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1.
Urol Clin North Am ; 47(2): 227-244, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32272995

RESUMO

Infertility caused by chemotherapy or radiation treatments negatively impacts patient-survivor quality of life. The only fertility preservation option available to prepubertal boys who are not making sperm is cryopreservation of testicular tissues that contain spermatogonial stem cells (SSCs) with potential to produce sperm and/or restore fertility. SSC transplantation to regenerate spermatogenesis in infertile adult survivors of childhood cancers is a mature technology. However, the number of SSCs obtained in a biopsy of a prepubertal testis may be small. Therefore, methods to expand SSC numbers in culture before transplantation are needed. Here we review progress with human SSC culture.


Assuntos
Células-Tronco Germinativas Adultas/transplante , Preservação da Fertilidade/métodos , Infertilidade Masculina/prevenção & controle , Neoplasias/terapia , Espermatogênese/fisiologia , Células-Tronco Germinativas Adultas/fisiologia , Humanos , Infertilidade Masculina/etiologia , Masculino , Espermatogênese/efeitos dos fármacos , Espermatogênese/efeitos da radiação , Transplante de Células-Tronco/métodos
3.
Medicine (Baltimore) ; 99(15): e19589, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282708

RESUMO

With development of tumor treatment, survival time of patients with cancer is significantly prolonged. Therefore, the current emphasis is not only the survival, but also the quality of life, especially, it is crucial for young male cancer patients who are unmarried and maintaining fertility. However, the awareness of fertility preservation for these patients is currently insufficient.To give physician and cancer patients more clear understanding of the importance and safety of sperm cryopreservation, so that achieve patient fertility benefits.First, the knowledge level and attitudes about fertility preservation were investigated by surveying 332 cancer patients and 103 medical staff with questionnaires. Second, 30 male cancer patients (experimental group) and 30 normal donors (control group) were selected and their sperm samples were cryopreserved. The sperm quality was compared between cancer patients and normal donors, before and after antitumor treatment in the cancer patients, and before and after sperm cryopreservation in both groups.In the questionnaire survey, we found that there were 70% to 80% of medical staffs and cancer patients lacked knowledge of fertility preservation, and 27.7% of patients worried that tumor and sperm cryopreservation might affect their offspring. In the sperm preservative experiment, we found that sperm quality in cancer patients was further damaged after radiotherapy/chemotherapy in addition to tumor itself had a negative effect. However, sperm deoxyribonucleic acid fragments were not affected by sperm cryopreservation although there were significant differences in sperm quality before and after sperm preservation in both groups.Radiotherapy/chemotherapy would further damage sperm quality of young male cancer patients. Medical staff should be aware of importance of sperm cryopreservation for fertility preservation for these patients. It is also necessary that medical staff should inform the patient about the safety of sperm freezing and guide the patient to participate in sperm cryopreservation.


Assuntos
Criopreservação , Preservação da Fertilidade , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias , Espermatozoides , Adulto , Estudos de Casos e Controles , Humanos , Masculino , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(11): e19566, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176115

RESUMO

Chemotherapy may cause ovarian toxicity and infertility. Cancer patients are usually overwhelmed, and focus exclusively on cancer diagnosis and may not pay attention to fertility-related issues. In this paper we look at the rate of amenorrhea and fertility counseling among such young patients.Premenopausal women with early-stage breast cancer treated with adjuvant or neoadjuvant chemotherapy were recruited. Amenorrhea was defined as absence of menstruation for ≥12 months after the completion of chemotherapy.A total of 94 patients met the eligibility criteria and were included in this analysis. Median age at diagnosis was 35.7 (range, 22-44) years. Seventy-nine (85.9%) respondents were counseled about amenorrhea and 37 (40.2%) were considering having children. Long-term amenorrhea was reported by 51 (54.3%) patients. The addition of taxanes to anthracyclines, in 2 different regimens, increased the risk of amenorrhea to 69.2% and 66.7% compared to 38.9% with anthracycline-alone, P < .0001. Longer duration of chemotherapy (≥24 weeks) might also be associated with higher rate of amenorrhea (67.7%) compared to 43.4% in those who had shorter duration (<24 weeks), P = .031.The addition of taxanes to anthracycline-based chemotherapy increased the risk of amenorrhea. However, shorter duration of chemotherapy, even with taxanes, may lower such risk. Our study highlights the importance of fertility counseling to improve fertility preservation rates. Given the importance of taxanes, shorter regimens are associated with lower amenorrhea rates and should be preferred over longer ones.


