Seminars in reproductive medicine最新文献

Progestogens in Menopausal Hormone Therapy: A Double-Edged Sword. 绝经期激素治疗中的孕激素：一把双刃剑。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-05-16 DOI: 10.1055/s-0045-1809186

Olavi Ylikorkala, Johanna M Joensuu, Heli Siitonen, Tomi S Mikkola

{"title":"Progestogens in Menopausal Hormone Therapy: A Double-Edged Sword.","authors":"Olavi Ylikorkala, Johanna M Joensuu, Heli Siitonen, Tomi S Mikkola","doi":"10.1055/s-0045-1809186","DOIUrl":"https://doi.org/10.1055/s-0045-1809186","url":null,"abstract":"Progestogens (norethisterone acetate, medroxyprogesterone acetate, dydrogesterone, micronized progesterone, levonorgestrel, drospirenone, and trimegestone) added to estrogen for endometrial protection are reviewed. They can be given orally or vaginally, norethisterone acetate can also be given transdermally, and levonorgestrel can be given through the intrauterine route. Sequential use of progestogens protects the endometrium if exposure lasts for at least 12 days/month; longer intervals are not safe. Continuous use of progestogens, whether oral, transdermal, or intrauterine, provides the most effective protection. Progestogen addition is accompanied with significant elevations in breast cancer risk, the largest drawback of progestogen use, and dydrogesterone, micronized progesterone, and a levonorgestrel intrauterine device may be safest in this regard. Progestogens also double deep vein thrombosis risk and diminish the positive effect of estrogen on colorectal cancer and vascular health. Recent data imply a neutral effect of progestogens in combination with estrogen on Alzheimer's disease risk, but the risk of vascular dementia is decreased. In conclusion, progestogens are a double-edged sword, effectively protecting the endometrium but causing several side effects and reducing many estrogen-induced benefits. With modern endometrial diagnostic tools, the safety of low-dose unopposed estrogen regimens should be assessed in a prospective controlled trial in women with an intact uterus.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Impact of Radiotherapy on the Uterus and Its Implications for Pregnancy. 放疗对子宫的影响及其对妊娠的影响。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-05-14 DOI: 10.1055/s-0045-1809040

Anne-Lotte L F van der Kooi, Wendy van Dorp

{"title":"The Impact of Radiotherapy on the Uterus and Its Implications for Pregnancy.","authors":"Anne-Lotte L F van der Kooi, Wendy van Dorp","doi":"10.1055/s-0045-1809040","DOIUrl":"https://doi.org/10.1055/s-0045-1809040","url":null,"abstract":"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.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fertility-Sparing Treatment in Young Women Diagnosed with Endometrial Cancer: Review of Safety, Pregnancy Outcomes, and Current Recommendations. 诊断为子宫内膜癌的年轻女性保留生育能力的治疗：安全性、妊娠结局和当前建议的回顾。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-05-02 DOI: 10.1055/s-0045-1809041

Anna Mathilde Yde, Signe Frahm Bjørn, Kirsten Louise Tryde Macklon

{"title":"Fertility-Sparing Treatment in Young Women Diagnosed with Endometrial Cancer: Review of Safety, Pregnancy Outcomes, and Current Recommendations.","authors":"Anna Mathilde Yde, Signe Frahm Bjørn, Kirsten Louise Tryde Macklon","doi":"10.1055/s-0045-1809041","DOIUrl":"https://doi.org/10.1055/s-0045-1809041","url":null,"abstract":"With the rising incidence of endometrial cancer, including among young women, and the trend of increasing age among first-time mothers, the need for safe and effective fertility-sparing treatments for endometrial cancer and atypical endometrial hyperplasia has become crucial. Focusing on studies from the past decade, this review synthesizes findings on the safety and outcomes of fertility-sparing treatments for endometrial cancer and atypical endometrial hyperplasia and provides an overview of current treatment recommendations. Fertility-sparing treatment, including hysteroscopic tumor resection followed by hormonal therapy with oral progestins and/or the insertion of a levonorgestrel-releasing intrauterine device, can be offered to a selected group of women of reproductive age who wish to preserve their ability to become pregnant in the future. The safety of conservative treatment for women diagnosed with Stage 1A, Grade 1 endometrial cancer without myometrial invasion is high; however, current evidence on the safety of this treatment for women with Grade 1, Stage 2 endometrial cancer is limited. Even though the success rate in terms of pregnancies and deliveries is high, it is not as high as in the general population, and women should be informed of the potential need for assisted reproductive technology.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Candidates for Fertility-Sparing Surgery in Case of Ovarian Cancer. 卵巢癌保留生育能力手术的候选者。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-04-28 DOI: 10.1055/s-0045-1808243

