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Semin Reprod Med 2025; 43(01): 003-004
DOI: 10.1055/s-0045-1811634
Preface

Reproduction and Gynecological Cancers

Authors

  • Kirsten Tryde Macklon

    1   Department of Gynecology, Fertility and Obstetrics, Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Kirsten Tryde Macklon, MD, PhD

Although gynecological cancers such as endometrial cancer or ovarian cancer primarily affect women after menopause, it is not uncommon that younger women of fertile age may contract a cancer in their reproductive organs potentially affecting their fertility. It has been shown from previous studies that treatment with chemotherapy or radiation therapy to an area near the ovaries and/or uterus can cause severe damage to fertility and the ability to carry a pregnancy to term.[1] [2] The gonadotoxic effect of chemotherapy is particularly pronounced when using alkylating agents, and this effect is dose-dependent and age-dependent, as older age increases the risk of premature ovarian insufficiency after chemotherapy.[3] This unwanted long-term sequelae can have enormous negative consequences for the patients.[4] [5] Qualitative studies have shown a reduced quality of life in cancer survivors, who have become infertile due to their cancer treatment, and an increased feeling of loss and grief despite an otherwise successful treatment.[6] [7]

With this in view, fertility-sparing treatments have recently been developed with the aim to allow for a pregnancy/pregnancies in young women with a gynecological cancer and a pregnancy wish, provided their cancer is at an early stage and with a favorable prognosis. This applies for cervical cancer, endometrial cancer as well as borderline ovarian tumors (BOTs) and certain types of ovarian cancer.[8] [9] For some of these patients, completion surgery will be offered once she has completed her family, has not been able to become pregnant, or in case of recurrence or progression of the disease.

In this issue of Seminars in Reproductive Medicine the impact of the various gynecological cancers on fertility is discussed, along with what fertility-sparing treatments and fertility-preservation methods are relevant. In the first review by Dr. Sellami the fertility-preservation options for young women with cervical cancer are thoroughly discussed depending on the stage of the disease. In the following review article by Dr. Soltanizadeh the reproductive and obstetrical outcomes in women with radical trachelectomy are reported. Pregnancies after radical trachelectomy require increased follow-up and surveillance and are associated with poorer outcomes, but the risk decreases with less invasive procedures such as conization/simple trachelectomy. Some patients with cervical cancer require treatment with radiation therapy, which can have pronounced negative effects on the uterus, which is also seen in the review by Dr. Van der Kooi. In here, the potential obstetrical complications and their influence on the chance of a healthy delivery are described.

Traditionally, ovarian cancer or BOTs meant bilateral oophorectomy and hysterectomy rendering the patient sterile. However, due to the favorable prognosis of some of these tumors there has recently been a shift toward offering fertility-sparing surgery instead, at least to those with a pregnancy wish. In the review by Dr. de Vos a useful clinical guidance for the provision of reproductive counseling to young women with BOTs is provided. In this review the author also discusses the possible use of ART and the various fertility-preservation tools that might be useful for the patients. In women with ovarian cancer, it is not always possible to avoid definitive surgery, but in the review by Dr. Gracia the possibility for fertility-sparing surgery according to each histological type of neoplasm and stage of disease is thoroughly discussed, which can be very useful for the clinician.

Moving on to endometrial cancer, we have two reviews highlighting why this is a group of patients requiring specific attention. First, as described by Dr. Macklon, young women with endometrial cancer often present themselves with certain problems such as polycystic ovarian syndrome (PCOS), obesity, anovulation, and oligo-/amenorrhea, which in themselves can pose a threat to their fertility. Second, as we see in the review by Dr. Yde, patients should follow a strict treatment program consisting of hysteroscopic tumor resection followed by oral progestins and/or levonorgestrel intrauterine device until complete response is obtained before they can try for a pregnancy, which will prolong their time to pregnancy.

Finally, this issue finishes with a review by Dr. Smith, in which she addresses the question often asked by general practitioners, oncologists, or even the patients themselves: Is it safe to take hormone replacement therapy for survivors of a gynecological cancer? Based on the available literature the authors answer this question in depth for each individual diagnosis.



Publication History

Article published online:
01 October 2025

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