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Transcript of Fertility Sparing in Gynecological Cancers Fırat Ortaç, MD Güven Hospital Güven Hospital...
Fertility SparingFertility Sparing in in
Gynecological Cancers Gynecological Cancers
Fertility SparingFertility Sparing in in
Gynecological Cancers Gynecological Cancers Fırat Ortaç, MDFırat Ortaç, MD Güven HospitalGüven Hospital
Department of Obstetrics and Department of Obstetrics and Gynecology Gynecology
Cancer TreatmentCancer Treatment
ObjectiveObjective
CureCure
Adverse EffectsAdverse Effects Psychological effectsPsychological effects Cosmetic problemsCosmetic problems Loss of organ functionLoss of organ function Sexual and reproductive Sexual and reproductive
dysfunctiondysfunction
Fertility sparing surgeryFertility sparing surgery
Goals of Fertility-SparingGoals of Fertility-Sparing Surgery(FSS)Surgery(FSS)Goals of Fertility-SparingGoals of Fertility-Sparing Surgery(FSS)Surgery(FSS)
Preservation of reproductive potential
Preservation of hormonal function
Preservation of healthy body image
No compromise in curability
FSS ObjectivesFSS ObjectivesFSS ObjectivesFSS Objectives
Similiar oncologic outcomes to standard therapy
Favorable obstetric outcome
Benefits > risksLow morbidity
Defining prognostic factorsDefining prognostic factors
Evidence-based DataEvidence-based Data
Fertility Sparing SurgeryFertility Sparing Surgery
PhysicianPhysician
Fertility-Sparing Fertility-Sparing in in
Gynecologic OncologyGynecologic Oncology
Fertility-Sparing Fertility-Sparing in in
Gynecologic OncologyGynecologic Oncology
The patient and family must be:The patient and family must be:aware of the problemaware of the probleminvolved in the final decisioninvolved in the final decision
Once Once the the fertility fertility has been has been completed, demolitive procedure completed, demolitive procedure should be consideredshould be considered
Fertility-Sparing Fertility-Sparing in in
GynGyneecologic Oncologycologic Oncology
Fertility-Sparing Fertility-Sparing in in
GynGyneecologic Oncologycologic Oncology
AgeAgeDesire to preserve Desire to preserve fertilityfertility Tumor factorsTumor factors
HHistologic type, grade, othersistologic type, grade, othersStage of diseaseStage of disease
Principles in Treatment of Early-Principles in Treatment of Early-Stage Cervical CancerStage Cervical Cancer
Principles in Treatment of Early-Principles in Treatment of Early-Stage Cervical CancerStage Cervical Cancer
PaPatient’s general statustient’s general status
Desire of fertilityDesire of fertility
Tumor factorsTumor factorsDepth and width of invasionDepth and width of invasionSize of cervical lesion Size of cervical lesion LVSILVSI
TTraditional treatment of early stage raditional treatment of early stage
cervical cancer beyond cervical cancer beyond
micro-invasionmicro-invasion
Radical hysterectomyRadical hysterectomy++
PPLNDPPLND
LLoss of fertilityoss of fertility
LVSILVSI
Pelvik lenf nodu Pelvik lenf nodu metastazımetastazı
Pelvik rekürensPelvik rekürens
Lenfadenektomi – Radikal cerrahiLenfadenektomi – Radikal cerrahi
Spread of Cervical CancerSpread of Cervical CancerSpread of Cervical CancerSpread of Cervical Cancer
Laterally (Dominant) Laterally (Dominant) Parametrium Parametrium
Vertically (rare)Vertically (rare)Stage Ib and IIa Stage Ib and IIa 0% 0%Stage IIb Stage IIb 20% 20%
FFertility Sparing Surgery ertility Sparing Surgery inin
Early-Stage Cervical CancerEarly-Stage Cervical Cancer
FFertility Sparing Surgery ertility Sparing Surgery inin
Early-Stage Cervical CancerEarly-Stage Cervical Cancer
ID<3 mmID<3 mmLVSI(-)LVSI(-)
MARGIN (-)MARGIN (-)
CONIZATIONCONIZATION
FOLLOW-UPFOLLOW-UP
Cold Conization
CONIZATIONCONIZATION < 10 mm < 10 mmCONIZATIONCONIZATION < 10 mm < 10 mm
Does not affect Does not affect fertility potentialfertility potential
