UCI Health cancer specialists have long recognized the importance of preserving quality of life for cancer survivors. Our gynecological oncologists are experts in leading-edge, fertility-preserving surgery as well as fertility-conserving medical therapy.
These therapies are designed for women with gynecologic cancers or other gynecologic conditions that could prevent pregnancy, and for women with non-gynecologic cancers for whom radiation therapy and chemotherapy may result in premature ovarian failure.
The multidisciplinary Fertility Preservation Program led by Dr. Krishnansu Tewari involves close coordination between UCI Health gynecologic oncologists, maternal and fetal medicine physicians, reproductive endocrinologists and infertility specialists, as well as pathologists and radiologists at the UCI Health Chao Family Comprehensive Cancer Center.
Precancerous conditions of the cervix as well as invasive cervical cancer also can affect women in their childbearing years, so it is not unusual for patients who have not yet had children or who have not completed their families, to undergo fertility preservation treatment.
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For women with invasive cervical cancer who want to preserve their fertility, a procedure called radical trachelectomy combined with laparoscopic lymph node dissection has emerged as the treatment of choice. UC Irvine Medical Center is among the few hospitals in the nation to offer this procedure.
Our gynecologic oncologists perform this operation with the da Vinci Surgical System®, which allows more precise removal of the cancer, leaving clear margins. This robot-assisted procedure also allows patients to recover faster and with less pain. Not every patient is a candidate for the procedure. Careful selection should be made by an experienced multidisciplinary team. UC Irvine has been a home to such a team for years.
The Fertility Preservation Program at UC Irvine Medical Center has a long track record of successfully treating endometrial cancer with specialized medical hormonal therapy, which allows select patients to retain their uterus. Once again, the decision to proceed with fertility preservation therapy is highly complex and requires a multidisciplinary approach and active patient participation.
UC Irvine gynecologic oncologists have published several key papers in medical journals detailing the successful management of fertility preservation in young, childless women diagnosed with malignant germ cell tumors of the ovary (early and advanced stages) or borderline tumors of the ovary, as well as some women with early stage epithelial ovarian cancer.
By removing only the cancerous ovary and sparing the uterus and remaining ovary, many patients treated at UC Irvine Medical Center have achieved both a cancer cure and subsequent pregnancy.
However, cautious patient selection by a multidisciplinary team is of critical importance with this most aggressive of gynecologic cancers.
Some patients are unable to become pregnant because their vagina does not develop along with the cervix and uterus. This complex condition is known as vaginal agenesis and is also referred to as the Mayer-Kuster-Hauser-Rokitansky syndrome.
Our gynecologic oncologists have refined a procedure for creating a vaginal canal. The technique, called the McIndoe neovagina procedure, results in the formation of a normal vagina and allows for sexual function. By using full thickness skin grafts to create the neovagina, patients have less scarring and improved elasticity.
The full thickness skin-grafting technique was adapted by UCI Health gynecologic oncologist Dr. Krishnansu Tewari from plastic surgery literature, with excellent results. Although many patients with vaginal agenesis lack a uterus and therefore cannot bear children, they often have normal ovaries and produce eggs that can be used for in vitro fertilization in a surrogate.
For patients who have a uterus, the McIndoe neovagina procedure allows them to have full sexual function and become pregnant.
Young patients with non-gynecologic cancers who are scheduled to receive pelvic radiation for lymphoma or other cancers often have their ovaries temporarily repositioned outside the area to be targeted by radiation.
This may also help prevent premature ovarian failure. Many women receiving high-dose chemotherapy for breast or other cancers are often treated by our gynecologic oncologists for medically induced ovarian suppression using GnRH analogs to protect the ovaries during chemotherapy.