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9 results

Caring for the Female Cancer Patient
  • Gynecologic Considerations
  • Edited by Laurie J. Mckenzie, Denise R. Nebgen
  • Published online:
    23 October 2024
    Print publication:
    17 October 2024
  • Globally, almost nine million women are diagnosed with cancer each year. Nearly every type of cancer affects the female reproductive system. This book is a comprehensive reference for the gynecologic care of women who have been directly impacted by cancer. Providing streamline management approaches to common clinical problems, the text is split into two sections. The first addresses common gynecologic concerns for all cancer patients, with chapters covering topics such as fertility assessment and preservation options, managing sexual health, and cancer and pregnancy. The second section addresses gynecologic considerations based on specific cancer sites including breast cancer, head and neck cancers and leukemias. Representative patient vignettes are included at the end of each chapter to reinforce clinical guidance, along with bulleted 'take home points' for rapid information access.

  • Chapter 1 - Fertility Assessment and Fertility Preservation Options

  • Edited by Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston, Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
  • Book:
    Caring for the Female Cancer Patient
    Published online:
    23 October 2024
    Print publication:
    17 October 2024, pp 1-23

  • Summary

    Approximately 10% of women diagnosed with cancer are of reproductive age. As survival rates improve, there is an increased focus on the complex issues surrounding cancer survivorship, particularly for younger women of reproductive age. Among young women diagnosed with cancer, concerns regarding future fertility are secondary only to concerns regarding survival. Guidelines from the American Society of Clinical Oncology (ASCO) and American Society for Reproductive Medicine (ASRM) state that healthcare providers should discuss the risk of infertility and fertility preservation options with all reproductive age patients diagnosed with cancer. This chapter reviews the proposed mechanisms of chemotherapy induced ovarian toxicity and how to assess baseline ovarian reserve. Fertility preservation options are discussed, including medical and conservative surgical management for select patients with gynecologic malignancies, oocyte and embryo cryopreservation, ovarian tissue cryopreservation and ovarian suppression. Data regarding the safety of ovarian stimulation and subsequent pregnancy are included.

  • Chapter 19 - Granulosa cells and their impact on human ART

  • Edited by David K. Gardner, University of Melbourne, Botros R. M. B. Rizk, University of South Alabama, Tommaso Falcone
  • Book:
    Human Assisted Reproductive Technology
    Published online:
    16 May 2011
    Print publication:
    31 March 2011, pp 209-222

  • Summary

    The majority of women with anovulation or oligoovulation due to polycystic ovary syndrome (PCOS) often have clinical and/or biochemical evidence of hyperandrogenism. This chapter describes the treatment with clomiphene citrate (CC), aromatase inhibitors (AIs), gonadotropins, and metformin followed by a discussion on the management of women with PCOS undergoing in vitro fertilization (IVF). It deals with the combined treatment of clomiphene with metformin. In women with PCOS, metformin is said to lower fasting insulin concentrations but also probably acts directly on theca cells and attenuates androgen production. The aim of the chronic low-dose step-up protocol is to obtain the ovulation of a single follicle. While results of IVF for women with PCOS are generally satisfactory compared with those with normal ovaries, ovarian stimulation protocols must be adapted accordingly to avoid the major pitfall of ovarian hyperstimulation syndrome (OHSS) in these women.

  • 6 - Evaluation of the Infertile Female

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 55-69

  • Summary

    Female fertility begins to decline many years before menopause, despite continued regular ovulatory cycles. Decreased fecundity with increasing female age has long been recognized in demographic and epidemiological studies. Traditionally, the evaluation of the infertile female consists of: (i) ovulation assessment (ovulatory factors), (ii) evaluation of the uterine morphology (ovulation assessment) and tubal patency (tubal factors), (iii) assessment of the presence of pelvic pathology (by laparoscopy) (peritoneal factors), and (iv) postcoital test (cervical factors). Hysterosalpingography (HSG), laparoscopy are widely used in assessing infertility. Chlamydia antibody testing is a screening method for assessing tubal infertility. HSG, sonohysterography, hystero-salpingo contrast sonography (HyCoSy), magnetic resonance imaging (MRI) and hysteroscopy are used in assessment of uterine factors related to infertility. Currently, the best method to monitor ovulation is transvaginal ultrasound, which can be used to demonstrate the growth of a dominant follicle and provide presumptive evidence of ovulation and leutinization.