This document discusses fertility preservation options for cancer patients. It begins by noting that advances in cancer treatment have led to improved survival rates but also increased risks of infertility. It then discusses the field of oncofertility, which aims to provide fertility preservation options for young cancer patients. The document reviews fertility preservation guidelines and options for both female and male patients, including embryo/oocyte cryopreservation, ovarian tissue cryopreservation, and sperm cryopreservation. It stresses the importance of discussing fertility preservation with patients before starting cancer treatment.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
For information of chronic disease
. very common these days and required early detection and cure.
for education purpose
.this is simplify version of very important but complex topic .
This is only prevented by early detection and cure .
By identifying red flags of disease first we can detect high group .by targeting high risk group we will be able to detect and treat disease with less resources.
Fertility And Pregnancy Outcome In Cancer PatientsMamdouh Sabry
Better life of Cancer patients during childhood and age reproductive period regarding fertility, fertility preservation and pregnancy outcome is the main concern.concentrating upon different safe diagnostic modalities, management and outcome.
SHARE, in partnership with Reproductive Medicine Associates of NY, FORCE, and Sharsheret, hold a presentation on fertility and family planning for patients recently diagnosed with cancer and those who are predisposed to hereditary cancer syndromes due to a genetic mutation. The presenter, Dr. Matthew Lederman, is a board-certified reproductive endocrinologist and infertility specialist.
SHARE Presentation: Having Children after Cancerbkling
Dr. Diana Chavkin, Reproductive Endocrinology and Infertility (REI) specialist at Genesis Fertility and Reproductive Medicine, made this presentation at SHARE about fertility preservation options before and after cancer treatment.
If you'd like to hear the audio, visit www.sharecancersupport.org/chavkin
The information in this presentation is not intended to be a substitute for professional medical advice, diagnosis or treatment. The presentation was given on May 15, 2014.
Panel Discussion on Post Menopausal Bleeding Lifecare Centre
Panel Discussion on Post Menopausal Bleeding
Moderator
Dr Jyoti Agarwal
Dr Meenakshi Sharma
Panelists
Dr Uma Rai
Dr Raj Bokaria
Dr Ila Gupta
Dr Vandana Gupta
Dr Renu Chawla
Dr Manju Barik
Dr Krishna Gopa
Dr Sharda Jain
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
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This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
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HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
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Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
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Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Dr. Niranjan Chavan
MD, FCPS, DGO, DFP, MICOG, DICOG, FICOG
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H
Chairperson, FOGSI Oncology and TT Committee (2012-2014)
Treasurer, MOGS (2017- 2018)
Chair and Convener, FOGSI Cell- Violence against Doctors (2015-2016)
Chief Editor, AFG Times (2015-2017)
Editorial Board, European Journal of Gynecologic Oncology
Editor of FOGSI FOCUS, MOGS, AFG & IAGE Newsletters
Member, Managing Committee, IAGE (2013-2017)
Member , Oncology Committee, AOFOG (2013 -2015)
Recipient of 6 National & International Awards
Author of 15 Research Papers and 19 Scientific Chapters
Course Co-Ordinator, of 11 batches, of MUHS recognized Certificate Course of
Basic Infertility Management Including Endoscopy (BIMIE) at LTMGH
3. • Advance in diagnosis & treatment of cancers
have lead to high cure rate & longer survival.
• Nearly 1 in 12 cases detected before 40 years
age.
• Survivors have to face infertility or early
menopause.
• More females delaying motherhood to 30s &
40s.
4. ONCOFERTILITY
Brings together Oncologists and fertility specialists
and hopes to provide real options to young
population who undergo life-preserving but fertility-
threatening treatment for cancers.
5. In 2006, the American Society of Clinical Oncology
(ASCO) published a clinical practice guideline on
fertility preservation for adults and children with
cancer
ASCO Guidelines are updated at intervals by Update
Committees of their original Expert Panels
6. • People with cancer are interested in
discussing fertility preservation so the doctor
MUST address the possibility of infertility
before the treatment starts.
• Direct them to fertility specialists.
7. • Give whole range of fertility preservation
options.
• Counsel patients along with spouse wherever
applicable.
• Refer patients to psychosocial providers if
distressed.
• Document the discussion on medical records.
8. TREATMENT OPTIONS FOR
FEMALES
1. Cryopreservation of unfertilized oocyte
2. Embryo cryopreservation
3. Ovarian transposition
4. Ovarian suppression
5. Ovarian tissue cryopreservation and
transplantation
6. Conservative medical therapy
7. Conservative gynecologic surgery
9. CANCER OVARY
Conservative surgery can be offered in
following:
1. Stage 1 invasive epithelial ovarian cancer
2. Malignant germ cell tumor (any stage)
3. Sex cord stromal tumor (any stage)
4. Borderline ovarian tumor (any stage)
10. • Ovaries are chemosensitive.
