The ovarian reserve is necessary for female fertility and endocrine health. Commonly used cancer therapies diminish the ovarian reserve, thus, resulting in primary ovarian insufficiency, which clinically presents as infertility and endocrine dysfunction. Prepubertal children who have undergone cancer therapies often experience delayed puberty or cannot initiate puberty and require endocrine support to maintain a normal life. Thus, developing an effective intervention to prevent loss of the ovarian reserve is an unmet need for these cancer patients. The selection of adjuvant therapies to protect the ovarian reserve against cancer therapies underlies the mechanism of loss of primordial follicles (PFs). Several theories have been proposed to explain the loss of PFs. The “burn out” theory postulates that chemotherapeutic agents activate dormant PFs through an activation pathway. Another theory posits that chemotherapeutic agents destroy PFs through an “apoptotic pathway” due to high sensitivity to DNA damage. However, the mechanisms causing loss of the ovarian reserve remains largely speculative. Here, we review current literature in this area and consider the mechanisms of how gonadotoxic therapies deplete PFs in the ovarian reserve.
Adolescent ; Child ; DNA Damage ; Female ; Fertility ; Fertility Preservation ; Humans ; Infertility ; Ovarian Follicle ; Ovarian Reserve ; Primary Ovarian Insufficiency ; Puberty ; Puberty, Delayed

Endometriosis is a chronic inflammatory disease that affects 10% to 15% of all women of reproductive age. Several studies show an association between endometriosis and infertility; however, clear causality remains unproven. The association between endometriosis and infertility is attributable to distorted pelvic anatomy secondary to adhesions, altered endocrine and ovarian function, impaired uterine implantation, and poor quality of oocytes/embryos. Medical treatment shows limited efficacy, without any evidence to support its role in improving fertility. Surgical treatment can improve ongoing pregnancy rates in minimal-to-mild endometriosis, although this approach may cause inevitable ovarian injury in women with ovarian endometrioma. Tailored treatment should be used in women with infertility and endometriosis. Age, ovarian reserve, a history of ovarian surgery, and bilateral endometriomas are important factors that should be carefully considered in these cases.
Endometriosis ; Female ; Fertility ; Humans ; Infertility ; Ovarian Reserve ; Pregnancy Rate ; Reproductive Techniques, Assisted

Background: This paper examined the impact of temporary international labor migration on completed marital fertility using the 2010 Census of Population data from the Philippines. The case of the Philippines was investigated because it is uniquely a major source of male and female labor migrants to over 100 countries in the world.
Objectives: To identify the trends in male and female Filipino migrants to various destinations and to quantify the impact of international labor migration on completed marital fertility in the Philippines.
Methodology: A Two-stage Residual Inclusion Censored Poisson model was used to handle problems of endogeneity and observation censoring.
Results and Conclusions: The results provide strong evidence for the negative impact of international labor migration on completed fertility that can be similarly observed in married women with Overseas Filipino Worker spouses and married women who are Overseas Filipino Workers themselves. These women who are exposed to labor migration exhibit approximately 60 percent lower completed fertility compared to women not exposed to labor migration. The negative impact can be attributed to the long and cyclical spousal separations that disrupt couple childbearing and the assimilation and adaptation of the destination country's low fertility norms. The findings of the paper contribute to the sparse demographic literature on the effect of migration on fertility in sending regions and countries.

Fertility ; Philippines

Anti-Müllerian hormone (AMH), a peptide growth factor of the transforming growth factor-β family, is a reliable marker of ovarian reserve. Regarding assisted reproductive technology, AMH has been efficiently used as a marker to predict ovarian response to stimulation. The clinical use of AMH has recently been extended and emphasized. The uses of AMH as a predictive marker of menopause onset, diagnostic tool for polycystic ovary syndrome, and assessment of ovarian function before and after gynecologic surgeries or gonadotoxic agents such as chemotherapy have been investigated. Serum AMH levels can also be affected by environmental and genetic factors; thus, the effects of factors that may alter AMH test results should be considered. This review summarizes the findings of recent studies focusing on the clinical application of AMH and factors that influence the AMH level and opinions on the use of the AMH level to assess the probability of conception before reproductive life planning as a “fertility test.”
Drug Therapy ; Female ; Fertility ; Fertilization ; Gynecologic Surgical Procedures ; Humans ; Menopause ; Ovarian Reserve ; Polycystic Ovary Syndrome ; Reproductive Techniques, Assisted

OBJECTIVETo investigate the outcome of pregnancy in women after surgical treatment of tubal pregnancy and measures to improve the rate of successful postoperative pregnancy.

METHODSA retrospective study was conducted among 424 women who underwent surgical treatment for tubal pregnancy between Jan 1999 and Jan 2004. All patients desiring a second pregnancy were followed up for 18-72 months for the outcome. Cumulative fertility and recurrence curve were compared and calculated by life-table.

RESULTSOf the 424 women with tubal pregnancy, 177 (41.7%) had intrauterine pregnancy after the operation, while 102 (24.1%) had recurrent ectopic pregnancy. Among the 177 women with intrauterine pregnancy, 85 (48.02%) became pregnant within 6 months after the operation, 133 (75.14%) within one year, and the cumulative intrauterine pregnancy rate approached 94.92% within 2 years. But among the 102 women with recurrent ectopic pregnancy, only 10 (9.8%) were pregnant within 6 months after the operation, and 49 (48.04%) within 18 months, with a cumulative ectopic pregnancy rate of 67.65%.

CONCLUSIONFor women receiving surgery for ectopic pregnancy, the chance for intrauterine pregnancy can be the greatest within 6 months after operation and reduced markedly after 2 years, when recurrent ectopic pregnancy can be likely. Early plans for pregnancy and hydrotubation following the surgery may prove beneficial for raising the chances for postoperative intrauterine pregnancy.

