卵巢非上皮性恶性肿瘤生育力保护

卵巢非上皮性恶性肿瘤约占卵巢肿瘤的10%，且多发生于年轻女性，手术和放化疗虽然能够使患者获得生存机会，但常带来不同程度的生育功能损害，造成其生理及心理上的痛苦，所以在改善卵巢恶性肿瘤患者生存率的同时，尽可能保护患者的生育力成为治疗中的重要问题。卵巢非上皮性癌尤其是恶性生殖细胞肿瘤保留生育功能治疗的效果良好，文章就卵巢非上皮性恶性肿瘤保护生育力的手术治疗、术后辅助治疗的实施及辅助生殖技术的应用等问题进行阐述。     

Fertility of women after conservative operation for borderline ovarian tumors

OBJECTIVES: The aim of the study was to assess procreation in group of patients who were treated by conservative operation for borderline tumors of the ovary. DESIGN: The analysis included 42 patients conservatively operated for ovarian tumor of borderline malignancy in Department of Gynecology Medical University of Gdansk between 1978-2000. The incidence of pregnancy, age of patients, tumor pathology, type of conservative surgery and the course of pregnancy and labour were evaluated in this study. RESULTS: In the analysis group were 36 (85.7%) stage IA, 2 (4.8%) stage IB, 3 (7.1%) stage IC and 1 (2.4%) stage III C patients. Unilateral adnexectomy was performed in 36 (85.7%) patients, 4 (9.5%) unilateral cystectomy, 2 (4.8%) bilateral cystectomy with omentectomy in one case. After conservative operation 10 (23.8%) patients were pregnant and delivered healthy children but 2 patients delivered twice and 1 third. Recurrence was observed in 2 patients in period of 27 and 50 months after operation. 5 years survival was 97.6%. CONCLUSIONS: Percentage of pregnancy after conservative treatment for borderline ovarian tumors was high (23,8%) and number of recurrences was low so conservative surgery allows young women to retain procreational potential without increasing risk of recurrence.     

Fertility after ovarian cancer treatment.

Considering the important improvement of surgical techniques and chemotherapy in the last few years, it is possible today, in selected cases of patients previously treated for ovarian cancer, to support their desire for motherhood, thus improving the quality of life for them. The major problem for the Gynecologic Oncologist in treating young women for ovarian tumour is the lack of statistically significant experience world-wide, because of the very few cases in which the reproductive function is preserved, and pregnancy is subsequently possible. In this report the problem is discussed, and the results obtained in our Institute are presented.     

Fertility after conservative treatment for borderline ovarian tumors: a French multicenter study

OBJECTIVE: To examine fertility outcomes and determinants of fertility after conservative surgery for women with borderline ovarian tumors. DESIGN: Retrospective multicenter study. SETTING: Thirteen specialized gynecologic units and one cancer center. PATIENT(S): In a study of women with borderline ovarian tumors, 162 of 360 women underwent conservative surgery; from these 162, we compared epidemiologic, surgical, and histological parameters between 21 women who conceived and 44 women who failed to conceive. INTERVENTION(S): Conservative surgery for borderline ovarian tumors. MAIN OUTCOME MEASURE(S): Fertility results and outcome. RESULT(S): Women undergoing conservative treatment were significantly younger and more likely to be nulliparous. Tumor size was significantly smaller in the conservative treatment group. Thirty pregnancies occurred in 21 (32.3%) of the 65 women who wished to conceive after conservative treatment. Twenty-seven pregnancies were spontaneous, whereas three occurred after ovarian stimulation and IUI (one case) or IVF (2 cases). Women who conceived did not differ from women who did not conceive in terms of the tumor recurrence rate or the mean time to recurrence (39.6 +/- 28.2 and 22.9 +/- 14.9 months, respectively). Age at initial treatment was the only determinant of fertility. CONCLUSION(S): Despite a high recurrence rate, our results confirm that conservative surgery for women with borderline ovarian tumors is an acceptable option and that fertility is preserved in nearly one third of cases.     

