Fertility Preservation in Patients With Gynecologic Cancer—Part I: The Impact of Gynecologic Malignancies on Fertility

Oncofertility was established as a new discipline in the field of obstetrics and gynecology in 2006, developed for the express purpose of preserving, expanding, and restoring the reproductive future of patients with cancer whose treatment may have compromised their fertility.1 Oncofertility as a discipline has far-reaching implications for the treatment of a malignancy and the preservation of fertility, and it spans all subspecialties of oncology. It can be a vital aspect of a patient’s cancer care, whether male or female and regardless of whether the patient has reached reproductive potential. Why is oncofertility just coming to the forefront of gynecologic and oncologic care? Currently, approximately 1 in 400 adults is a cancer survivor. More than 72,200 adolescents, young adults, and adults between the ages of 15 and 39 years were diagnosed with a malignancy in 2006, making cancer the leading cause of disease-related death in that age group.2 By 2030, there will be an anticipated 50% increase in the number of patients diagnosed with cancer. Approximately 45% of those patients will be female, and 10% of this group will be diagnosed with a gynecologic malignancy during their lives.3 As basic science and clinical research progress at an astounding rate, the medical community is able to diagnose malignancies earlier and with less-invasive methods, thus extending disease-free intervals and overall survival. The most common cancers in reproductive-age women are breast cancer, melanoma, cervical cancer, non-Hodgkin lymphoma, and leukemia.4 The 5-year female cancer survival rate is dependent on the stage at diagnosis but is currently 90% for breast cancer, 91% for melanoma, 71% for cervical cancer, 69% non-Hodgkin lymphoma, and 55% for leukemia at first diagnosis.5 For surgically treatable malignancies, the advent of minimally invasive surgery has allowed surgeons the opportunity to offer patients a “lowimpact” approach to surgical therapy, providing faster recovery and return to normal activity. Furthermore, new drug protocols and the development of targeted biologic agents allow for improved outcomes in disease-free survival and overall survival rates in patients diagnosed with cancer before or during their child-bearing years. Maintaining the ability to bear children is of the utmost importance for many patients diagnosed with a malignancy during their fertile years. Noyes et al6,7 stated that 55% of patients said that having a child was the most important event Learning Objectives: After completing this CME activity, the obstetrician/gynecologist should be better able to: 1. Define oncofertility as an emerging discipline in obstetrics and gynecology. 2. Describe the impact of gynecologic cancer treatment on fertility. 3. Describe the initial evaluation of ovarian reserve in a patient with a gynecologic malignancy.