Oncofertility

This study is designed as a Phase I clinical trial enrolling female patients aged 18-40 years who have been diagnosed with pelvic malignancies requiring whole pelvic external radiation therapy (WPXRT) and who express interest in preserving fertility and ovarian function. The trial's primary objective is to assess the feasibility and safety of uterine and ovarian transposition (UOT). Premenopausal women under the age of 40 will undergo UOT using a novel minimally invasive approach. Feasibility and safety will be evaluated through standardized postoperative assessments, including: (A) success in mobilizing and repositioning the uterus, ovaries, and fallopian tubes while maintaining vascular integrity; (B) documentation of surgical complications; (C) monitoring the timeliness and adherence to planned WPXRT. To enhance safety and optimize outcomes, intraoperative imaging with indocyanine green fluorescence and Doppler ultrasonography will be employed. Short-term success will be defined by technical success in repositioning the uterus and ovaries with preserved vascular integrity, absence of major surgical complications, and timely initiation and completion of WPXRT. Long-term success will be evaluated by the preservation of fertility. The study's primary objective is also to evaluate surgical, reproductive, and quality-of-life outcomes following UOT. This objective will determine the procedure's efficacy in preserving ovarian and menstrual function and its potential to support future pregnancies. Endpoints include: (A) maintenance of normal premenopausal levels of FSH, LH, AMH, and estradiol at defined postoperative intervals; (B) assessment of menstrual timing, regularity, and characteristics to document return of ovulatory cycles; (C) evaluation of uterine integrity and reproductive potential using pelvic ultrasonography; (D) comprehensive evaluation of patient quality of life encompassing physical, emotional, sexual, and reproductive well-being. These measures will inform optimization of surgical techniques and provide a foundation for scaling the procedure to a broader population in future studies.

Improvements in diagnostic methods and cancer treatments have led to a steady increase in survival rates. The 5-year survival rate for men diagnosed with cancer between the ages of 15 and 39 has exceeded 81%. As a result, quality of life-and in particular, addressing the issue of parenthood-has become essential. Cancer treatments-surgery, radiation therapy, and chemotherapy-can significantly impair fertility. They may cause sexual dysfunction (anejaculation, anerection), androgen deficiency, or permanent impairment of spermatogenesis. Yet the desire for parenthood ranks among the top three life goals of patients newly diagnosed with cancer, and 50% of patients wish to have a child in the future. Preserving male fertility is therefore a crucial issue. Before puberty, this can be done by taking a testicular tissue sample, although this is still considered experimental. After puberty, a sample taken from ejaculate allows for the storage of sperm straws. Thus, when a couple wishes to conceive, following a potential reassessment of spermatogenesis if it is impaired, Assisted Reproductive Technology (ART) can be performed with or without the frozen sperm. According to the literature, the sperm is typically used within 10 years of fertility preservation. Little data has been collected regarding whether men with a history of cancer conceive naturally or not. It is therefore important to gather this information regarding fatherhood, particularly whether men with a history of cancer have used ART or not, and whether frozen sperm was used or not, based on the results of the follow-up semen analysis performed after treatment. Primary objective To describe fertility-whether spontaneous or following assisted reproductive technology (ART)-with or without the use of preserved gametes, among patients who underwent fertility preservation for cancer treatment at the CECOS in Lyon between 2010 and 2024. Secondary objective: To assess the population of men who preserved their fertility prior to cancer treatment at the Center for the Study and Preservation of Eggs and Sperm (CECOS) in Lyon between 2010 and 2024, specifically: * The number and clinical and epidemiological characteristics of the patients. * Describe post-cancer fertility * Understand CECOS's care protocols to improve the patient care pathway. * Describe the psychological difficulties at the time of collection that prevented the procedure and thus the preservation of fertility. * Determine the fate of preserved straws that were not used Methodology: * Retrospective analysis of data from the CECOS in Lyon between 2010 and 2024. * Information collected from the database: patient age, indication, type of fertility preservation performed (testicular tissue or ejaculate) * Subsequently, a paper and electronic questionnaire was sent to these same patients to collect data on their fertility following fertility preservation. * Information collected via the questionnaires: marital status, place of residence, paternity prior to cancer, type of cancer, treatment received, achievement of pregnancy after cancer and method (spontaneous pregnancy, reuse of straws at the center, or ART at another center), donation of gametes to research, or destruction if unused. The CECOS in Lyon is an integral part of the Department of Reproductive Medicine and Biology at the Hopsices Civils de Lyon. Population studied: This study focuses on patients with a history of cancer who underwent gonadotoxic treatment and preserved their fertility at the CECOS in Lyon between 2010 and 2024 Inclusion criteria: This study will include patients who: * were between the ages of 18 and 60 at the time of fertility preservation * underwent fertility preservation at the CECOS in Lyon between January 1, 2010, and December 31, 2024. * underwent fertility preservation in the context of cancer treatment * who have indicated their consent to participate in the study by completing the questionnaire Exclusion criteria: * Persons deprived of their liberty by a judicial or administrative decision * Persons receiving psychiatric care * Persons admitted to a health or social care facility for purposes other than research * Adults subject to a legal protection measure (guardianship, conservatorship) Procedure: An information sheet will be sent to patients regarding the analysis of their medical data collected during their care, along with a questionnaire (see attached questionnaire) for the collection of prospective data. The materials will be sent either by mail (with a stamped envelope for free return shipping as part of the study) or electronically via a dedicated and secure CECOS email address for email responses. Number of subjects : 950 Study duration : 1 year Study location : Center for the Study and Preservation of Eggs and Sperm (CECOS)