Fertility after conservative treatment of ovarian immature teratomas

The objective of this study was to assess the reproductive experience of patients with immature teratomas who underwent fertility preserving therapy. Thirty-five consecutive patients with immature teratoma of the ovary treated, or consulted on, by the Yale Gynecologic Oncology Service over a 20-year period were assessed. Charts were reviewed retrospectively and when necessary, follow-up information was obtained by telephone calls to patients or their referring physicians. All 35 patients underwent surgery. Thirty-four (97%) patients received chemotherapy according to protocols current at the time of their treatment. One patient (2.8%) had an ovarian cystectomy only with no further adjuvant therapy. Twenty-three patients (65.7%) had fertility preserving treatment. Of these patients, two have not yet completed their sexual development and one underwent bilateral tubal ligation immediately after completion of her chemotherapy as she had fulfilled her reproductive goals prior to her diagnosis. Of the remaining 20 patients, 10 (50%) had undergone wedge biopsy of the contralateral ovary. This information was not available in an additional two patients. Of the 13 patients attempting pregnancy, 11 have been successful. Eight of these patients had stage I and three had stage III disease. Twenty-six conceptions have occurred. Of these, five have culminated in elective and two in spontaneous abortions while the other 19 have led to the delivery of 19 healthy infants. Two patients (8.7%) have experienced infertility, one due to pelvic inflammatory disease and the other due to postoperative adhesions. Both of these patients had stage I disease. Fertility preserving treatment is appropriate for all patients with immature teratomas of the ovary who wish to maintain their reproductive function.     

Fertility and tumor recurrence rate after conservative laparoscopic management of young women with early-stage borderline ovarian tumors.

OBJECTIVE: To evaluate the efficacy of laparoscopic conservative surgery in young women with borderline ovarian tumors who want to preserve their childbearing potential, and to assess whether pregnancy influences the recurrence rate during the follow-up evaluation period. DESIGN: Retrospective study. SETTING: Center for Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola Hospital, University of Bologna, Italy. PATIENT(S): Nineteen women (mean age 27.4 +/- 4.7) with borderline ovarian tumors who underwent laparoscopy between January 1995 and January 1998. All of the women wanted to preserve their fertility. INTERVENTION(S): A standardized conservative laparoscopic approach and a strict follow-up schedule. MAIN OUTCOME MEASURE(S): A complete preoperative examination. RESULT(S): Follow-up evaluations (mean 42 +/- 19 months) were made available to all patients. Among 19 patients, 10 attempted pregnancy and 6 conceived spontaneously. All six pregnancies went to term and the disease did not affect the gestation or the follow-up period after the pregnancy (24.5 +/- 15.7 months). CONCLUSION(S): Conservative laparoscopic management of borderline ovarian tumors is a potentially safe alternative in young women who want to retain their childbearing potential. Fertility and pregnancy outcome remain excellent in these women. Our preliminary data seem to indicate that the recurrence rate after pregnancy is not influenced by this approach.     

Pregnancy outcomes after surgical treatment of ovarian pregnancy

Objective

To investigate pregnancy outcomes subsequent to ovarian pregnancy treated by surgery.

Methods

A retrospective analysis was conducted of ovarian pregnancies that were treated by surgery at a hospital in Korea between January 1996 and December 2009.

Results

Forty-nine women with ovarian pregnancies (1.6% of all ectopic pregnancies) were treated; 28 of these patients who were followed-up for more than a year were included in the study. The most common risk factor for ovarian pregnancy was endometriosis (42.9%). Accurate diagnosis of ovarian pregnancy was made preoperatively in 7 patients (25%). Of the 28 patients, 16 (57.1%) had subsequent pregnancies: 13 (46.4%) were intrauterine pregnancies and 3 (10.7%) were tubal pregnancies. However, no subsequent ovarian pregnancies occurred. In addition, only 1 patient had secondary infertility after surgery for ovarian pregnancy.

Conclusions

After an ovarian pregnancy treated by surgery, the outcome of a subsequent pregnancy is reasonable; there is a high rate of successful subsequent pregnancy and a low rate of subsequent ectopic pregnancy or of infertility.     

Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience

Objective  

The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type.     

Fertility after ectopic pregnancy in relation to background factors and surgical treatment

To study the importance of certain background factors and surgical treatment, the obstetric outcome in 205 women consecutively treated for ectopic pregnancy was analyzed by means of questionnaires 4 to 5.5 years after surgery. The response rate was 83.4% and, among women desiring pregnancy (n = 112), the total pregnancy rate was 75.9% and the delivery rate 53.6%. The total incidence of repeat ectopics was 27.3%, and the proportion of women who had a repeat ectopic pregnancy but no delivery was 20.5%. Six of seven women having an ectopic pregnancy with a copper intrauterine contraceptive device in situ had a normal delivery during the follow-up period. The subsequent fertility among nonresponders appeared lower than among responding women. A number of background factors present at the time of surgery were correlated to subsequent infertility, e.g., history of infertility and previous abdominal surgery. Conversely, there was no correlation between the fertility outcome and the type of operative procedure.     