Adult ; Female ; Fertility ; physiology ; Humans ; Postoperative Period ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Tubal ; surgery ; Retrospective Studies ; Time Factors

Over 150,000 reproductive age individuals face fertility-threatening cancer treatments each year. Improved detection and treatment of cancer in reproductive-age patients have greatly increased the long-term survival and made it possible for these individuals to consider their long-term quality-of-life after cancer including having biologic offspring. Various methods of fertility preservation (FP) are now available for both males and females. In order to maximize FP options available to patients facing imminent gonadotoxic therapies, it is crucial that women have quick access to FP care and that providers expedite FP strategies. The overarching goal of a clinical FP program is to help patients and their physicians consider the impact of treatment on future fertility and facilitate FP efforts in what is often a limited time period before cancer treatment begins.
Female ; Fertility Preservation* ; Fertility* ; Humans ; Male

Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation. The clinical characteristics of a UTROSCT are not fully understood. Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility. We present a case of UTROSCT with myometrial invasion, which resulted in a successful delivery after the patient was treated by resectoscopic surgery and conservation of the uterus, and a brief review of the literature.
Fertility ; Fertility Preservation ; Humans ; Hysterectomy ; Uterus

Background: The increasing number of young survivors after cancer treatment and of patients with non-malignant conditions who are at risk for subfertility has resulted in a demand for fertility preservation services, including the Philippines. Objective: The aim of this paper is to provide an overview of the history, indications, and management principles of fertility preservation. Also, the available strategies in the Philippines in both pre-pubertal and post-pubertal men and women and future directions of the field in the country will be discussed. Materials and methods: Literature review, historical accounts Results and conclusions Fertility preservation should be a priority when treating children and adults of reproductive age with agents that have deleterious effects on the gonads. If harmful treatment will be used, the options of fertility preservation should be discussed, as early as possible by the primary physician in collaboration with the oncologist and the reproductive medicine specialist. Most of the known options for fertility preservation are available in the Philippines and are being implemented in the local IVF centers. Recent developments hint of a potentially faster progress in the field with the establishment of the Philippine Society for Fertility Preservation in collaboration with other professional societies and a linkage with the Department of Health with the signing into law of the National Integrated Cancer Control Act of 2019.
Fertility Preservation ; Cryopreservation ; Oocytes ; Ovary ; Fertility

OBJECTIVE: This study aimed to identify factors that affect in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR). METHODS: We reviewed 99 IVF cycles in 52 women with DOR between September 2010 and January 2015. DOR was defined as serum anti-Müllerian hormone level of <1.1 ng/dL or serum follicle-stimulating hormone level of ≥20 mIU/mL. Total 96 cycles in 50 patients were evaluated after excluding fertility preservation cases. RESULTS: The clinical pregnancy rate was 11.5% per cycle, and the total cancellation rate was 34.4%. Clinical pregnancy rate was significantly associated with the antral follicle count and the cause of the DOR. Age, serum anti-Müllerian hormone and follicle-stimulating hormone levels, antral follicle count, peak estradiol level, and the cause of DOR were significantly associated with cycle cancellation. However, history of previous ovarian surgery remained as a significant factor of clinical pregnancy (model 1: odds ratio [OR] 10.17, 95% confidence interval [CI] 1.46 to 70.84, P=0.019; model 2: OR 10.85, 95% CI 1.05 to 111.71, P=0.045). In cancellation models, idiopathic or previous chemotherapy group showed borderline significance (model 1: OR 3.76, 95% CI 0.83 to 17.04, P=0.086; model 2: OR 3.15, 95% CI 0.84 to 11.84, P=0.09). CONCLUSION: DOR caused by previous ovarian surgery may show better pregnancy outcome, whereas that caused by chemotherapy could significantly increase the cycle cancellation rate. Furthermore, patients with DOR who previously received gonadotoxic agents may show reduced efficacy and increased risk of IVF cycle cancellation.
Drug Therapy ; Estradiol ; Female ; Fertility Preservation ; Fertilization in Vitro* ; Follicle Stimulating Hormone ; Humans ; In Vitro Techniques* ; Odds Ratio ; Ovarian Reserve* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

Endometriosis is a chronic inflammatory condition that affects fertility and could be toxic to the ovary. Endometrioma per se and surgical interventions for endometrioma significantly reduce the ovarian reserve. Therefore, to prepare for surgical intervention for endometrioma, the high-risk group with decreased ovarian reserve must be considered. There is no evidence to support the use of surgical intervention before in vitro fertilization (IVF) to improve the reproductive outcomes of subsequent IVF in infertile women with advanced-stage endometriosis or endometrioma. As surgical treatment has few benefits, IVF could be recommended immediately for aiding conception in these women. However, the reproductive prognosis of IVF may be worse in the more advanced stages of endometriosis. When dysmenorrhea is severe or when cancer is suspected, surgery prior to IVF may be necessary and justified. When the size of the endometrioma is very large, surgery could be required prior to IVF to facilitate access to follicles during oocyte retrieval or to improve the ovarian response to controlled ovarian stimulation. Prolonged pituitary downregulation in women with surgically diagnosed endometriosis may be helpful to increase the clinical pregnancy rate in subsequent IVF cycles. The purpose of this paper was to review the efficiency and clinical application of the surgical intervention and IVF for infertile women with advanced-stage endometriosis or endometrioma.
Cystectomy ; Down-Regulation ; Dysmenorrhea ; Endometriosis* ; Female ; Fertility ; Fertilization ; Fertilization in Vitro ; Humans ; Infertility ; Laparoscopy ; Oocyte Retrieval ; Ovarian Reserve ; Ovary ; Ovulation Induction ; Pregnancy Rate ; Prognosis