Oncofertility care and fertility preservation in gynaecological cancer: experience from Singapore's largest tertiary centre.

Abstract

Introduction: Fertility-sparing management is an option for young patients with gynaecological cancers, conferring comparable oncological and favourable reproductive outcomes as standard treatment. With delayed childbearing, the need for fertility-sparing treatment and demand for fertility preservation have increased. We describe the development of an oncofertility model of care at a tertiary hospital, along with our experiences.

Methods: This was a retrospective audit of patients who attended the OncoFertility Clinic, KK Women's and Children's Hospital, Singapore, from 9 September 2020 to 9 March 2023, focusing on the epidemiology and short-term outcomes.

Results: A total of 144 women (median age 31 years) attended the OncoFertility Clinic, of whom 69 (47.9%) had uterine conditions, 65 (45.1%) had ovarian conditions, six (4.2%) had cervical conditions and four (2.8%) had synchronous uterine and ovarian conditions. Among the 45 women on fertility-sparing management for endometrial cancer, 66.7% had complete regression, 11.1% had persistent carcinoma and 22.2% regressed to endometrial hyperplasia. Fourteen women underwent in vitro fertilisation (IVF), resulting in three live births and one miscarriage. Thirty-two women had ovarian cancer, 23 had borderline ovarian tumours, one had Krukenberg tumour and nine had benign ovarian tumours. Fertility-sparing surgery was performed in 90.6% of the ovarian cancer cases. Fertility preservation was offered to twenty women, four of whom proceeded with fertility-preserving procedures. Three patients underwent assisted reproductive therapy. Four patients had surgery for suspected recurrences, but histologies were benign.

Conclusion: A multidisciplinary OncoFertility Clinic provides comprehensive counselling for young women with gynaecological cancers or precancers, addresses their reproductive health concerns, supports their decision-making and ensures timely access to fertility services.