早发性卵巢功能不全促生育治疗

早发性卵巢功能不全（POI）的促生育治疗除赠卵外,目前并无统一公认的直接证据证实使用自身卵子获得妊娠的有效方法。针对有生育要求的患者,可尝试通过治疗原发病、调整促排卵方案、添加一些辅助药物等方法改良卵巢功能。文章主要介绍POI促生育治疗的方法和POI影响生育力的预防。     

Fertility preserving surgical treatment of borderline ovarian tumour: long-term consequence for fertility and recurrence

BACKGROUND: Borderline tumours of the ovary comprise >10% of all epithelial ovarian tumours, and about one-quarter of these tumours are seen in women of fertile age. In the present study, the outcomes with regard to fertility and recurrence were followed in patients with borderline tumours, who were treated with ovarian and uterus preserving surgery. METHODS: Of 101 women surgically treated for borderline tumours in our institution, 22 underwent fertility preserving surgery, defined as the preservation of at least part of one ovary and the uterus. A retrospective follow up of these patients was conducted. RESULTS: The 22 patients (mean age 30.5 years) underwent surgery with either unilateral salpingoophorectomy (USO; n=14) or USO combined with cystectomy of the contralateral ovary (n=8). All these patients had tumours of FIGO-stage 1 (1a = 13; 1b = 3; 1c = 6). No recurrence was seen during the follow up time (mean 8.1 years; range 5-12 years). Thirteen of the 22 patients have, since the surgery, been given a chance of pregnancy (10 actively aimed to achieve pregnancy; 3 with no contraceptive during the follow up period), and 9 of the 13 patients have become pregnant. Seven patients conceived spontaneously and 2 became pregnant through IVF. Eight of the 9 pregnant patients have given birth to a total of 14 infants, all born at term. CONCLUSION: This study shows that borderline ovarian tumours in patients of fertile age can be successfully treated conservatively to preserve fertility with no apparent risk of recurrence.     

Fertility in women after age forty-five.

Pregnancy after age 45 years is infrequent and the mother and baby should be considered as a high risk. There is a greater incidence of spontaneous abortion, gestational trophoblastic disease and chromosomal abnormalities in the fetus. Birth control practices should be discontinued after 49 years of age in the best interest of the woman's sexuality if abortion is acceptable to her. The patient should be completely informed of the risks and, in the event of pregnancy, abortion should be advised.     

Intrauterine factors and risk of nonepithelial ovarian cancers

Objective

The majority of ovarian tumors in girls and young women are nonepithelial in origin. The etiology of nonepithelial ovarian tumors remains largely unknown, and intrauterine exposures may play an important role. We examined the association of perinatal factors with risk of nonepithelial ovarian tumors in girls and young women.

Methods

National cohort study of 1,536,057 women born in Sweden during 1973–2004 and followed for diagnoses of nonepithelial ovarian tumors through 2009 (attained ages 5–37 years). Perinatal and maternal characteristics and cancer diagnoses were ascertained using nationwide health registry data.

Results

147 women were diagnosed with nonepithelial ovarian tumors in 31.6 million person-years of follow-up, including 94 with germ cell tumors and 53 with sex-cord stromal tumors. Women born preterm (< 37 weeks of gestation) had a significantly increased risk of developing nonepithelial ovarian tumors (adjusted hazard ratio 1.86, 95% CI 1.03–3.37; p = 0.04). Histological subgroup analyses showed that preterm birth was associated with increased risk of sex-cord stromal tumors (4.39, 2.12–9.10; p < 0.001), but not germ cell tumors (0.68, 0.21–2.15; p = 0.51). No significant associations were found with fetal growth, birth order, and maternal age at birth.

Conclusions

This large cohort study provides the first evidence that preterm birth is a risk factor for developing sex cord-stromal tumors. Ovarian hyperstimulation in response to high gonadotropin levels in preterm girls could mediate disease risk through the proliferative and steroidogenic effects of FSH and LH on granulosa and theca cells, from which most sex-cord stromal tumors are derived.     

Fertility after ovarian drilling by transvaginal fertiloscopy for treatment of polycystic ovary syndrome

STUDY OBJECTIVE: To evaluate fertiloscopy ovarian drilling with bipolar energy in women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). DESIGN: Prospective study (Canadian Task Force classification II). SETTING: University teaching hospital and private clinic. PATIENTS: Eighty women with clomiphene citrate-resistant PCOS. INTERVENTION: Operative transvaginal fertiloscopy with a coaxial bipolar electrode. MEASUREMENTS AND MAIN RESULTS: During a mean follow-up of 18.1 months (+/- 6.4), 73 women (91%) recovered regular and ovulatory cycles. The cumulative pregnancy rate was 60% (44/73) for spontaneous and stimulated cycles, with 39.7% (29/73) imputed to drilling alone. The mean time to conceive was 3.9 months (range 1-11.8). There were eight miscarriages (18%), and no ectopic pregnancies or multiple pregnancy. No complications occurred. CONCLUSION: Ovarian drilling by transvaginal fertiloscopy with bipolar electrosurgery appears to be an effective minimally invasive procedure in patients with PCOS resistant to clomiphene citrate.