RESUMO
Over the past decades, progresses in oncology have improved the recovery rates after numerous malignant diseases, including breast cancer, that strike young adults in childbearing age. Quality of life of young cancer survivors has become a major issue. However, anticancer therapies can have a detrimental impact on fertility. It is now well-established that all patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available. These techniques aim to limit the negative impact of chemotherapy on the ovaries or to preserve gametes before treatment. Currently, oocyte or embryo freezing after controlled ovarian hyperstimulation represents the most effective method for preserving female fertility. Over the past years innovative protocols of ovarian stimulation have been developed to enable breast cancer patients to undergo oocyte or embryo cryopreservation irrespective of the phase of the cycle or without exogenous follicle-stimulating hormone related increase in serum estradiol levels. When controlled ovarian hyperstimualtion cannot be implemented, other techniques such as cryopreservation of ovarian cortex, in vitro maturation or the use of GnRH agonists may be proposed. However, it is important to inform patients that all these fertility preservation techniques do not represent a guarantee of pregnancy.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Embrião de Mamíferos , Preservação da Fertilidade/métodos , Oócitos , Ovário , Adulto , Antineoplásicos/efeitos adversos , Neoplasias da Mama/genética , Criopreservação/métodos , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Masculino , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Gravidez , Qualidade de Vida , Testículo/efeitos dos fármacos , Adulto JovemRESUMO
The epidemic of multiple pregnancies continues albeit in a different form with twin pregnancies predominating. Determination of chorionicity is the key to management and regular monitoring by ultrasound is a hallmark of quality care. All multiple pregnancies should be offered first trimester screening by nuchal translucency for aneuploidy. Monochorial twins should be scanned at fortnightly intervals to allow complications such as twin-twin transfusion or IUGR to be detected and referral made to a fetal medicine centre.
