ABSTRACT
In recent years, medical advances have substantially improved survival of cancer patients, generating growing concern about the quality of life of the survivors. Increased attention has been paid to reproductive problems after oncological treatments. International guidelines on fertility preservation in cancer patients require that healthcare teams discuss, as early as possible, the impact of cancer treatments on fertility and encourage access to fertility preservation techniques. The development of these techniques in women is a recent effort and many patients and health care providers are not familiar with their rapid expansion. This article discusses indications, results, and risks of the different options currently available.
En los últimos años, los avances médicos han mejorado sustancialmente la sobrevida de los pacientes con cáncer, generando una mayor preocupación por la calidad de vida de los sobrevivientes. En particular, se ha prestado una creciente atención a los problemas reproductivos posteriores a los tratamientos oncológicos. Las pautas internacionales sobre la preservación de la fertilidad en pacientes con cáncer, recomiendan que los equipos de salud debatan lo más pronto posible con todos los pacientes en edad reproductiva el impacto de la terapia sobre el sistema reproductor. También insta a que se disponga y facilite el acceso oportuno a técnicas de preservación de la fertilidad. El desarrollo de estas técnicas en mujeres pre y post puberales son un esfuerzo reciente, y muchos pacientes y proveedores de la salud no están familiarizados con el rápido avance en su investigación. En la presente revisión se exponen las indicaciones, resultados y riesgos de las diferentes opciones disponibles en la actualidad.
Subject(s)
Fertility Preservation/methods , Neoplasms/therapy , Quality of Life , Cancer Survivors , Fertility , Humans , Internationality , Practice Guidelines as TopicABSTRACT
This paper aimed to describe the basic aspects of uterine transplant (UTx) research in humans, including preliminary experiences in rodents and domestic species. Studies in rats, domestic species, and non-human primates validated and optimized the UTx procedure in terms of its surgical aspects, immunosuppression, rejection diagnosis, peculiarities of pregnancy in immunosuppressed patients, and patients with special uterine conditions. In animal species, the first live birth from UTx was achieved in a syngeneic mouse model in 2003. Twenty-five UTx procedures have been performed in humans. The first two cases were unsuccessful, but established the need for rigorous research to improve success rates. As a result of a controlled clinical study under a strictly designed research protocol, nine subsequent UTx procedures have resulted in six healthy live births, the first of them in 2014. Further failed UTx procedures have been performed in China, Czech Republic, Brazil, Germany, and the United States, most of which using living donors. Albeit still an experimental procedure in, UTx is the first potential alternative for the treatment of absolute uterine factor infertility (AUFI).