In recent years, gynecological malignancies have been increasingly affecting younger populations, with 15% to 20% of gynecological tumor patients being of childbearing age. As the level of diagnosis and treatment has improved, the cure rate for cancer patients has significantly increased, and more and more patients are hoping to enhance their quality of life and achieve fertility. However, after undergoing treatment, their ovarian function has been impaired to varying degrees, leading to a decline in endocrine function and infertility…

In the context of surgery, the target of gynecological malignant tumor operations is the female reproductive organs. While excising the lesions, it is often necessary to partially or even completely remove the corresponding organs, inevitably resulting in damage to reproductive functions.

Furthermore, many patients require additional chemotherapy or radiotherapy. Depending on their type and dosage, chemotherapeutic drugs can have varying degrees of toxic effects on ovarian function. The ovaries are highly sensitive to radiotherapy, and the already limited ovarian follicle pool is often compromised, leading to a further reduction in the number of follicles and premature ovarian failure. Although the uterus is less sensitive to radiotherapy, the muscle layer and blood vessels can still undergo degeneration, affecting uterine volume, muscle elasticity, and endometrial thickness. Consequently, the risks of infertility, miscarriage, and preterm birth are significantly increased.

Even when afflicted with tumors, many young women still aspire to become mothers. Currently, fertility preservation methods for gynecological cancer patients include fertility-sparing surgeries, ovarian function-preserving drug therapies, and cryopreservation techniques.

Surgical Fertility Preservation

Surgical fertility preservation involves the removal of tumor tissue while retaining the reproductive organs, thereby offering the possibility of future fertility. For conditions such as cervical cancer, endometrial cancer, and ovarian cancer, it is possible to perform tumor resection while preserving fertility, provided that the cases meet the relevant guidelines. Additionally, to prevent damage to ovarian function from radiotherapy, a bilateral ovarian transposition can be performed during surgery to relocate the ovaries outside the radiation field. A case in point is 30-year-old Xiaofei, who was married and childless. She sought medical attention due to bleeding during intercourse for two months and was diagnosed with cervical squamous cell carcinoma. Both she and her family were eager to have a child. Considering that Xiaofei’s lesion was small, there was no lymph node metastasis, and after a rigorous evaluation and discussion, it was determined that she met the criteria for fertility preservation. Professor Hua Keqin’s team performed a fertility-sparing radical trachelectomy for her, removing the affected cervix while preserving the uterine body. Xiaofei was closely followed up postoperatively, and everything was normal. One year later, she was able to conceive naturally. It is crucial to emphasize that fertility-preserving treatment must be based on a strict evaluation, conform to guideline recommendations, and involve meticulous follow-up.

Medication for Ovarian Function Preservation

One of the more commonly reported methods is the use of Gonadotropin-Releasing Hormone Agonists (GnRH-a). Theoretically, pituitary suppression occurs approximately two weeks after the injection of GnRH-a, which inhibits follicular growth and ovulation. Typically, the medication is administered about two weeks before the start of chemotherapy to minimize the damage to follicles caused by chemotherapeutic agents. However, there is ongoing debate and controversy in both domestic and international research regarding the effectiveness of this approach.

Cryopreservation Technology

The third method, which has always piqued everyone’s curiosity, is “cryopreservation.” The subjects of cryopreservation can be embryos, oocytes, or ovarian tissue.

Choosing which method to use is not straightforward and requires a comprehensive consideration of the patient’s specific medical condition, marital status, and fertility desires.

1.Embryo Cryopreservation

After the application of ovulation induction drugs, once the follicles have matured, the eggs are retrieved. These eggs are then fertilized in vitro to form embryos, which are subsequently cryopreserved.

2.Oocyte Cryopreservation

Commonly referred to as “egg freezing,” this process includes the cryopreservation of mature oocytes and the in vitro maturation of immature oocytes followed by their cryopreservation. It is important to note that our country has not yet approved the freezing of eggs for social reasons.

Young patients with gynecological malignancies

Still have the chance to become mothers

However, regardless of the chosen option

Strict screening and comprehensive evaluation are required

Wishing everyone “good luck with pregnancy”

撰文：邵书铱 张英

审核：王珏

编辑：李妙然

上海市科委科普项目资助（项目编号：20DZ2311000）