• Chemo leads to loss of primordial & growing
follicles.
• Radiation causes dose related germ cell
damage.
• 16.5 Gray causes immediate ovarian damage
in females under 20 years & 14 Gray in under
30 yrs.
11.
12. CRYOPRESERVATION OF
UNFERTILIZED OOCYTES:
• For patients who do not have a male partner
• Do not wish to use donor sperm
• Have religious or ethical objections to
embryo freezing.
13. EMBRYO CRYOPRESERVATION
• An established ART
• Involves ovarian stimulation with gonadotrophins, surgical
oocyte retrieval, in vitro fertilization of oocyte & sperm in a
lab dish followed by freezing of all resulting embryos.
• Survival rate of thawed embryos upto 90%
• Implantation rate upto 30%
• Cumulative pregnancy rate upto 60%
16. OVARIAN TISSUE CRYOPRESERVATION AND
TRANSPLANTATION
• Does not require ovarian stimulation or
sexual maturity
• May be the only method available in children
• Considered experimental
• Should be performed only in centers with the
necessary expertise, under IRB-approved
protocols that include follow-up for recurrent
cancer
17. OVARIAN SUPPRESSION
• Done with GnRH analogues
• Insufficient evidence regarding the
effectiveness of gonadotropin releasing
hormone analogues
• Can be offered in Ca Breast & Hodgkin’s
lymphoma
18. OVARIAN TRANSPOSITION
(OOPHOROPEXY)
• Offered when pelvic radiation is performed
as cancer treatment
• Because of radiation scatter, ovaries are not
always protected
• Strongly recommended in young girls
needing radiotherapy
19. OVARIAN TRANSPOSITION
(OOPHOROPEXY)
erformed through laparoscopy or laparotomy
nvolves division of utero-ovarian ligament & fixing ovary
within the paracolic gutter
an be combined with cryopreservation of contralateral
ovary
20.
21.
22. CANCER ENDOMETRIUM
• Uncommon under 40 years
• British National Formulary recommends MPA
upto 200 – 400 mg daily or
• Megesterol Acetate 40 – 320 mg daily
23.
24. CANCER CERVIX: RADICAL
TRACHELECTOMY
• Restricted to stage IA2-IB1 with <2 cm diameter,
<10 mm invasion
• Removal of cervix & adjacent parametrium while
preserving uterus
• Can be performed through vaginal, laparoscopic or
laparotomy routes
25. CANCER CERVIX: RADICAL
TRACHELECTOMY
• Disadvantages:
• Cervical stenosis
• Preterm labour, premature rupture of membranes
• 2nd
trimester loss
• Boss et al reported 70% conception with 49% term
delivery
• Plante et al reported 46% conception
with ¾ term deliveries
26.
27. PATIENT AND CLINICIAN
COMMUNICATION
• Health care providers can use the following points
for a discussion of infertility and fertility
preservation with a patient (or parents or
guardians):
• Inform Patient of Individual Risk
• Some cancer treatments can cause
infertility or early menopause
28. INDIVIDUAL RISK ASSESSMENT
ndividual factors
• Cancer type
• Age
• Treatment plan
lassify risk
• High/Medium/Low/Non-existent
ertility status before cancer may also
29. FOR ADULT FEMALES
Both embryo and oocyte cryopreservation are
established fertility preservation methods
Discuss the option of ovarian transposition
(oophoropexy) when pelvic radiation is performed
as cancer treatment
30. FOR ADULT FEMALES
• Ovarian suppression (GnRH analogs)
• Insufficient evidence regarding their effectiveness as a
fertility preservation method
• Should not be relied on to preserve fertility
• Ovarian tissue cryopreservation
• Does not require sexual maturity for the purpose of
future transplantation)
• Experimental
31. TREATMENT OPTIONS FOR MALES
1. Sperm cryopreservation after masturbation
2. Sperm cryopreservation after alternate methods
of collection
3. Testicular transposition
4. Testicular suppression
5. Testicular tissue cryopreservation
6. Testicular transposition
7. Gonadal shielding during radiation
therapy
32. FOR ADULT MALES
Present sperm cryopreservation (sperm
banking) is the only established fertility
preservation method
Hormonal therapy is not recommended
• Not successful in preserving fertility
33. FOR ADULT MALES
Testicular tissue cryopreservation
• Does not require sexual maturity for the purpose of future re-
implantation or grafting of human testicular tissue
• Experimental
Potentially higher risk of genetic damage in sperm
collected after initiation of therapy
34. CONCLUSIONS
• Fertility preservation is often possible in people
undergoing cancer treatment
• Fertility preservation must be considered before
starting cancer treatment
• Broader application is limited by several factors
- Lack of knowledge
- Lack of insurance
- Failure to discuss options
- Investigational status of various fertility
preservation methods
35. CONCLUSIONS
• Fertility preservation methods are applied infrequently.
