Fertility-sparing surgery - a hopeful strategy for young women with cancer

Sep 24, 2026

Uploaded by Grenda

Fertility preservation in cancer is currently achieved through assisted reproductive technology or fertility-sparing surgery. Fertility loss can result from excisional gynecologic surgery affecting adnexal or uterine pathology, or from gonadal insufficiency triggered by chemotherapy or radiation. Counseling is essential and must be delivered jointly by the oncologist, gynecologist, and reproductive medicine specialist. Fertility-sparing reproductive surgery aims to minimize adhesions and tissue trauma by using standard laparoscopic or robotic approaches that are increasingly accessible across specialists.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Oncofertility and factors affecting fertility preservation

Biomarkers of ovarian reserve and recovery

Fertility-sparing surgical options by cancer type

Cervical cancer

Endometrial cancer

Ovarian cancer

JOURNAL of MEDICINE and LIFE JML | REVIEW Fertility-sparing surgery: a hopeful strategy for young women with cancer Valentin Nicolae Varlas1,2, Roxana Georgiana Borș1,*, Rebeca Crețoiu3, Irina Bălescu4, Nicolae Bacalbașa5, Monica Cîrstoiu6 Author Affiliations 1. Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania 2. Department of Obstetrics Gynecology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 3. Department of Pituitary and Neuroendocrine Disorders, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania 4. Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania 5. Department of Visceral Surgery, Fundeni Clinical Institute, Bucharest, Romania 6. Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Romania * Corresponding Author: Roxana Georgiana Borș Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania Email: [roxana_georgiana20@yahoo.com](roxana_georgiana20@yahoo.com) DOI 10.25122/jml-2023-0203 Dates Received: 6 June 2023 Accepted: 25 June 2023 ABSTRACT Fertility preservation in cancer patients is currently based on either assisted reproductive technology or fertility-sparing surgery. Loss of fertility may be caused by excisional surgery associated with an adnexal or uterine pathology or secondary to gonadal insufficiency caused by chemotherapy or radiation. The counseling of these patients is very important, being carried out jointly by the oncologist, gynecologist, and reproductive medicine specialist. Reproductive surgery usually requires avoiding laparotomy to significantly reduce the formation of adhesions and trauma or tissue damage. This is done using standard laparoscopic surgery or robotic surgery (computer-assisted laparoscopy), a method increasingly used and accessible to all specialists who want to maintain the fertility of their patients with various oncological diseases. KEYWORDS: fertility preservation, oncofertility, fertility-sparing surgery, young cancer patient, computer-assisted surgery, ovarian tissue transplantation; ovarian transposition; robotic surgery INTRODUCTION Adolescents and young adults (AYA) with cancer are often unaware that their life-preserving treatments can also threaten their future fertility potential [1–3] . Oncofertility (OF) is a growing area due to the increasing number of cancer survivors, the development of new oncologic therapies, the extension of treatments'duration, and the development and refinement of reproductive treatments [4] . The decision to protect fertility from the damaging effects of treatments, like radiation and chemotherapy, is complicated by the patient’s age, marital status, whether they can delay treatment, and, sometimes, the uncertainty of survival [5] . In women, chemotherapy is associated with a decrease in anti-Müllerian hormone (AMH) levels and an increase in follicle-stimulating hormone (FSH) levels, indicating a decline in ovarian reserve and potential impairment of fertility [6, 7] . Decreased estrogen levels leading to symptoms of menopause (such as hot flashes, vaginal dryness, or mood swings) are also frequent [8] . Biological markers serve not only as valuable tools for assessing infertility but also for investigating the recovery of ovarian function. Kim et al. concluded that post-chemotherapy AMH levels could bea relatively accurate predictor of ovarian function recovery, as indicated by the resumption of menstruation, in breast cancer patients with chemotherapy-induced amenorrhea [9] . Current studies revealed the risk-stratified priority in cancer patients to optimize care among various malignancies; thus, Smith et al. [10] on breast cancer, Wallis et al. [11] on urologic cancers, Sica et al. [12] and Passamonti et al. [13] on onco-hematology, Martinelli et al. [14] and Colombo et al. [15] on gynecologic cancers

FAQs

What are the main approaches to fertility preservation in cancer patients?

Fertility preservation relies on either assisted reproductive technology or fertility-sparing surgery.

Why is fertility counseling especially important in young cancer patients?

Counseling is crucial because fertility can be threatened by cancer treatments, and decisions depend on patient age, marital status, treatment timing, and survival uncertainty.

How does fertility-sparing surgery aim to reduce harm during treatment?

It typically avoids laparotomy to significantly reduce adhesions and trauma or tissue damage, using standard laparoscopic surgery or robotic (computer-assisted) surgery.

Sep 24, 2026

Uploaded by Grenda