The reproductive prognosis of women considering fertility preservation for early stage endometrial cancer
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The reproductive prognosis of women considering fertility preservation for early stage endometrial cancer Pietro Gambadauro1,2,3 Received: 23 July 2018 / Accepted: 14 December 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Keywords Assisted reproductive technologies · Endometrial cancer · Fertility preservation · Hysteroscopy · Infertility · Progestins Dear Editors, The recent survey by La Russa et al. [1], despite low participation, gives an interesting overview of the attitude of European gynaecological oncologists towards conservative management of early endometrial cancer (CM) in young women. The study is very timely and, although it cannot scientifically legitimate the routine use of CM more than what is already known, it suggests that oncologists are concerned with the fertility wish of women with early endometrial cancer. The findings of the survey give insights about what would be recommended (i.e., medical/surgical treatment and referral to assisted reproduction), though less is unfortunately revealed about who would eventually be offered CM. Statistics about pregnancy rates after CM by progestins, with or without hysteroscopic resection, largely ground on observational retrospective data [2], hence care should be adopted when interpreting and extrapolating published success rate figures. Therefore, clinicians may need to individualize their assessment and consider how likely the woman under their care is to conceive after CM, before offering it as an option. In other words, a reproductive prognosis should inform the choice of offering CM, as fertility preservation may not be appropriate without good chances of achieving a pregnancy and a live birth [3].
* Pietro Gambadauro [email protected]; [email protected] 1
Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
2
Karolinska Institutet, NASP/LIME-C7, 17177 Stockholm, Sweden
3
Res Medica Sweden, 752 24 Uppsala, Sweden
A first crucial topic that was apparently overlooked by the survey regards the specific age [4] of women who should or could be offered CM, as the paper generically refers to “young women” or “reproductive age”. Age-related fertility decline should also be thoroughly considered when offering maintenance treatments to women with no short-term fertility wish. Obesity, which the authors cite as a correlate of hyperestrogenism and polycystic ovary syndrome, reduces the reproductive potential (e.g., through lower pregnancy rates or increased obstetric risk), and may sometimes be an exclusion criterion for assisted reproduction. Age and body mass index are effective yet easy-to-obtain markers of fertility, and obtaining the clinicians’ viewpoint would make a very relevant addition to the survey, should the authors plan to extend their work. The assessment of many other factors potentially affecting the reproductive prognosis may certainly prove complex [5], whereas not all European gynaecological oncologists necessarily have specialist competence and
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