Clin. Exp.Clin. Exp. Obstet. Gynecol, 1992: 19(1):40-2Obstet. Gynecol, 1992: 19(1):40-2
Effect of Con on Pregnancy Outcome
< 18 mm
< 15 mm NO EFFECT
> 18 mm
25% PRETERM LABOR 18% PROM
Sadler L. Et al., Am J Med Ass, 2004
Frencezy A, 1995Haffenden DK, 1993Tan L, 2004
> 15 mm
FFertility Sparing Surgeryertility Sparing Surgery inin Early-Stage Early-Stage Cervical CancerCervical Cancer
Stage IStage Iaa11 (LVS +) (LVS +)
Stage IaStage Ia22 (LVS (LVS ))
Stage Ib-IIa (Stage Ib-IIa (2cm)2cm)
FFertility Sparing Surgeryertility Sparing Surgery inin Early-Stage Early-Stage Cervical CancerCervical Cancer
Stage IStage Iaa11 (LVS +) (LVS +)
Stage IaStage Ia22 (LVS (LVS ))
Stage Ib-IIa (Stage Ib-IIa (2cm)2cm)
Desire of fertilityDesire of fertility
LymphLymph Node Dissection Node Dissection
(L/S, L/T)(L/S, L/T)
Node (-)Node (-) Node (+)Node (+)
RVTRVT RTRTSentinel Lymph NodeSentinel Lymph Node
RRAATT
Sentinel lymph nodeSentinel lymph nodeSentinel lymph nodeSentinel lymph node
Radical TrachelectomyRadical TrachelectomyRadical TrachelectomyRadical Trachelectomy
1994 1994 DargentDargent
Vaginal Radical Trachelectomy (VRT)Vaginal Radical Trachelectomy (VRT)inin
Early-Stage Cervical CancarEarly-Stage Cervical Cancar
Vaginal Radical Trachelectomy (VRT)Vaginal Radical Trachelectomy (VRT)inin
Early-Stage Cervical CancarEarly-Stage Cervical Cancar
by Dargent in Lyon, Franceby Dargent in Lyon, FranceModification of the Schauta-Stoeckel Modification of the Schauta-Stoeckel technique of vaginal radical hysterectomytechnique of vaginal radical hysterectomy
L/SL/S
Pelvic Pelvic lymphadenectomylymphadenectomy
Preservation ofPreservation ofthe upper endocervixthe upper endocervixand uterine corpusand uterine corpus
Radical TrachelectomyRadical Trachelectomy(RT)(RT)Radical TrachelectomyRadical Trachelectomy(RT)(RT)
VRVRT-AbRTT-AbRTVRVRT-AbRTT-AbRT
IndicationsIndicationsPatient who desires preservation of Patient who desires preservation of
fertilityfertility
FIGO Stage IaFIGO Stage Ia11 (+ (+LLVSI), Ia2, Ib1VSI), Ia2, Ib1
Lesions Lesions 2 cm in diameter 2 cm in diameterLimited endocervical involvement Limited endocervical involvement
- - MRI and colposcopyMRI and colposcopy
Lymph node dissection(Sentinel lymph node)Lymph node dissection(Sentinel lymph node)
ParametrectomyParametrectomy
Trachelectomy (FS analyse- free margin 5-8 mm)Trachelectomy (FS analyse- free margin 5-8 mm)
Cervical circlageCervical circlage
Surgıcal procedure Surgıcal procedure
RTRTRTRT
FeasibilityFeasibilityNo evidence of lymph node metastasis No evidence of lymph node metastasis
(Frozen section at L/S)(Frozen section at L/S)(ultrastaging)(ultrastaging)
Upper endocervical margins free of Upper endocervical margins free of tumor (Frozen section)tumor (Frozen section)
VRTVRTVRTVRT
ResultsResults Dargent (Lyon)Dargent (Lyon) 8282 Plante and Roy (Quebec)Plante and Roy (Quebec) 4444 Covens (Toronto) Covens (Toronto) 5858 Shepherd (London, UK) Shepherd (London, UK) 4040 TotalTotal
224224
VRTVRTVRTVRT
Oncologic Outcome (N:24)Oncologic Outcome (N:24)
FFollow-up (months)ollow-up (months) 3030RecurrencesRecurrences 7(3.1%)7(3.1%)
Parametrium Parametrium 33 Pelvic side wallPelvic side wall 11 DDistant istant 33
No cervico-uterine recurrenceNo cervico-uterine recurrence
Pregnancy Results after VRTPregnancy Results after VRTPregnancy Results after VRTPregnancy Results after VRT
n FertilityDesire
No.of Pregn/ Patient
Livebirth
96 42 56/33 3472 42 48/31 2893 39 22/18 1830 13 14/8 919 4 4/3 210 4 4/4 2
315 144 148/97 93
Fertil Steril 2005;84:156
VRTVRTVRTVRT
ConclusionsConclusionsAbdominal way is possibleAbdominal way is possibleThe risk of recurrence is unchangedThe risk of recurrence is unchangedFertility is preservedFertility is preservedBut pregnancies are at high riskBut pregnancies are at high riskAn international study is An international study is requiredrequired to to
