Motherhood after breast cancer: can we balance fertility preservation and cancer treatment? A narrative review of the literature.

Breast cancer may affect young women who have not yet completed childbearing. Assisted reproductive technology (ART) provides alternatives for fertility preservation such as oocyte, embryo or ovarian tissue cryopreservation. We reviewed the published literature on fertility-preserving management in breast cancer, aiming at finding evidence to answer the following questions: (1) What are the fertility sparing options available?; (2) How do these women respond to IVF? and (3) Can pregnancy influence breast cancer recurrence? There is a paucity of publications describing clinical experience and outcome data which limits accessibility to fertility preservation in this setting. Presently, oocyte or embryo cryopreservation are the main options for fertility preservation. IVF success rates are comparable to the ones of non-oncological populations according to the woman's age but current published studies lack data on definitive success rates following embryo banking for cancer patients. The perception that IVF and pregnancy may worsen cancer prognosis remains, despite the lack of scientific evidence to support this notion. Published studies show reassuring results for pregnancies occurring >2 years after breast cancer diagnosis. The best published evidence suggests pregnancy after breast cancer does not increase the risk of disease recurrence, thus pregnancy should not be forbidden once treatment is completed. Decision making for women diagnosed with cancer requires up-to-date knowledge of the efficacy and safety of available options. Providing consultation with a reproductive specialist and appropriate information on fertility preservation for these women should be an essential aspect of their supportive care.

Association between Toll-like receptor and tumor necrosis factor immunological pathways in uterine cervical neoplasms.

INTRODUCTION: The immune system plays a critical role in the defense against human papillomavirus (HPV) infection and its persistence. Toll-like receptors (TLRs) are membrane receptors responsible for activation of the innate immune response, and an association between TLR expression and uterine cervical cancer has been shown. Tumor necrosis factors (TNFs) are among the main mediators of skin and mucosa inflammation. The aim of this study was to demonstrate the association between TLR and TNF immune expression and cervical cancer and premalignant cervical lesions. METHODS: A total of 64 embedded tissues were obtained from gynecological procedures, including 35 specimens with cervical intraepithelial neoplasia (CIN) and 10 specimens with cervical squamous cell carcinoma (CSCC) as well as 19 normal cervical samples. The expression of TLR2, TLR3, TLR4, TNF-α and TNF-ß was measured by immunohistochemistry and graded into low and high levels of expression. RESULTS: There was an association between the expression levels of TLR2 and those of TNF-α and TNF-ß (p = 0.01 and p = 0.021, respectively) in the cervical cancer and CIN groups. TLR4 expression was associated with TNF-α and TNF-ß expression (p = 0.016 and p = 0.025, respectively) in these 2 groups. By contrast, TLR3 was not statistically associated with TNF-α or TNF-ß in any of the groups. CONCLUSIONS: There might be an association of the TLR2 and TLR4 pathways with the immunological response of TNF-α and TNF-ß in cervical cancer. These markers are also expressed at higher levels in cervical cancer and premalignant lesions compared to normal controls.

Charting new frontiers in In Vitro Fertilization (IVF): The Role of Bioengineering.

Since the beginning of in vitro fertilization (IVF) 36 years ago, scientists have studied and critically analyzed the techniques in order to find ways to improve outcomes. However, success rates vary significantly among clinics due to poor reproducibility and inconsistency across operators. Much research has been conducted on the chemical environment, or culture medium, surrounding the oocyte/ embryo, but little attention has been given to the actual equipment and physical culture environment, which has changed very little over the years. The aim of this paper was to evaluate how the physical factors are important regulators of oocyte and embryo function and to improve understanding of the physical forces involved in the processes in human reproduction. A review the available literature was conducted using PubMed from 1966 through July 2014 in an attempt to help integrate mechanics into our understanding of the molecular basis of IVF. Keywords included in vitro fertilization, biomechanics, bioengineering, oocyte and embryo. The mechanical characterization of oocytes and embryos represents an opportunity to detect cellular defects, assess quality and bio-viability of processes such as cryopreservation as well as select the best embryo for transfer. Defining the mechanical forces at play during embryo transfer is also an important step towards improving results in in vitro fertilization. The further analysis of these phenomena needs a detailed monitoring of the mechanical conditions and more extensive studies of events on the cellular and molecular levels.

Safe fertility-preserving management in gynecological malignancies.

OBJECTIVE: To provide a review in the available literature about the safe fertility-preserving management in gynecological malignancies, focusing on the selection criteria of the patients, treatment options and follow-up. DESIGN: Literature survey. RESULTS: The incidence of cancer in women who still want to get pregnant is increasing significantly. An early detection in gynecological malignancies allows less aggressive approaches to cure such disorders. A more conservative management, which preserves fertility, is considered safe and an option for those who have not completed their child-bearing. CONCLUSIONS: Selected patients with cervical, endometrial and ovarian cancer may be candidates to a safe fertility-preserving management. A careful stage and follow-up of the patients is essential to achieve success with this practice.

Histological evaluation of the effects of cryopreservation in bovine ovarian tissue.

The aim of this study was to show the effects of freezing and thawing in bovine ovarian tissue by histological analysis. Ten cortical slices (2-4 mm in diameter) were obtained from each ovary by tru-cut biopsy and randomly divided into two groups: five fragments were immediately processed as a fresh tissue control group, while the remaining 5 fragments were slowly frozen using DMSO plus sucrose as cryoprotectors, then stored for two weeks and quickly thawed. Histological examination of all cryopreserved ovarian fragments showed no damage in the structure of the organ. Furthermore, there was no difference in the average number of primordial and primary follicles between the two groups of ovarian tissue. These data suggest that the bovine ovary can be used as a suitable model to test new freezing and thawing procedures in search for a standard protocol of human ovary cryopreservation.