General Gynecology · Cancer and Fertility
Abstract
Gynaecological cancer incidence in children and prepubertal girls is low but the risk of losing fertility potential is high due to the oncological treatments' toxicity. Consequently, fertility preservation is a top concern for survivors. This narrative review aims to summarize the best way of approaching each tumor treatment during prepubertal age with the goal of preserving fertility, and to discuss the latest methods used for fertility preservation for each gynaecological cancer. These procedures do not lack risks or uncertainities and offer a broad area of research.
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By this author
Exploring MAR perceptions in Kosovo - disparities in knowledge about MAR among young people
Dimitrievska V et al., 2025 · Open research Europe · Free full text on PubMed Central
Research on knowledge and perception about (in) fertility and Medically Assisted Reproduction (MAR) techniques among young people in Kosovo is lacking. Part of the European Project's B 2-InF's team conducted a qualitative study in Kosovo with young adults (18-30) in 2021 assessing perceptions and views related to MAR and information provided by the MAR clinics in Kosovo. Main objective of this study is to explore perceptions about motherhood/fatherhood and to understand (in) fertility issues among young people in Kosovo. It is focused to delve more into MAR knowledge and techniques of young people in Kosovo and in general. Fifteen interviews with young people living in Kosovo were conducted between June and July 2021. A total of 3 themes emerged during the qualitative analysis and were grouped in three main theme levels. The first level, perceptions about motherhood and fatherhood among young people in Kosovo is about different views of young people, desires about becoming parents, and what is their personal attitude towards parenting. The second, analyzing how (in) fertility is perceived by young people from a gendered perspective. The third, MAR perceptions and new techniques that are prevailing in the global sense as different access opportunities are present. The findings from our interviews demonstrated that parenthood is still gender related. Male (in) fertility is often considered a taboo among the young people in Kosovo. A substantial amount of lack of knowledge was found in relation to MAR techniques, highlighting the importance of detailed information about the whole process of MAR treatments.
Policy and Regulation · Professional Standards
Information and misinformation on assisted human reproduction techniques in Europe: a normative analysis of the information provided on the websites of medically assisted reproduction clinics
Albert M et al., 2026 · BMC medical ethics · Free full text on PubMed Central
As part of the European Be better informed about Fertility project (B2-InF), we carried out a normative analysis of the information provided online by assisted reproduction clinics to the European public. This analysis aimed to determine the degree to which this information complies with regulations of medically assisted reproduction (MAR) and commercial information, and the main ethical implications related to the duty of information. Information was gathered from the websites of 33 clinics across 8 European countries (Albania, Belgium, Spain, Italy, Kosovo, Northern Macedonia, Slovenia, Switzerland). Nearly 2000 pages of information were reviewed and checked for compliance with relevant frameworks of national and international law. The assessment revealed significant inconsistencies in how clinics present information online, with particular concerns regarding transparency about success rates, associated risks, add-on techniques and the legal and ethical issues that may arise during the use of these techniques. The results of our analysis indicate an urgent need for enhanced regulatory oversight and standardized information requirements for assisted reproduction clinics across Europe. These findings suggest the necessity for harmonized legal frameworks that mandate comprehensive disclosure standards and establish effective enforcement mechanisms to ensure transparent and accurate information provision to potential patients.
Reflecting sex, social class and race inequalities in reproduction? Study of the gender representations conveyed by 38 fertility centre websites in 8 European countries
Rozée V et al., 2024 · Reproductive health · Free full text on PubMed Central
Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries. The 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective. Each centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers. MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters.
Industry, Cost and Access · Clinic Marketing and Transparency
Motives of patients crossing borders to pursue assisted reproduction – why the Czech Republic is a frequent choice for egg donation treatment
Dostálová A et al., 2022 · Česká gynekologie
Cross-border reproductive care is undoubtedly a current phenomenon. The number of people interested in receiving reproductive care abroad is increasing every year. This new context needs a political solution that would respond to the definition of standard care within the circumstances of providing healthcare to the citizens of another country. Patients that undergo reproductive treatment abroad very often face complications such as language problems, insufficient information, separation from family members, cultural differences and customs, potential unrealistic expectations, and also restrictions by law. This work is descriptive in nature and aims to illustrate the variables that come into play when choosing the Czech Republic over other destinations as a country to receive infertility treatment. We analyze the phenomenon by selecting documents used as sources of data. In our research, we focused on infertility treatment and justified the reasons why foreign citizens choose the Czech Republic over other destinations for infertility treatment. The variables that lead to the selection of cross-border infertility treatment in the Czech Republic include no waiting time, anonymous donations, international departments in various languages, and affordable prices compared to other destinations.