confirm indications and limits of this confirm indications and limits of this conservative techniqueconservative technique
Preserving Fertility in Endometrial Preserving Fertility in Endometrial Cancer Cancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial Cancer Cancer
2% -14 % of endometrial 2% -14 % of endometrial cancercancer
40 years40 years
Up to 25% Up to 25% PCOSPCOS
GG11 Early stageEarly stage
Respond to Respond to progestin progestin treatment treatment
Stage Ia, GStage Ia, G11
Standart treatmentStandart treatment
TAH + BSOTAH + BSO
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Endometrial Cancer Endometrial Cancer
Fertility DesireFertility Desire
Pretreatment Evaluation Pretreatment Evaluation
Tumor Tumor GradeGrade
Depth Depth of MIof MI
Tumor Tumor SizeSize
Hormone Hormone receptor statusreceptor status
Flow cytometric Flow cytometric analysisanalysis
FavorableFavorable prognosisprognosis
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Inclusion CriteriaInclusion Criteria
Age < 40 yearsAge < 40 years Nulliparous statusNulliparous status Endometrioid Carcinoma Endometrioid Carcinoma G1G1 Presence of PgRPresence of PgR Normal serum levels of CA 125 (<35 u/mL) and CEA Normal serum levels of CA 125 (<35 u/mL) and CEA
(< 5 ng/mL)(< 5 ng/mL) Tumor DNA index < 1.3 Tumor DNA index < 1.3 Absence of MI or extrauterine spread (by vaginal USG Absence of MI or extrauterine spread (by vaginal USG
and MRI) ,surgıcal stagingand MRI) ,surgıcal staging
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Pretreatment EvaluationPretreatment Evaluation Pretreatment EvaluationPretreatment Evaluation History (infertility...)Physicial ExaminationTVUSGD&CAbdominopelvic/ endovajinal coil
MRICa-125Laparoscopic evaluation
Staging Laparotomy
Response to Progesteroneor
Explain the patient the risk of conservative treatmentExplain the patient the risk of conservative treatment
Evaluate the patient for prognosisEvaluate the patient for prognosis
Medical treatment (Megestrol acetate 40-160 mg/d , MPA 30 Medical treatment (Megestrol acetate 40-160 mg/d , MPA 30
mg/d mg/d Tamoxifen 30 mg/d or GnRHa) Tamoxifen 30 mg/d or GnRHa)
Repeated D&C; hysteroscopy (+tubal blockage)Repeated D&C; hysteroscopy (+tubal blockage)
No residual diseaseNo residual disease
Assisted reproductionAssisted reproduction
Elective hysterectomy when the patient no longer desires to Elective hysterectomy when the patient no longer desires to
maintain fertilitymaintain fertility
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Progestogenic AgentsProgestogenic AgentsProgestogenic AgentsProgestogenic Agents MPA 30/mg/ day Megace 40-160 /mg/day IUD / Prog Response Rate Hyperplasia with Atypia %83-94 End. Ca %57-75.6 Duration of Treatment Range 3-6 months Median 9 months Recurrens Hyperplasia with Atypia % 13 End. Ca % 11-50
There is no consensusThere is no consensusThere is no consensusThere is no consensus
Which progesterone formulation to use What schedule to use What dose to use How long to treat How often to resample
72 cases in literature72 cases in literature
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Preserving Fertility in Endometrial Preserving Fertility in Endometrial CancerCancer
Positive responsePositive response histologically documented histologically documented
55 cases (76%)55 cases (76%)
Endometrial CancerEndometrial CancerEndometrial CancerEndometrial CancerLiterature Overview (1966-2006)
No pts.= 53 80% were nulliparousIn 96% of them the tumor was well
differentiatedAt least 36 pregn. were obtained by ART70% of pts. Underwent a hysterectomy
after completing gestation
DiagnosisDiagnosisPre-operative?Pre-operative?Intra-operative frozen section?Intra-operative frozen section?Histopathological evaluation ofHistopathological evaluation of
hysterectomy or myomectomyhysterectomy or myomectomy
specimen.specimen.