Assuntos
Amenorreia/induzido quimicamente , Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Preservação da Fertilidade , Taxoides/efeitos adversos , Adulto , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/efeitos adversos , Aconselhamento , Feminino , Humanos , Jordânia , Estadiamento de Neoplasias , Estudos Retrospectivos , Adulto Jovem
5.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32071259

RESUMO

Many cancers presenting in children and adolescents are curable with surgery, chemotherapy, and/or radiotherapy. Potential adverse consequences of treatment include sterility, infertility, or subfertility as a result of gonad removal, damage to germ cells as a result of adjuvant therapy, or damage to the pituitary and hypothalamus or uterus as a result of irradiation. In recent years, treatment of solid tumors and hematologic malignancies has been modified in an attempt to reduce damage to the gonadal axis. Simultaneously, advances in assisted reproductive technology have led to new possibilities for the prevention and treatment of infertility. This clinical report reviews the medical aspects and ethical considerations that arise when considering fertility preservation in pediatric and adolescent patients with cancer.


Assuntos
Sobreviventes de Câncer , Preservação da Fertilidade , Infertilidade/etiologia , Neoplasias/terapia , Adolescente , Antineoplásicos/efeitos adversos , Criança , Aconselhamento , Criopreservação , Preservação da Fertilidade/ética , Humanos , Cobertura do Seguro , Seguro Saúde , Masculino , Oócitos/citologia , Radioterapia/efeitos adversos , Espermatozoides
6.
Endocr Pract ; 26(4): 423-428, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32045294

RESUMO

Objective: To describe patient characteristics at presentation, management, and fertility preservation rates among a cohort of Israeli children and adolescents with gender dysphoria (GD). Methods: We performed a retrospective chart review of 106 consecutive children and adolescents with GD (<18 years) referred to and followed at the multidisciplinary Israeli Pediatric Gender Dysphoria Clinic from March 2013 through December 2018. Results: Of the 106 patients, 10 were prepubertal (9 prepubertal transgender females), and 96 were pubertal (38 pubertal transgender females). The GD population increased 11-fold since the establishment of our clinic in 2013. The subject's median age at referral was 15.5 years (range, 4.6 to 18 years). At the time of referral, 91 (95%) of the pubertal group had completed sexual maturation in their assigned gender at birth. Thirteen (13.5%) patients had attempted suicide, and 11 (11.5%) reported having had suicidal thoughts. Fourteen (45%) pubertal transgender females and 3 (6.5%) pubertal transgender males completed fertility preservation. Gonadotropin-releasing hormone analog treatment was prescribed in 77 (80%) patients at a mean age of 15.9 ± 1.6 years. Gender-affirming hormones were prescribed in 61 (64%) patients at a mean age of 16.5 ± 1.3 years. No severe side effects were recorded. Two (2%) of the pubertal group expressed regret about medical treatment. Conclusion: Children and adolescents with GD are presenting for medical attention at increasing rates. Israeli adolescents with GD have high fertility preservation rates, perhaps attributable to cultural perspectives. Taking advantage of the option to preserve fertility can be achieved when proper counseling is both available and promoted by medical personnel. Abbreviations: GAH = gender-affirming hormone; GD = gender dysphoria; GnRHa = gonadotropin-releasing hormone analog; MHP = mental health professional.


Assuntos
Preservação da Fertilidade , Disforia de Gênero , Pessoas Transgênero , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Israel , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos
8.
J Cancer Res Clin Oncol ; 146(3): 647-657, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32006118

