Looking beyond the ovary for oncofertility care in women: uterine injury as a potential target for fertility-preserving treatments.

Abstract:

:Treatment for cancer has the potential to significantly diminish fertility and, further, to negatively impact the obstetrical outcomes of pregnancies that do occur. Cancer survivors have decreased rates of fertility and increased rates of pregnancy complications, such as preterm birth and low birth weight, after exposure to chemotherapy. To date, research on the impact of chemotherapy and radiotherapy on fertility and pregnancy outcomes has focused largely on the gonadotoxic effect of cancer treatments on ovaries, while the uterus and endometrium have not been extensively studied. It is intuitive, however, that decreased fertility and poorer obstetrical outcomes may be substantially mediated through injury to a highly mitotic tissue like the endometrium, which is also central to embryo implantation and utero-placental exchange. Pregnancy complications in cancer survivors might be due to compromised blood supply to the endometrium and myometrium affecting placentation or altered remodeling of the pregnant uterus secondary to radiation fibrosis. Alterations in endometrial receptivity at the molecular level could affect pregnancy implantation and early pregnancy loss, but later complications also can occur. This review focuses on understanding the unintended effects of chemotherapy and radiotherapy on uterine function in female cancer survivors and the impact on pregnancy, and summarizes mechanisms to protect and treat the uterus before and after cancer chemotherapy and radiotherapy.

journal_name

J Assist Reprod Genet

authors

Garg D,Johnstone EB,Lomo L,Fair DB,Rosen MP,Taylor R,Silver B,Letourneau JM

doi

10.1007/s10815-020-01792-9

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1467-1476

issue

6

eissn

1058-0468

issn

1573-7330

pii

10.1007/s10815-020-01792-9

journal_volume

37

pub_type

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