Myriam Gracia, María Alonso-Espías, Ignacio Zapardiel

{"title":"Candidates for Fertility-Sparing Surgery in Case of Ovarian Cancer.","authors":"Myriam Gracia, María Alonso-Espías, Ignacio Zapardiel","doi":"10.1055/s-0045-1808243","DOIUrl":"https://doi.org/10.1055/s-0045-1808243","url":null,"abstract":"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.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

After Radical Trachelectomy: Reproductive and Obstetrical Outcomes of Fertility-Sparing Surgery for Cervical Cancer. 根治性气管切除术后：保留生育能力的宫颈癌手术的生殖和产科结果。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-04-17 DOI: 10.1055/s-0045-1808092

Sinor Soltanizadeh, Mikkel Rosendahl, Ligita Paskeviciute Frøding, Signe Frahm Bjørn, Berit Jul Mosgaard, Claus Høgdall

{"title":"After Radical Trachelectomy: Reproductive and Obstetrical Outcomes of Fertility-Sparing Surgery for Cervical Cancer.","authors":"Sinor Soltanizadeh, Mikkel Rosendahl, Ligita Paskeviciute Frøding, Signe Frahm Bjørn, Berit Jul Mosgaard, Claus Høgdall","doi":"10.1055/s-0045-1808092","DOIUrl":"https://doi.org/10.1055/s-0045-1808092","url":null,"abstract":"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.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Safety of Hormone Replacement Therapy in Gynecological Cancer Survivors. 激素替代疗法在妇科癌症幸存者中的安全性。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2025-03-18 DOI: 10.1055/s-0045-1802985

Victoria Dodhia, Ying Cheong

{"title":"The Safety of Hormone Replacement Therapy in Gynecological Cancer Survivors.","authors":"Victoria Dodhia, Ying Cheong","doi":"10.1055/s-0045-1802985","DOIUrl":"10.1055/s-0045-1802985","url":null,"abstract":"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.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Environmental Hazards and Male Fertility: Why Don't We Know More? 环境危害与男性生育能力：为什么我们知之甚少？

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2024-12-01 Epub Date: 2025-02-10 DOI: 10.1055/s-0044-1801746

Makiko Mitsunami, Jaime E Hart, Jorge E Chavarro

引用次数: 0

Environment and Reproduction. 环境与繁殖。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2024-12-01 Epub Date: 2025-03-10 DOI: 10.1055/s-0044-1800828

Audrey J Gaskins, Lidia Minguez-Alarcon

引用次数: 0

The Environment and Reproduction. 环境与繁殖。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2024-12-01 Epub Date: 2025-03-10 DOI: 10.1055/s-0044-1801397

Kathleen M Hoeger, Terhi T Piltonen

引用次数: 0

PFAS Exposure and Male Reproductive Health: Implications for Sperm Epigenetics. PFAS暴露与男性生殖健康：对精子表观遗传学的影响。

IF 1.9 3区医学

Seminars in reproductive medicine Pub Date : 2024-12-01 Epub Date: 2025-01-09 DOI: 10.1055/s-0044-1801363

DruAnne L Maxwell, Michael C Petriello, J Richard Pilsner

{"title":"PFAS Exposure and Male Reproductive Health: Implications for Sperm Epigenetics.","authors":"DruAnne L Maxwell, Michael C Petriello, J Richard Pilsner","doi":"10.1055/s-0044-1801363","DOIUrl":"10.1055/s-0044-1801363","url":null,"abstract":"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.","PeriodicalId":21661,"journal":{"name":"Seminars in reproductive medicine","volume":" ","pages":"288-301"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142954272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0