Uterine LeiomyosarcomaUterine Leiomyosarcoma (LMS) (LMS)Uterine LeiomyosarcomaUterine Leiomyosarcoma (LMS) (LMS)
IncidenceIncidence
Uterine LUterine LMSMSUterine LUterine LMSMS
patients operated for patients operated for presumed leiomyomapresumed leiomyoma
0.1-0.3%0.1-0.3%
Safe margin: 3-5 mm. Safe margin: 3-5 mm. ??
<10 mitoses/per 10 HPF<10 mitoses/per 10 HPF
Solitary pedinculated massSolitary pedinculated mass
FFertility Sparing Surgery ertility Sparing Surgery inin
LMSLMS
FFertility Sparing Surgery ertility Sparing Surgery inin
LMSLMS
Accurately restage the patientsAccurately restage the patients
Color doppler USGColor doppler USGHysteroscopyHysteroscopyChest X-rayChest X-rayMRI or CT scanMRI or CT scan
FFertility Sparing Surgery ertility Sparing Surgery inin
LMSLMS
FFertility Sparing Surgery ertility Sparing Surgery inin
LMSLMS
Cesarean sectionCesarean sectionMultiple uterine biopsies Multiple uterine biopsies
should be taken.should be taken.
FFertility Sparing Surgeryertility Sparing Surgery inin
LMSLMS
FFertility Sparing Surgeryertility Sparing Surgery inin
LMSLMS•DeliveryDelivery
Lissoni A (Gynecol Oncol 70(3): 348-50 (1998)Lissoni A (Gynecol Oncol 70(3): 348-50 (1998)
Between 1982-1996 (8 patients)Between 1982-1996 (8 patients) Median age: 29Median age: 29 All nulliparousAll nulliparous Tumor was confined to myomaTumor was confined to myoma Mean mitotic count 6 per 10 HPFMean mitotic count 6 per 10 HPF 3 pregnancies3 pregnancies Median follow-up 42 monthsMedian follow-up 42 months 7 patients alive7 patients alive One patient died (26 months after diagnosis).One patient died (26 months after diagnosis).
FFertility Sparing Surgeryertility Sparing Surgery inin
LMSLMS
FFertility Sparing Surgeryertility Sparing Surgery inin
LMSLMS
FFertility Sparingertility Sparing in in
Epithelial Ovarian Cancer Epithelial Ovarian Cancer and Borderline Tumorsand Borderline Tumors
FFertility Sparingertility Sparing in in
Epithelial Ovarian Cancer Epithelial Ovarian Cancer and Borderline Tumorsand Borderline Tumors
Optimal Staging:Optimal Staging: USO or cystectomy (in BOT)USO or cystectomy (in BOT) Peritoneal washing and cytologyPeritoneal washing and cytology Inspection of the contralateral ovarian Inspection of the contralateral ovarian
surface, biopsies of any suspicious lesionssurface, biopsies of any suspicious lesionsWedge resection of the opposite ovary?Wedge resection of the opposite ovary?
Staging biopsies of the peritoneal cavityStaging biopsies of the peritoneal cavity Sampling of retroperitoneal lymph nodes or Sampling of retroperitoneal lymph nodes or
radical lymphadenectomy since 1990radical lymphadenectomy since 1990 Omentectomy, appendectomy.Omentectomy, appendectomy.
FFertility Sparing Surgeryertility Sparing Surgery in Epithelial in Epithelial Ovarian Cancer and Borderline TumorsOvarian Cancer and Borderline TumorsFFertility Sparing Surgeryertility Sparing Surgery in Epithelial in Epithelial
Ovarian Cancer and Borderline TumorsOvarian Cancer and Borderline Tumors
Recurrence rate in the patients Recurrence rate in the patients underwent conservative surgery underwent conservative surgery for border-line tumors is %7for border-line tumors is %7
Gynecol Oncol 55;552-6, 1994.Gynecol Oncol 55;552-6, 1994.
