This special issue contains valuable articles highlighting various aspects of the relationship between infertility and gynecologic oncology. Magdy and El-Bahrawy[4] specifically review the role of the fallopian tube in infertility and gynecologic oncology.
ENDOMETRIOSIS AND CANCER
There is an increased incidence of ovarian cancer after menopause when there is a relative predominance of androgens over estrogens. Furthermore, there is increasing evidence that ovarian and uterine carcinomas express gonadotropin receptors, suggesting the possibility of a direct tumorigenic role for FSH and LH [29–32].
PCOS AND GYNECOLOGICAL NEOPLASIA
However, a large-scale British study confirms that the standardized mortality rate for ovarian cancer in these patients does not exceed 0.39 (95% CI). There is insufficient evidence to implicate PCOS in the development of vaginal, vulvar and cervical cancer[34].
OVARIAN DYSGENESIS, GENETIC INFERTILITY AND CANCER
FERTILITY DRUGS AND GYNECOLOGICAL CANCER
CONCLUSION
Polycystic ovary syndrome and increased number of polyps as risk factors for malignant transformation of endometrial polyps in premenopausal women. Polycystic ovary syndrome increases the risk of endometrial cancer in women younger than 50 years: an Australian case study.
INTRODUCTION
Recently, several studies have suggested a role for the fallopian tube in the development of ovarian carcinoma, mainly high-grade serous carcinoma.
THE FALLOPIAN TUBE AND INFERTILITY
Fallopian tube: Its role in infertility and gynecological oncology
Abstract
The fallopian tube itself acts as a storage place for sperm, as the endosalpinx provides a favorable environment for sperm. Tubal factor infertility may result from complete blockage of the distal end of the fallopian tube (hydrosalpinx) due to a sexually transmitted disease (STD), surgery or other intra-abdominal conditions, non-gynecological abdominal-pelvic infection, endometriosis or a congenital defect.
CONGENITAL ANOMALIES AND GENETIC DISORDERS
This complex movement also aims to stir the tubal contents to ensure mixing of gametes and embryos with tubal secretions[6]. Peritubal adhesions or damage to the lining of the tube can impair tubal mobility, oocyte retrieval and/or sperm and embryo transport[7].
INFLAMMATORY DISEASES
In chronic salpingitis, the tubal fimbriae attach to the ovary and adjacent tissues with subsequent obliteration of the ostium, leading to a hydrosalpinx or pyosalpinx. Late stages of chronic salpingitis can result in fibrous obliteration of the entire tubal lumen[16].
ENDOMETRIOSIS
Tuberculous salpingitis is uncommon in the Western world, but is prevalent in developing countries [24] and accounts for much less than 1% of cases in the United States, whereas it accounts for nearly 40% of cases in India [1]. SIN or tubal adenomyosis is a pseudoinfiltrative lesion consisting of diverticula of the tubal epithelium in the isthmus.
ECTOPIC PREGNANCY
It is associated with infertility in approximately half of patients[17] by interfering with the upward migration of sperm[31].
THE FALLOPIAN TUBE AND GYNECOLOGICAL ONCOLOGY
ROLE OF THE FALLOPIAN TUBE IN TYPE
Ⅰ OVARIAN SURFACE EPITHELIAL TUMORS
Ⅱ OVARIAN SURFACE EPITHELIAL TUMORS
Thus, the fallopian tube appears to be a strong player in both infertility and gynecological neoplasia. A new morpho-functional classification of the Fallopian tube based on its three-dimensional myoarchitecture.
Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma
DIAGNOSIS
STAGING
HORMONAL TREATMENTS
FOLLOW UP
Long-term oncological outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Treatment with medroxyprogesterone acetate plus levonorgestrel-releasing intrauterine system for early-stage endometrial cancer in young women: a single-arm, prospective, multicenter study: The Korean Gynecologic Oncology Group Study (KGOG2009).
