Treatment
Recommendation 3.3
➤ Ovarian transposition: Ovarian transposition (oophoropexy) can be
offered when pelvic irradiation is performed as cancer treatment.
However, because of radiation scatter, ovaries are not always protected,
and patients should be aware that this technique is not always
successful.
➤ Because of the risk of remigration of the ovaries, this procedure should
be performed as close to the time of radiation treatment as possible.
Recommendation 3.4
➤ Conservative gynecologic surgery: It has been suggested that radical
trachelectomy (surgical removal of the uterine cervix) should be
restricted to stage IA2 to IB cervical cancer with diameter <2 cm and
invasion < 10 mm.
➤ In the treatment of other gynecologic malignancies, interventions to
spare fertility have generally centered on doing less radical surgery
with the intent of sparing the reproductive organs as much as possible.
Ovarian cystectomy can be performed for early-stage ovarian cancer.
Recommendation 3.5 [Updated]
➤ Ovarian suppression: There is conflicting evidence to recommend
GnRHa and other means of ovarian suppression for fertility preservation.
The Panel recognizes that, when proven fertility preservation methods
such as oocyte, embryo or ovarian tissue cryopreservation are not
feasible, and in the setting of young women with breast cancer, GnRHa
may be offered to patients in the hope of reducing the likelihood of
chemotherapy-induced ovarian insufficiency. However, GnRHa should not
be used in place of proven fertility preservation methods.
Recommendation 3.6 [Updated]
➤ Ovarian tissue cryopreservation and transplantation: Ovarian tissue
cryopreservation for the purpose of future transplantation does not
require ovarian stimulation and can be performed immediately. In
addition, it does not require sexual maturity and hence may be the only
method available in children. Finally, this method may also restore
global ovarian function. However, it should be noted further investigation
is needed to confirm whether it is safe in patients with leukemias.
Qualifying Statement: As of the time of this publication, ovarian tissue cryopreservation
remains experimental. However, emerging data may prompt reconsideration of this
designation in the future. (This technique is already considered non-experimental in some
countries and its experimental status is undergoing evaluation in the U.S.)