RESUMO

Breast cancer (BC) is the most common malignancy in women with a significant increasing incidence during the reproductive life. However, based on the newest anti-cancer molecular targeting drugs, successful treatments lead to the disease healing particularly in young patients, thus refreshing their motherhood programs. However, as effect of the BC treatment, a premature depletion of the ovarian follicle reserve occurs in more than one-third of patients resulting in permanent infertility. To prevent the cancer treatment-related infertility (CTRI), several options are today utilized. Besides the ovary suppression by gonadotropin-releasing hormone agonist (GnRHa), other procedures include either oocytes or embryos cryopreservation as well as ovarian cortex cryopreservation that are currently adopted before anti-cancer therapies. These modern techniques appear variably successful in terms of pregnancy rate though their safety concerning the hormonal stimulation to promote the folliculogenesis is still debated in relation to the potential oncogenic risk in patients bearing hormone-sensitive tumors as BC, while the ovarian cortex re-implantation often results in a low number of regenerated follicles including oocytes of unknown quality. Recent studies on ovarian stem cells (OSCs) suggest their use for future application in CTRI. In fact, OSCs from ovarian cortex have been shown to differentiate in vitro into oocyte-like cells (OLCs) and express molecular markers of mature oocytes. Once the OSC technology will be optimized and translated to clinical use, oocytes derived from these cells will be molecularly assessed before fertilization to assure their best embryo quality resulting in a safe procedure to treat CTRI in patients as young women with BC.


Assuntos
Neoplasias da Mama , Preservação da Fertilidade/métodos , Infertilidade Feminina/prevenção & controle , Adulto , Feminino , Preservação da Fertilidade/tendências , Humanos , Infertilidade Feminina/etiologia
9.
Radiol Clin North Am ; 58(2): 401-412, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044014

RESUMO

Gynecologic cancers impact women of all ages. Some women may wish to preserve their capacity for future childbearing. With appropriate patient selection, acceptable oncologic outcomes may be achieved with preservation of fertility. Determination of eligibility for fertility preservation is guided by patient factors, tumor histology, and preoperative local staging with pelvic MR imaging. The aim of this article is to educate radiologists on the current guidelines for fertility-sparing techniques in women with early stage cervical, endometrial, and ovarian malignancies.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/terapia , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Adulto , Feminino , Genitália Feminina/diagnóstico por imagem , Humanos
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(1): 21-28, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32074769

RESUMO

Objective: To analyze the clinical efficacy and pregnancy outcomes of fertility- preserving re-treatment in patients with recurrent atypical endometrial hyperplasia (AEH) and early stage endometrial carcinoma (EEC) after achieved complete remission (CR) of primary fertility-preserving therapy. Methods: There were 104 cases of AEH and EEC collected from 9 hospitals in the multi-center research network platform of fertility-preserving therapy of endometrial carcinoma in China from January 2005 to May 2019. Thirth-one cases of them relapsed from four hospitals mentioned above,who achieved CR after primary fertility-preserving therapy,was analyzed retrospectively. Of the 31 cases, 27 cases chose fertility-preserving re-treatment. The demographic characteristics, re-treatment effect, clinical factors and pregnancy outcomes were observed. Results: (1) There were 16 AEH cases and 11 ECC cases among 27 recurrent patients who chose fertility-preserving therapy again. After re-treatment, CR was found in 13 out of 16 cases of AEH and 9 out of 11 cases of EEC. The overall CR rate was 81% (22/27). (2) After CR of recurrence, 5 cases (23%, 5/22) of re-recurrence were found after with a median time of 33 months (range 21-80 months). There were 4 cases underwent comprehensive surgical staging, and 1 patient chose the third round of fertility preservation therapy with fully informed consent, and CR was reached after 15 months. (3) There were 16 cases with pregnancy intention, with a total of 12 pregnancies, including 5 cases were natural pregnancy and 7 cases were assisted reproductive technology pregnancy. There were 5 live births. The follow-up time was up to May 2019, and the median follow-up time was 73 months (range 0-123 months). All 27 patients had disease free survival. Conclusions: Recurrent patients with AEH and EEC after achieving successful fertility-preserving therapy could choose fertility-preserving therapy again with comprehensive assessment and fully informed consent. After re-treatment, there is a certain tumor CR rate and pregnancy rate, while the close follow-up is required during treatment.


