Journal of Reproductive Endocrinology & Infertility

Description

It is essential for residents-in-training to be equipped with the knowledge of tried-and-true methods for preserving fertility in order to serve as primary reproductive healthcare providers. The study focused on the obstetrics and gynecology knowledge, attitudes, and perceptions of Filipino residents regarding fertility preservation. The option to pursue one's desire for children is a fundamental human right. Gender affirming care may make it harder for Transgender and Gender-Diverse (TGD) people to have children because of how it affects their reproductive organs. We systematically included 76 descriptions of varying quality: desire to be parents and have children; counseling and use as a fertility treatment; and the outcomes of TGD patients' fertility preservation options. The majority of people with TGD stated that they desired children. Utilization rates of fertility preservation were low as a result of the numerous obstacles that prevent individuals from pursuing fertility preservation. The most common methods for preserving fertility are sperm banking through masturbation and oocyte vitrification. Oocyte vitrification was successful even after testosterone was stopped. When banking sperm, sperm analyses revealed a lower quality than male samples and an uncertain recovery of spermatogenesis after treatment was stopped, even prior to treatment with gender-affirming hormones.

Molecular Detection

Endometrial Cancer (EC), the fourth most common type of cancer among women worldwide, is on the rise annually. In 10%–15% of young patients, EC is identified. Patients of childbearing age with early endometrial cancer or atypical hyperplasia may elect to have their uterus removed during childbirth. When it comes to assisting these patients in safely becoming pregnant as soon as possible, reproductive doctors and oncologists face a significant obstacle. This article will discuss the most recent advancements in conservative treatment, candidates for fertility preservation, the use of molecular detection, the fertility outcome, and follow-up treatment with the intention of stimulating additional thought. In many mammalian species, Small Antral Follicle (SAF) in vitro matured oocytes are successfully used for reproduction. Due to the unique regulation of oocyte maturation in women and the limited availability of immature oocytes, humans are the only exception. With the introduction of cryopreservation of the ovarian cortex for the purpose of preserving fertility, immature oocytes from SAF in the medulla are now available for the development of IVM, according to actual human studies. Recent findings in support of developing human IVM include oocyte diameter, follicle size from which immature oocytes are collected, the required concentration of FSH and LH to accelerate IVM, and secretions of factors from the Cumulus-Oocyte Complex (COC) that influence oocyte maturation. Studies in human granulosa cells and follicle fluid collected during the final maturation of follicles in vivo have also revealed a number of signal transduction pathways and hormone concentrations that are active under physiological conditions. New candidates and methods for enhancing the current IVM platform are provided by this.

In addition, it has been hypothesized that the tiny droplet of culture medium that is used for IVM could be used to accelerate the nuclear and cytoplasmic maturation of oocytes, mimicking the hormonal environment inside a follicle that is made by somatic cells and the oocyte in vivo. Our collective hope for research in the future is an IVM platform for humans that are as effective as those for other mammalian species. In early breast cancer patients, it has been demonstrated that systemic treatment strategies like chemotherapy, endocrine therapy, targeted therapy, and, more recently, immunotherapy significantly increase survival rates. However, this gain frequently comes at the expense of increased toxicity, necessitating a greater focus on issues related to survivorship, such as preserving young women's fertility. According to the guidelines that are currently in place, all cancer patients who have been diagnosed at a reproductive age should receive oncofertility counseling. The possibility of gonad toxicity from cancer treatments and the availability of fertility preservation methods ought to be the primary focus of counseling. However, numerous surveys demonstrate that these recommendations have not been effectively implemented. A summary of the evidence that is currently available on oncofertility will be provided by this review to healthcare professionals who are involved in the treatment of young women who have breast cancer. There are two viable options for preserving fertility: cryopreservation of oocytes and embryos and cryopreservation of ovarian tissue. Consider patient, disease, and treatment characteristics carefully when offering these strategies. During chemotherapy, every premenopausal woman should have the opportunity to discuss and receive ovarian function preservation from gonadotropin-releasing hormone agonists if she is concerned about developing premature ovarian insufficiency or wants to keep her fertility.

Fertility Preservation

Advances in early detection and treatment have maintained a decline in mortality despite an increase in cancer incidence worldwide. Two types of cancer treatments, chemotherapy and radiotherapy, can affect survivors' reproductive capacity by causing premature ovarian failure and infertility, which can cause significant psychological distress and lower quality of life. As a result, the goal of this article is to provide an overview of the effects of cancer treatment on fertility, the options for fertility preservation, and the factors that influence whether or not women with cancer use fertility preservation. In addition, we discuss the practices, outcomes, and availability of fertility preservation services in low-, middle-, and high-income nations, as well as the practical steps that can be taken to improve global access to oncofertility care for women with cancer. Advances in cancer treatment that have resulted in significant increases in long-term survival rates have raised awareness of the numerous medical and social challenges faced by cancer survivors. The rising trend of delaying childbearing and the higher proportion of patients who have not completed their family at the time of diagnosis raise the demand for an optimized fertility preservation service. Women and transgender men are particularly concerned about the potential effects on fertility. Fertility preservation for this group after a cancer diagnosis is a rapidly expanding field of reproductive medicine; however, the availability of this treatment frequently varies by region.

Advances in oocyte cryopreservation and, more recently, ovarian tissue cryopreservation have significantly expanded this field of fertility care. There were few treatment options in the past. This review will cover all cisgender women, but not necessarily all transgender and non-binary people. There are distinct transgender fertility preservation considerations that go beyond the scope of this paper. Every person who possesses female reproductive organs should be given the opportunity to discuss preserving their fertility prior to beginning any gonad toxic treatment. Their choice of anticancer treatment and treatment adherence may suffer if this is not done. As the demand for these treatment options grows, there are currently few networks streamlined around offering this service. It is recognized that these complex patients require specialist management within recognized care pathways. We want to talk about some of the unique challenges that come with providing cutting-edge services, especially in the volatile financial environment of the COVID-19 pandemic. Fertility Preservation (FP) is now required as an essential part of the treatment plan for patients with cancer or pathology who are at risk of gonad toxicity. As a direct consequence of this, clinical-biological platforms such as the PREFERA platform have come into existence with the intention of developing and enhancing this method of practice. Breast cancer is still the most common cancer that women are diagnosed with, and it is the cancer that causes the most Disability-Adjusted Life Years (DALYs) to be lost than any other cancer. However, improvements in treatments have led to an increase in survival rates, reviving interest in quality of life following treatment. Reproductive-age cancer survivors are concerned about their capacity to conceive. This article examines the significance of oncofertility services for breast cancer patients as well as fertility preservation options like oocyte/embryo cryopreservation, GnRH agonist therapy, and ovarian tissue cryopreservation. The most recent data support the safety of pregnancy following breast cancer treatment, in terms of baby safety and long-term clinical outcomes; However, these pregnancies must be closely monitored due to the slightly higher prevalence of obstetrical and birth complications. For fertility preservation and desire for pregnancy to be central components of the multimodal management of breast cancer in young women, a multidisciplinary approach that is based on close collaboration between oncologists and fertility specialists is required.