Impact of pelvic radiotherapy on the female genital tract and fertility preservation measures
The impact of pelvic radiotherapy on fertility of cervical carcinoma cases occurring in women under 45 years of age was 53%[1]. Treatment of early-stage cervical carcinoma (International Federation of Gynecologic Oncologists, FIGO stages Ⅰ and ⅡA of the cervix) is radical surgery, although radical radiotherapy is equally effective[7].
IMPACT OF PELVIC RADIOTHERAPY ON THE FEMALE GENITAL TRACT
Furthermore, the prepubertal uterus is believed to be more vulnerable to the effects of pelvic irradiation[14]. There are few studies assessing uterine changes after high-dose pelvic radiotherapy in adults.
ADVERSE PREGNANCY OUTCOMES IN WOMEN TREATED WITH PELVIC
In postmenopausal women, irradiation did not significantly alter the MR imaging of the uterus. After radiotherapy for cervical cancer, the very high doses delivered to the endometrial surface from brachytherapy are thought to cause complete destruction of the basal layer of the endometrium.
MEASURES TO PRESERVE FERTILITY PRIOR TO RADIOTHERAPY
Ovarian tissue cryopreservation is the only option for prepubertal girls, patients who require treatment without delay or when ovarian stimulation is contraindicated due to hormone sensitive cancers [5,74-76]. However, gestational surrogacy is the only option for women with preserved embryos, or preserved ovarian tissue, but who have uterine compromise secondary to radiotherapy [76].
FUTURE PROSPECTS
Pregnancy outcome of childhood cancer survivors: a report from the Childhood Cancer Survivorship Study. Preservation of ovarian tissue in the treatment of cervical carcinoma by radical surgery.
Chemotherapy for gynaecological malignancies and fertility preservation
Treatment of gynecological malignancies includes three treatments that may contribute to fertility loss; surgery, pelvic radiotherapy and chemotherapy, making fertility preservation a particularly challenging area. In addition, fertility preservation techniques such as embryo cryopreservation can be performed prior to surgery and chemotherapy, allowing for the possibility of a surrogate pregnancy.
CHEMOTHERAPY INDUCED INFERTILITY
A multicenter retrospective study examined 52 patients with stage Ⅰ epithelial ovarian cancer who were treated with fertility-sparing surgery between 1965 and 2000. From these studies, it is clear that there is a realistic expectation of pregnancy after chemotherapy for ovarian cancer where fertility-sparing surgery is possible.
PRESERVING FERTILITY
However, improved techniques led to increasing success in cryopreservation in the second half of the 1990s, and live birth following oocyte cryopreservation and ICSI was reported in 1997[28], followed by several other reported successes. As discussed above, ovarian stimulation must begin within the first three days of the menstrual cycle, and this technique risks delaying the onset of chemotherapy by as much as 5 weeks.
OVARIAN SUPPRESSION WITH GNRH ANALOGUES
Furthermore, the procedure involves the use of general anesthesia for both the ovarian biopsy and subsequent reimplantation, with all the associated risks.
AVAILABILITY AND FUNDING
Autotransplantation of cryopreserved ovarian tissue in 12 women with chemotherapy-induced premature ovarian failure: the Danish experience. Ovarian protection with goserelin during adjuvant chemotherapy for premenopausal women with early breast cancer (EBC).
Ovulation induction in the gynecological cancer patient
However, survival rates for women with cancer have increased dramatically in recent decades, reflecting improved diagnosis and treatment. The purpose of this review is to discuss ovarian stimulation for fertility preservation in women with gynecological cancer.
CANCERS IN REPRODUCTIVE AGE
The effect will depend on the age of the patient and on the type and dose of chemotherapeutic agent. The effect of radiation therapy depends on the patient's age, location, type and dose of radiation[18].
INDUCTION OF OVULATION IN
The oncological treatment of gynecological cancers is used to end the patient's fertility potential due to surgical removal of the reproductive organs that harbor the malignancy. Alkylating agents appear to pose the greatest risk of ovarian failure due to the profound loss of primordial follicles[17].
GYNECOLOGICAL CANCER PATIENTS
Endometrial cancer is considered the most common gynecologic malignancy in the United States according to the American Cancer Society and the fourth most common cancer in women, behind only breast, lung, and colorectal cancer[8]. However, recently fertility-sparing management of such cancers has been developed to safely remove or treat the cancer without removing the reproductive organs.
