Christine Rousset-Jablonski

Fertility Assessment after Ovarian Transposition in Children and Young Women Treated for a Malignant Tumor

Ovarian transposition (OT) has been proposed as a protective measure against radiation-induced damage to ovarian function and fertility. Despite its historical use, limited research has focused on evaluating endocrine and exocrine ovarian function after OT performed in adolescents and young adults (AYAs) before or during puberty. The purpose of our study was to investigate the fertility, pubertal development, and ovarian function of women with a previous history of OT during childhood, adolescence or young adulthood. In an observational bicentric retrospective study, we included 32 young female cancer patients who underwent OT before the age of 26 between 1990 and 2015 at Lyon Léon Bérard Cancer Center or Nancy University Hospital. The mean age at the time of OT was 15.6 years with a cancer diagnosis at 15 ± 4.8 years. Among the 10 women attempting pregnancy post-treatment, 60% achieved successful pregnancies. After a mean follow-up of 9.6 ± 7 years, 74% (17 out of 23) of women recovered spontaneous menstrual cycles (seven out of eight evaluable women with OT before or during puberty). Notably, 35% of women who did not attempt pregnancy demonstrated adequate ovarian reserve. Ovarian reserve and function recovery were influenced by the specific chemotherapy received. Importantly, our findings suggest that OT’s effectiveness on ovarian activity resumption does not significantly differ when performed before or during puberty compared to pubertal stages. This study contributes valuable insights into the long-term reproductive outcomes of young women undergoing OT, emphasizing its potential efficacy in preserving ovarian function and fertility across different developmental stages.

Gynaecological follow-up of adolescent and young adult cancer survivors: a comparative cohort study

Objective To assess whether gynaecological follow-ups among adolescent and young adult (AYA) cancer survivors are less compliant with recommendations than those without a history of AYA cancer. Design A retrospective national cohort study with exposed–unexposed design was conducted using the French National Health Data System. Setting The exposed group included AYAs who underwent cancer treatment in France between 2012 and 2014 and was matched in a 1:1 ratio with the unexposed group of AYAs without cancer or chronic disease. Participants A total of 7312 AYAs initiated cancer treatment during the specified period. After applying exclusion criteria, 3663 AYAs were matched to unexposed AYAs. Primary and secondary outcomes measures The primary outcome was compliance with gynaecological follow-up recommendations, including gynaecological consultation, sexually transmitted infections screening and cervical cancer screening. Secondary outcomes involved assessing each component of the follow-up, along with human papillomavirus vaccination coverage. Results Exposed AYAs were significantly more likely to comply with gynaecological follow-up guidelines, with a compliance rate of 23.2%, compared with 16.5% among unexposed AYAs (OR 1.53, 95% CI 1.36 to 1.70; p<0.001). When each component of the primary outcome was analysed separately, compliance rates remained significantly higher among those exposed than among those unexposed AYAs. Regarding human papillomavirus vaccination, exposed AYAs displayed higher coverage, with a significantly greater proportion having initiated a catch-up schedule (28.1% vs 18.5%). Conclusion AYA cancer survivors were more likely to have gynaecological follow-up compliant with recommendations, including gynaecological consultations, sexually transmitted infections and cervical cancer screenings.

Improvement in contraceptive coverage and gynecological care of adult women with cystic fibrosis following the implementation of an on-site gynecological consultation

Our study aimed to evaluate the impact of the introduction of a new gynecologic referral service in our adult Cystic Fibrosis (CF) center on contraceptive coverage, gynecological follow-up regularity, and cervical cancer screening coverage. We implemented an on-site gynecological consultation in our adult CF center in 2015. We compared the results of two surveys conducted successively in 2014 and in 2017 in a cohort of women with CF attending the Lyon CF center. Women completed the same self-report written questionnaire as in 2014. Main outcome measures were the comparisons of contraceptive coverage, gynecological follow-up regularity, and cervical cancer screening coverage between 2014 and 2017. All the 136 women (100%) who attended the clinic in 2017 participated. Contraceptive prevalence rate increased from 69%(CI95%:60.3-78.1) to 86%(CI95%:79.6-92.9) between 2014 and 2017 (p = 0.005). Among transplanted patients, the contraceptive prevalence rate was 92.3%(CI95%:82.0-100) in 2017. Long acting reversible contraceptive use markedly increased from 10% to 21.6% (p = 0.005). The proportion of women that reported an access to gynecological care increased between 2014 and 2017 (74%(CI95%:66.3-82.0) vs 91%(CI95%:86.9-95.4), p < 0.005) and reached 100% among transplanted patients. Cervical cancer screening improved (55%(CI95%:51.2-68.8) vs 85%(CI95%:78.6-90.6) women ever screened) (p < 0.0005) and reached 100% among transplanted patients. We observed an improvement in contraceptive coverage and gynecological care of adult women with CF following the implementation of a dedicated gynecological consultation in the CF center. Service linkages and formal links between CF centers and gynecologists can facilitate access to disease-specific contraceptive counseling, adequate gynecological management and cervical cancer screening.