Assuntos
Carcinoma/terapia , Hiperplasia Endometrial/terapia , Neoplasias do Endométrio/terapia , Preservação da Fertilidade , China , Feminino , Humanos , Recidiva Local de Neoplasia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
11.
Cir. pediátr ; 33(1): 25-29, ene. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186134

RESUMO

Introducción: La transposición ovárica es una técnica quirúrgica que permite alejar los ovarios de la zona de irradiación en pacientes que van a recibir radioterapia abdominal o pélvica. Se han descrito buenas tasas de conservación de función. Sin embargo, no existen estudios en pacientes pediátricos. Presentamos nuestra serie de pacientes intervenidas en nuestro centro. Material y métodos: Estudio retrospectivo de pacientes a las que se le realizó transposición ovárica en nuestra unidad de cirugía oncológica pediátrica entre los años 2008 y 2018. La técnica empleada dependió de la edad, la zona de la irradiación y de la asociación o no con la cirugía del tumor primario. Resultados: Durante el periodo de estudio se realizaron un total de 21 transposiciones ováricas en 13 pacientes (8 bilaterales, 4 izquierdas y 1 derecha). En todos los casos se realizó criopreservación de corteza ovárica dentro del programa de preservación de fertilidad. Once de las 13 intervenciones fueron por laparoscopia, seccionándose el ligamento tubo-ovárico en 16 unidades y en 5 se realizó transposición ovárica sim-ple. La estancia hospitalaria media fue de 2,4 días sin registrarse ninguna complicación en el postoperatorio. Actualmente 9 pacientes continúan seguimiento en sus unidades de oncología pediátrica de referencia, sin haberse notificado ninguna complicación. Conclusión: La transposición ovárica es una técnica segura y reproducible. Estas pacientes requieren un seguimiento prolongado para conocer el estado de los ovarios tras el tratamiento oncológico


Introduction: Ovarian transposition is a surgical procedure allow-ing gonadal mobilization from a radiation spotlight to a safer, radiation therapy-free place in patients receiving abdominal or pelvic radiation therapy. And these patients can be managed using minimally invasive surgery. Although some authors have reported good results in fertility preservation with this technique, there are no long-term studies in the pediatric population. We present our results with this procedure in our oncological patients from the last decade. Materials and methods: Retrospective review of medical reports of patients who underwent laparoscopic ovarian transposition in our pediatric oncological surgery unit from 2008 to 2018. The technique varied depending on age, irradiation zone, and concomitant oncologi-cal resections. Results: A total of 21 ovarian transpositions were successfully per-formed in 13 patients. Eight were bilateral, four were left and only one was right. An ovarian cortex cryopreservation was simultaneously carried out in all patients. Eleven procedures were completed laparoscopically, and the suspensory ovarian ligament was divided in sixteen cases. The Fallopian tube was divided in one case, and a simple ovarian transposition was conducted in five cases. Mean hospital stay was 2.4 days, and no complications in the immediate postoperative period were noted. Conclusion: Ovarian transposition is a feasible, safe technique. These patients require an extended follow-up to assess ovarian function after oncological treatment


Assuntos
Humanos , Feminino , Criança , Adolescente , Preservação da Fertilidade/métodos , Preservação da Fertilidade/tendências , Atenção Terciária à Saúde , Criopreservação/métodos , Ovariectomia/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias , Epidemiologia Descritiva , Ovário/cirurgia , Radioterapia/métodos , Laparoscopia
13.
J Surg Oncol ; 121(5): 730-742, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31845348

RESUMO

BACKGROUND: Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS: The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS: It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.


Assuntos
Países em Desenvolvimento , Neoplasias do Endométrio/cirurgia , Acesso aos Serviços de Saúde , Brasil , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Continuidade da Assistência ao Paciente , Diagnóstico por Imagem , Neoplasias do Endométrio/patologia , Feminino , Preservação da Fertilidade , Humanos , Histerectomia , Excisão de Linfonodo , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Exame Físico , Encaminhamento e Consulta , Biópsia de Linfonodo Sentinela , Sociedades Médicas
14.
Fertil Steril ; 112(6): 1022-1033, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31843073

RESUMO

Patients preparing to undergo gonadotoxic medical therapy, radiation therapy, or gonadectomy should be provided with prompt counseling regarding available options for fertility preservation for iatrogenic infertility. 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 with a similar name, last published in 2013.