THE CHALLENGES
The use of low dose gonadotropins (FSH 150 U/d) in the GnRH antagonist protocol in combination with letrozole has been found to lead to acceptable oocyte yield while maintaining low estradiol levels [36]. However, the use of higher doses of gonadotropins (FSH 150-375 U/d) in a GnRH antagonist protocol in combination with letrozole was recently studied by Ben-Haroush et al [41].
SAFETY OF OVARIAN STIMULATION IN CANCER PATIENTS
Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. GnRH agonist efficacy for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation.
Cost effective evidence-based interventions to manage obesity in pregnancy
Women who are obese at conception and subsequently have excessive GWG experience the highest rates of complications. Expensive strategies to manage obesity during pregnancy are not logistically or financially feasible given the volume of cases to be treated.
PREGNANCY PLANNING IN PRIMARY CARE
In 2009, the Institute of Medicine revised its recommendations for GWG and advised that overweight and obese women should limit gains to 6.8-11.3 kg and 4.9-9.0 kg, respectively[2]. The high prevalence of women who are overweight or obese at conception, and of women who have excessive GWG during pregnancy, means that every woman presenting for antenatal care is at risk of obesity-related complications.
ANTENATAL CARE AND THE HOSPITAL RESPONSIBILITY
If motivated pregnant obese women will not attend aerobics classes despite free gym membership, physical testing and personal coaching, and given the cost of the intervention to the public health budget, then meaningful changes in health status at a population level are unlikely to be achieved will become The other public health interventions that should be implemented in antenatal care is to advise all women to take Folic Acid and Iodine supplements.
POSTNATAL CARE AND LINKING BACK INTO THE COMMUNITY
Randomized trial of the effects of nutritional counseling on gestational weight gain and glucose metabolism in obese pregnant women. Effect of a lifestyle intervention on dietary habits, physical activity and gestational weight gain in obese pregnant women: a randomized controlled trial.
Effect of gynecologic oncologist availability on ovarian cancer mortality
Ovarian cancer (OC) is the most lethal gynecologic malignancy and the fifth leading cause of cancer death among women in the United States[1]. Our objective was to examine the geographic relationship between GO providers and OC mortality, in order to determine the effect that geographic availability of specialty care has on mortality, and to add further evidence for the association between receipt of GO care and OC outcomes.
MATERIALS AND METHODS
Mapping and statistical analyzes were used to assess the association between county-level death rates and distance to the nearest GO. A logistic regression model was fit to the data to determine the association between distance to a GO and high county death rate, after adjusting for other county-level variables.
RESULTS
These physicians were less prevalent in counties 50 miles or more from a GO practice compared to those within 24 miles of a GO practice. Overall, higher percentages of women aged 65 years and older were found in counties farther from GO practice sites compared with those within 24 miles of a GO practice site.
DISCUSSION
A similar coordinated approach may help mitigate the negative outcomes (higher OC mortality) that geographic barriers to GO care have in the United States. To our knowledge, it is the first to link geographic proximity to GO with lower OC mortality in the United States.
ACKNOWLEDGMENTS
Given the lack of geographic availability of GO in many areas of the United States, an emphasis on OC prevention may be suggested. Future studies examining the effects of GO distribution on OC mortality at the individual level may help further identify barriers to quality OC care in the United States.
COMMENTS
Impact of surgeon specialty on processes of care and outcomes of patients with ovarian cancer. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized controlled trial.
Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy
Keynote: We studied total bile acid (TBA) concentration in maternal, fetal, and amniotic fluid and its association with fetal surfactant, surfactant protein A, amniotic lamellar body, and fetal lung development. As maternal bile acid concentration increases, fetal blood bile acid increases and causes fetal lung development delay[15].
Simulation training in contemporary obstetrics education
Residents were not expected to complete the delivery due to simulator limitations. Scale bars should be used instead of magnification factors, with the length of the bar defined at the leg end rather than on the bar itself.