FFertility Sparing Surgeryertility Sparing Surgery in in
Borderline Tumors Borderline Tumors
FFertility Sparing Surgeryertility Sparing Surgery in in
Borderline Tumors Borderline Tumors
Retrospective reviewRetrospective review82 patients82 patients39 patients underwent conservative 39 patients underwent conservative
managementmanagementThree patients had a contralateral Three patients had a contralateral
recurrence (7%)recurrence (7%)22 pregnancies were achieved.22 pregnancies were achieved.
Border-line Tumors of the Ovary Border-line Tumors of the Ovary Conservative Management and Conservative Management and
Pregnancy OutcomePregnancy Outcome
Border-line Tumors of the Ovary Border-line Tumors of the Ovary Conservative Management and Conservative Management and
Pregnancy OutcomePregnancy OutcomeCancer 1998 Jan, 1;82(1):141-6Cancer 1998 Jan, 1;82(1):141-6
Stage IaStage IaG1 and Border-lineG1 and Border-line
No further treatment
Stage IaStage IaG2, G3G2, G3
Chemotherapy
Stage Ic-IIIStage Ic-III• Selected cases• Requested by
patients herself• Preliminary reports.
FROZENFROZEN
Invasive Epithelial Ovarian CancerInvasive Epithelial Ovarian Cancer
and Border-Line Tumorsand Border-Line Tumors
Desire for fertility
Endometrial biopsy
Optimal Staging
Can conservative surgical approach be used in Can conservative surgical approach be used in selected young patients with ovarian cancer who selected young patients with ovarian cancer who would usually undergo radical operations.would usually undergo radical operations.
Cancer 1998 Jan, 1;82(1):141-6Cancer 1998 Jan, 1;82(1):141-6
Retrospective study between 1980-1994Retrospective study between 1980-1994 10 patients with high grade or limited 10 patients with high grade or limited
extraovarian diseaseextraovarian disease• Stage Ia G3Stage Ia G3 22• Stage IcStage Ic 22• Stage IIIaStage IIIa 22• Stage IIIcStage IIIc 44
All patients were given adjuvant CTAll patients were given adjuvant CT All patients were alive median follow-up 70 All patients were alive median follow-up 70
monthsmonths 9 patients were menstruating regularly9 patients were menstruating regularly Three had became pregnant.Three had became pregnant.
Ovarian Cancer Treatment Ovarian Cancer Treatment with Fertility-Sparing Therapy with Fertility-Sparing Therapy Ovarian Cancer Treatment Ovarian Cancer Treatment with Fertility-Sparing Therapy with Fertility-Sparing Therapy Stage IA and IC epithelial ovarian cancerStage IA and IC epithelial ovarian cancer 1965 to 2000, n=521965 to 2000, n=52 20 (%38) received chemotherapy20 (%38) received chemotherapy 9 (17%) eventual TAH9 (17%) eventual TAH 5(10%) recurred, 2 died5(10%) recurred, 2 died 24 (46%) attempted, 17 (33%) conceived 24 (46%) attempted, 17 (33%) conceived
26 term, 5 SAb26 term, 5 SAb 33% take home baby33% take home baby
Schilder et al., Gynecol Oncol, 2002Schilder et al., Gynecol Oncol, 2002
FFertility Sparing Surgeryertility Sparing Surgery in Epithelial in Epithelial Ovarian Cancer and Borderline TumorsOvarian Cancer and Borderline TumorsFFertility Sparing Surgeryertility Sparing Surgery in Epithelial in Epithelial
Ovarian Cancer and Borderline TumorsOvarian Cancer and Borderline Tumors
CONCLUSIONSCONCLUSIONSFor more advanced stages, additional For more advanced stages, additional
investigation is needed.investigation is needed.After completion of fertility, residual After completion of fertility, residual
ovary should be taken out.ovary should be taken out. Incidence of ovarian cancer gets Incidence of ovarian cancer gets
higher with age.higher with age. Screening method are unreliable.Screening method are unreliable.
Germ Cell TumorGerm Cell Tumorss of the Ovary of the OvaryGerm Cell TumorGerm Cell Tumorss of the Ovary of the Ovary
Incidence: less than %5 of all Incidence: less than %5 of all ovarian neoplasm.ovarian neoplasm.
