What are the indications?

The risk of infertility needs to be assessed at the time of diagnosis of the disease, in order to propose the most appropriate fertility preservation methods in relation to subjects characteristics (age, ovarian reserve) and diagnosis itself.

Indeed, there are a number of indications for fertility preservation, divided into malignant, non-malignant and elective.

Malignant indications

Overall cancer death rates in children and young adults have been in constant decline for the last four decades, leaving a growing population of adult survivors of previous malignancy. Most cancer treatments, including chemotherapy and radiotherapy, are very harmful to the gonads and can accelerate natural age-related fertility decline, resulting in an increased risk of premature ovarian insufficiency. 

The most common oncological indications are hematological malignancies (Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and leukemia) and breast cancer due to their high incidence among the younger population. Other indications include sarcoma, central nervous system tumors, ovarian tumors, which all may need either chemo- and/or radiotherapy, with significantly increasing risk of long-term fertility issues.

Fertility preservation should be discussed also in case of pelvic gynecological cancers like endometrial cancer or cervical cancer, or to the intestine like colorectal cancer may need to fertility preservation due to the detrimental effect of their treatments on future fertility. 

The standard treatment for gynecological malignancies to the uterus involves non-conservative surgery. However, an increased survivorship after gynecological cancers in young women over the last decades demanded the development of a novel fertility-sparing surgical approach and tailored for each and every type of malignancy. 

Fertility-sparing surgery involves preservation of the uterus and of at least one part of the ovary. This approach can be proposed to children and young women with a wish of future pregnancy, who are diagnosed with gynecological cancer (of the uterus or the ovaries) at an early-stage and with favorable prognosis, without increasing their risk of disease persistence or recurrence.