Related research
Cancer and Fertility · Fertility Preservation Before Treatment
Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review
Gałczyński K et al., 2021 · Journal of clinical medicine · Free full text on PubMed Central
Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.
Cancer and Fertility · Fertility Preservation Before Treatment
Chemotherapy and fertility
Blumenfeld Z, 2012 · Best practice & research. Clinical obstetrics & gynaecology
The overall increase in cancer prevalence and the significant increase in long-term survival have generated worldwide interest in preserving fertility in young women exposed to gonadotoxic chemo- and radiotherapy. Infertility represents one of the main long-term consequences of combination chemotherapy given for lymphoma, leukaemia and other malignancies in young women. The gonadotoxic effect of various chemotherapeutic agents is diverse, may involve a variety of pathophysiologic mechanisms, and is not unequivocally understood. Proliferating cells, such as in tissues with high turnover (i.e. bone marrow, gastrointestinal tract and growing ovarian follicles) are more vulnerable to the toxic effect of alkylating agents. These agents may also be cytotoxic to cells at rest, as they are not cell-cycle specific. Alkylating agents, the most gonadotoxic chemotherapeutic medications, cause dose-dependent, direct destruction of oocytes and follicular depletion, and may bring about cortical fibrosis and ovarian blood-vessel damage. The reported rate of premature ovarian failure after various diseases and chemotherapeutic protocols differ enormously, and depend mainly on the chemotherapeutic protocol used and age range of the woman. Several options have been proposed for preserving female fertility, despite gonadotoxic chemotherapy: ovarian transposition, cryopreservation of embryos, unfertilised metaphase-II oocytes and ovarian tissue, and administration of gonadotropin-releasing hormone agonistic analogs in an attempt to decrease the gonadotoxic effects of chemotherapy by simulating a prepubertal hormonal milieu. None of these methods is ideal and none guarantees future fertility in all survivors; therefore, a combination of methods is recommended for maximising women's chances of future fertility.
Fertility preservation in patients with medical indications: a committee opinion
Practice Committee of the American Society for Reproductive Medicine, 2026 · Fertility and sterility
Patients preparing to undergo therapies that pose a risk to their fertility or who are at risk of premature ovarian insufficiency should be provided prompt counseling regarding available options for fertility preservation. Fertility preservation can best be provided by comprehensive programs designed and equipped to confront the unique challenges facing these patients. This document replaces the document entitled "Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion," last published in 2019.
Safety and Risks · Long Term Child Outcomes
The association between fertility treatments and the incidence of paediatric cancer: A systematic review and meta-analysis
Zhang Y et al., 2020 · European journal of cancer (Oxford, England : 1990)
It is important to explore the association between different fertility treatments and the incidence of paediatric cancer, as this will provide crucial guidance for clinical decision-making. Previous studies have explored the relationship between fertility treatments and different types of cancer in offspring, but the results are controversial. Two authors searched PubMed, Embase, Web of Science and Cochrane databases independently to acquire qualified studies. Then, the same authors extracted data from these studies and analysed these data using RevMan 5.3. Eleven case-control studies and 16 cohort studies were included in this review and meta-analysis. The relative risk of association between in vitro fertilisation (IVF) and paediatric cancer incidence was 1.01 (95% confidence interval [CI]: 0.80-1.28) in cohort studies and 1.09 (95% CI: 0.74-1.58) in case-control studies. The relative risk of association between intracytoplasmic sperm injection (ICSI) and paediatric cancer incidence was 0.97 (95% CI: 0.80-1.17) in cohort studies. The relative risk of association between fertility drugs and paediatric cancer incidence was 1.07 (95% CI: 0.68-1.69) in cohort studies and 1.12 (95% CI: 0.90-1.41) in case-control studies. The relative risk of association between frozen embryo transfer and paediatric cancer incidence was 1.37 (95% CI: 1.04-1.81) in natural pregnancy controls and 1.28 (95% CI: 0.96-1.69) in fresh embryo transfer controls. There is no evidence that IVF, ICSI and fertility drugs are associated with an increase in paediatric cancer incidence in offspring; however, frozen embryo transfer is associated with an increase in paediatric cancer incidence in the offspring, but this finding needs further research and attention.
General Gynecology › Cancer and Fertility › Fertility Preservation Before Treatment · Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation
PMID 39638650 39638650 DOI 10.1016/j.ejso.2024.109483 10.1016/j.ejso.2024.109483 Errasti et al. 2025, Errasti 2025