Assuntos
Antineoplásicos/efeitos adversos , Castração/efeitos adversos , Preservação da Fertilidade , Doença Iatrogênica , Infertilidade Feminina/terapia , Infertilidade Masculina/terapia , Lesões por Radiação/terapia , Técnicas de Reprodução Assistida , Feminino , Fertilidade/efeitos dos fármacos , Fertilidade/efeitos da radiação , Preservação da Fertilidade/efeitos adversos , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/fisiopatologia , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco , Resultado do Tratamento
15.
BMC Urol ; 19(1): 133, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842847

RESUMO

BACKGROUND: Human sperm cryopreservation is a simple and effective approach for male fertility preservation. METHODS: To identify potential proteomic changes in this process, data-independent acquisition (DIA), a technology with high quantitative accuracy and highly reproducible proteomics, was used to quantitatively characterize the proteomics of human sperm cryopreservation. RESULTS: A total of 174 significantly differential proteins were identified between fresh and cryoperservated sperm: 98 proteins decreased and 76 proteins increased in the cryopreservation group. Bioinformatic analysis revealed that metabolic pathways play an important role in cryopreservation, including: propanoate metabolism, glyoxylate and dicarboxylate metabolism, glycolysis/gluconeogenesis, and pyruvate metabolism. Four different proteins involved in glycolysis were identified by Western blotting: GPI, LDHB, ADH5, and PGAM1. CONCLUSIONS: Our work will provide valuable information for future investigations and pathological studies involving sperm cryopreservation.


Assuntos
Criopreservação , Preservação da Fertilidade/métodos , Espectrometria de Massas/métodos , Proteoma/análise , Espermatozoides/química , Western Blotting/métodos , Glicólise , Humanos , Masculino , Mapas de Interação de Proteínas , Proteínas/análise , Proteínas/metabolismo , Proteoma/metabolismo , Proteômica/métodos , Espermatozoides/metabolismo
16.
Rinsho Ketsueki ; 60(9): 1378-1385, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597867

RESUMO

The frequency of hematological malignancies is quite high in children, adolescents and young adults. Infertility after treatment is an important issue affecting the quality of life of long-term survivorsas the outcome of treatment is improved. Recently, several guidelines for infertility and fertility preservation have been published. Consequently, it has become easier to obtain information on the risk of infertility and fertility preservation therapy for each treatment. However, the information on the optimal timing for fertility preservation and current outcomes of assisted reproductive technology using stored oocytes, embryos, ovarian tissues, or sperm remains limited. Further, whether fertility preservation while using a new drug with unknown risk for infertility should be performed remains an unresolved issue.


Assuntos
Preservação da Fertilidade , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Infertilidade/prevenção & controle , Adolescente , Criança , Criopreservação , Humanos , Qualidade de Vida , Adulto Jovem
18.
Gynecol Oncol ; 155(3): 522-529, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604663

RESUMO

An increasing number of women in modern societies are delaying childbearing beyond the age of 35, and gynecologic cancers affect a significant proportion of reproductive age women who wish to preserve fertility for a future chance of childbearing. As a result, providing treatment options for fertility preservation in women with gynecologic cancer has become a crucial component of cancer survivorship care. In this review article, we discussed the current knowledge on fertility-sparing surgical approaches, as well as assisted reproductive technologies that can be utilized to preserve reproductive potential in women with cervical, endometrial, and ovarian cancer. A brief section on fertility preservation in pediatric gynecologic malignancies is also provided.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias dos Genitais Femininos/terapia , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Técnicas de Reprodução Assistida
19.
Urol Clin North Am ; 46(4): 487-493, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582023

RESUMO

Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.


Assuntos
Preservação da Fertilidade , Procedimentos de Readequação Sexual , Transexualidade , Feminino , Humanos , Masculino
20.
Urol Clin North Am ; 46(4): 495-503, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582024

RESUMO

The process of gender affirmation may have an impact on fertility. Counseling on the impact of affirmation and opportunities for fertility, future family building, and reproductive health is an important first step in the affirmation process. This article discusses the options for fertility preservation for transmen. The barriers and outcomes in this unique population are also considered. In addition, insights are provided on the future of fertility preservation and suggestions are made for how to build a comprehensive team for male transgender patients.


Assuntos
Preservação da Fertilidade , Procedimentos de Readequação Sexual , Transexualidade , Feminino , Humanos , Masculino
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