physiology, highlighting key issues such as the development of fibrosis and loss of elasticity, vascular damage, and hormonal disruption, all of which can compromise uterine function. These changes can negatively impact fertility and pregnancy outcomes, such as miscarriage, preterm birth, and low birth weight. Limited evidence is also available suggesting that radiotherapy may affect endometrial receptivity and contribute to abnormal placentation. We conclude by discussing strategies aimed at mitigating the damage caused by radiotherapy, such as fertility-preserving treatments and hormonal interventions. A thorough understanding of these effects is essential for healthcare providers to offer informed support to women who wish to maintain their fertility and have children following cancer treatment.

Nearly all (97%) the studies in the recent literature addressing the relationship between environmental hazards and male fertility use at least one of three common study design strategies: recruiting men presenting to fertility centers (53%), evaluating only one environmental exposure at a time (87%), and using conventional semen quality parameters as the only study outcome (45%). While each of these study design features is logical, defensible, and has generated an enormous amount of information regarding the impact of the environment on male reproductive function, they may also be barriers to furthering our understanding. In this article, we examine in which ways each of these study design features limits progress on male fertility research and propose strategies to go beyond them. Rather than abandoning these strategies, we propose that they should be a starting point instead of the default strategy for the future of male fertility research to more fully understand how men's environmental exposures impact human fertility and human reproduction more generally.

Per- and polyfluoroalkyl substances (PFASs) are persistent environmental contaminants found in human tissues and persist in the environment, posing significant risks to reproductive health. This review examines the impact of PFAS exposure on male reproductive health, with a focus on sperm epigenetics. PFASs disrupt endocrine function by altering key reproductive hormones and impairing sperm motility, quality, and viability. Epidemiologic and animal studies highlight inconsistent yet concerning associations between PFAS exposure and semen parameters, as well as altered gene expression and DNA methylation patterns. Moreover, PFAS exposure during critical windows of development has been linked to differential impacts on male versus female pubertal development, cognitive outcomes, and reproductive physiology, emphasizing the complexity of PFAS interactions. This comprehensive analysis highlights the need for continued research into the mechanisms by which PFASs influence reproductive health and development with potential implications for sperm epigenetics. The review emphasizes the importance of understanding the epigenetic mechanisms behind these disruptions, particularly DNA methylation and its role in heritable changes. Investigating the epigenetic modifications driven by PFAS exposure is crucial for elucidating the mechanisms by which these chemicals influence reproductive health. Future research should focus on understanding these epigenetic changes in both immediate fertility outcomes and transgenerational health risks.