• Many methods are still in an experimental phase
• To be performed at recognized centers only
• Patients interested are encouraged to enroll in clinical
trials that will advance medical knowledge.
Informed consent cancer patients must include
Infertility
• Fertility preserving options
• Referral to appropriate specialists
36. Questionnaire
Fertility preservation in Cancer Patients
Prepared by Oncology Committee and Reproductive
Endocrinology and Infertility Committee of Asia-Oceana
Federation of Obstetrics and Gynecology
Prof. Kazunori Ochiai
Chair, Oncology Committee of AOFOG
37. Is fertility preservation a matter of your practice?
If Yes, Please proceed following questions.
1. What are the cancers for which fertility preservation is indicated?
2. Is a cancer specialist contacted to provide information when
fertility preservation will be offered to a cancer patient?
3. Is psychological support provided when fertility preservation is to
be provided for cancer patients? If yes, what kind of intervention
(e.g., a psychotherapist, a licensed special nurse, or the
department of neuropsychiatry) do you use?
38. Is fertility preservation a matter of your practice?
If Yes, Please proceed following questions.
4. Do you provide fertility preservation for cancer patients who
already have a child (or children) if they want it? If yes,
please give us the reasons, indications, and other
information.
5. Is there any patient-doctor network for fertility preservation
(such as the Oncofertility Consortium in the United States or
FertiPROTEKT in the German-speaking sphere) in your area
or country?
39. Is fertility preservation a matter of your practice?
If Yes, Please proceed following questions.
6. Is information about future loss of fertility given to patients
before the administration of chemotherapy (with alkylating
agents, etc.) that shows ovarian toxicity? (In such cases,
does the information include verbal information from a
doctor or nurse, written materials, and counselling.)
7. Is actual treatment only provided after fertility preservation
has been performed, in the case of a patient’s strong
request?
40. CERVICAL CANCER
1. Do you perform trachelectomy as a fertility preservation procedure in
cervical cancer patients?
2. What is the most advanced stage for which trachelectomy is indicated?
3. Is there any age limit for patients undergoing trachelectomy? If yes, what
is the age limit for trachelectomy?
4. Is trachelectomy indicated for adenocarcinoma? If yes, to what is the
most advanced stage for which trachelectomy is applicable?
41. CERVICAL CANCER
5. Is trachelectomy performed after the administration of NAC? In such
cases, what is the indication of trachelectomy?
6. How long is the time interval between trachelectomy and pregnancy
being allowed?
7. Is there any case where, pregnancy/delivery has occurred after
trachelectomy? If yes, please give the relevant information briefly (e.g.,
spontaneous pregnancy or ART and the delivery method).
42. CERVICAL CANCER
8. What do you pay attention to during pregnancy in patients who have had
trachelectomy (e.g., do you perform cervical circlage, do you admit the
patient to hospital, or do you administer a tocolytic agent)? If there are
any such cases, please give the relevant information briefly.
9. Is there any case where cervical cancer has recurred after trachelectomy?
If yes, please give the relevant information briefly.
10. What is the operative procedure used for trachelectomy (e.g.,
laparotomy or a laparoscopic, robot, or vaginal method)?
43. CERVICAL CANCER
11. Is the operation performed with the intention of preserving the uterine
artery as a general rule? Or is the artery cut at the start?
12. When a patient achieves pregnancy and gives birth to a baby after
fertility preservation, will radical surgery be performed on another
occasion?
13. Is surgical shifting of the ovary carried out in patients with cervical
cancer? If there has been any such case, please give us the relevant
information (concerning indications, site of shifting, etc.) briefly.
14. Can a surrogate mother be used by a patient with cervical Ca?
44. ENDOMETRIAL CANCER
1. Has high-dose hormone therapy been given as fertility
preservation to patients with endometrial cancer?
2. If yes, please identify the drug used for high-dose hormone
therapy, daily dose and the duration of administration.
3. Please let us know about the examinations conducted during
high-dose hormone therapy and the testing intervals.
46. OVARIAN CANCER
1. Is fertility preservation (ie; preservation of health looking ovary) is carried out
in ovarian cancer patient? If yes, answer following questions
2. What is your indication to preserve contralateral ovary?
1) Histopathology? ( Histology, Grade)
2) Stage?
3) Age?
3. Is adjuvant chemotherapy recommended?
4. Is total abdominal hysterectomy with contralateral adnexectomy is
recommended after completion of fertility?
47. OVARIAN CANCER
5. Please let us know about the modality and the interval of examinations
conducted during follow up or chemotherapy.
a. Modality
b. Tumour markers
c. Radiological examination
d. Second look surgery
e. Interval of examinations
- 3 monthly
- 6 monthly
- yearly
48. OVARIAN CANCER
6. How long is the time interval between primary
treatment (surgery or chemotherapy) and
pregnancy being allowed?
7. Can a surrogate mother and/or egg donation be
used by a patient with ovarian cancer?