Age: the first and second decadeAge: the first and second decade
Usually unilateralUsually unilateral
1978 Forney first reported a case of successful pregnancy in a 18 year-old with EST of ovary.
Obstet Gynecol 52, 360-62 (1978)Obstet Gynecol 52, 360-62 (1978)1985 Gershenson at the MD Anderson
Hospital.48 patients with malignant germ cell
tumorsFull-term pregnancies in 6 cases
Cancer 56, 2756-2761 (1985)Cancer 56, 2756-2761 (1985)
FFSS SS in Germ Cell Tumors of the Ovaryin Germ Cell Tumors of the OvaryFFSS SS in Germ Cell Tumors of the Ovaryin Germ Cell Tumors of the Ovary
FFSS SS in Germ Cell Tumors of the Ovaryin Germ Cell Tumors of the OvaryFFSS SS in Germ Cell Tumors of the Ovaryin Germ Cell Tumors of the Ovary
RationalesRationalesUnilaterality of tumorUnilaterality of tumorImprovement of prognosis by Improvement of prognosis by
modern combination chemotherapymodern combination chemotherapy
1970s the 1970s the VAC regimenVAC regimen
1980s the 1980s the PVB regimenPVB regimen POMP/ACE.POMP/ACE.
A Report of 28 Cases / Cancer 42, 1152-1160 (1978)A Report of 28 Cases / Cancer 42, 1152-1160 (1978)
Tumor was confined to one ovary in all Tumor was confined to one ovary in all cases.cases.
All patients were taken chemotherapy All patients were taken chemotherapy except two with stage I immature except two with stage I immature teratoma.teratoma.
More than 5 years survival in 13 cases More than 5 years survival in 13 cases (59.1%)(59.1%)
7 of 12 married patients, became pregnant, 7 of 12 married patients, became pregnant, all had term delivery.all had term delivery.
Treatment of Malignant Ovarian Germ Treatment of Malignant Ovarian Germ Cell Tumors With Preservation of FertilityCell Tumors With Preservation of Fertility
Treatment of Malignant Ovarian Germ Treatment of Malignant Ovarian Germ Cell Tumors With Preservation of FertilityCell Tumors With Preservation of Fertility
ObstetricObstetricObstetricObstetric
Author % Pregnancy Term Delivery
Abort. Ektopic Anomaly
Gershenson 1988
100 (12/16) 22 0 0 0
Perrin1999
------ 8 -- -- 0
Low 2000
95 (19/20) 16 -- -- 0
Zanetta 2001
80 (16/20) 26 9 -- 3
Tangir 2003 76 (25/33) 38 2 -- 0
Toplam 87.75 (72/89)
110 11 0 3
Outcome in GCTOutcome in GCT
ConclusionConclusion RRegardless of the stage is a safe egardless of the stage is a safe
and practicable procedure in the and practicable procedure in the absence of involvement of absence of involvement of CONTRALATERAL OVARY CONTRALATERAL OVARY AND UTERUSAND UTERUS
FFertility Sparing Surgery ertility Sparing Surgery in Germ Cell in Germ Cell Tumors of the OvaryTumors of the Ovary
FFertility Sparing Surgery ertility Sparing Surgery in Germ Cell in Germ Cell Tumors of the OvaryTumors of the Ovary
History of ARTHistory of ARTHistory of ARTHistory of ART
The new millenium:The new millenium:2001 Clinic Specific Success 2001 Clinic Specific Success
about 28% per cycle overallabout 28% per cycle overallOocyte and ovarian slice Oocyte and ovarian slice
cryopreservation with function cryopreservation with function (Oktay)(Oktay)
İnvitro maturation maturesİnvitro maturation matures
Lancet, Lancet, March March 13, 2004 13, 2004
Fertility Preservation StrategiesFertility Preservation StrategiesFertility Preservation StrategiesFertility Preservation Strategies
As we discover what As we discover what can be done, we need to can be done, we need to learn what should done learn what should done
Thank you…Thank you…Thank you…Thank you…
Fertility-Preserving Fertility-Preserving Treatment in Endometrial Treatment in Endometrial
AdenocarcinomaAdenocarcinoma
Fertility-Preserving Fertility-Preserving Treatment in Endometrial Treatment in Endometrial
AdenocarcinomaAdenocarcinoma Stage IA, grade 1, 1991-9Stage IA, grade 1, 1991-9 N=9, average 32 yearsN=9, average 32 years Megace, tamoxifen, +GnRHaMegace, tamoxifen, +GnRHa 8 CR, 1 TAH8 CR, 1 TAH 4 pregnant4 pregnant
2 term after ART, 2 ectopic2 term after ART, 2 ectopic %22 take home baby%22 take home baby
Wang et al., Cancer, 2002Wang et al., Cancer, 2002