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Provision of Fertility Preservation for Young Women with Early-Stage Breast Cancer

Advances in Reproductive Sciences 2023年第1期11卷 23-35页

作者： Rosliza Shafie Danielle Elizabeth Robson Dinithi Samarawickrama william ledger Royal Hospital for Women’s and Children’s Health Sydney Australia Royal Prince Alfred Hospital for Women and Babies Sydney Australia University of Notre Dame Sydney Australia University of New South Wales Sydney Australia

Breast cancer is the most common cancer in women worldwide, constituting 25% of all cancer diagnoses. Even though it is only affecting 4% - 6% of women under the age of 40, it remains the most common malignancy among younger patients. Advancement in the treatment and earlier detection gives excellent 5 years of survival. However, the standard treatment that comprises surgical-chemo radiation therapy or hormonal treatment often results in an increased incidence of treatment-induced infertility. Therefore, adding fertility preservation to primary cancer treatment may offer the best opportunity for future fertility. However, despite advancements in Assisted Reproductive Technology (ART), the uptake of fertility services in this group remains low. In this review, we highlighted the effect of all breast cancer treatments on women’s fertility, the effectiveness and safety of ART in breast cancer patients as well as the safety of pregnancy in breast cancer survivors. Our aim is to improve awareness of fertility preservation for breast cancer to ensure all women diagnosed with breast cancer have multidisciplinary approaches with early referral to fertility specialists to discuss regarding potential risks and benefits of fertility preservation to improve the uptake of fertility preservation among this group of patients.

关键词： Fertility Preservation Ovarian Reserve Young Women Early-Stage Breast Cancer

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Sperm DNA fragmentation, recurrent implantation failure and recurrent miscarriage

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Asian Journal of Andrology 2015年第4期17卷 681-685页

作者： Carol Coughlan Helen Clarke Rachel Cutting Jane Saxton Sarah Waite william ledger Tinchiu Li Allan A Pacey Department of Human Metabolism Academic Unit of Reproductive and Developmental Medicine University of Sheffield Level 4 The Jessop Wing Tree Root WalkSheffield S10 2SF UK Assisted Conception Unit Jessop Wing Tree Root Walk Sheffield S10 2SF UK Department of Obstetrics and Gynaecology School of Women'sand Children's Health University of New South Wales Royal Hospital for Women Sydney New South Wales Australia

Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage （RM）. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurrent implantation failure （RIF） following in vitro fertilization, 16 women diagnosed with RM and seven recent fathers （control） were examined. Sperm were examined pre- and post-density centrifugation by the sperm chromatin dispersion （SCD） test and the terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay. There were no significant differences in the age of either partner or sperm concentration, motility or morphology between three groups. Moreover, there were no obvious differences in sperm DNA fragmentation measured by either test. However, whilst on average sperm DNA fragmentation in all groups was statistically lower in prepared sperm when measured by the SCD test, this was not seen with the results from the TUNEL assay. These results do not support the hypothesis that sperm DNA fragmentation is an important cause of RIF or RM, or that sperm DNA integrity testing has value in such patients. It also highlights significant differences between test methodologies and sperm preparation methods in interpreting the data from sperm DNA fragmentation tests.

关键词： DNA recurrent implantation failure recurrent miscarriage sperm

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The “behind-the-knee” test for menstrual tampon irritation

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Open Journal of Obstetrics and Gynecology 2012年第1期2卷 34-38页

作者： Miranda A. Farage Kenneth W. Miller william J. ledger Department of Obstetrics and Gynecology The New York-Presbyterian Hospital Weill Medical College Cornell University New York USA Feminine Clinical Sciences The Procter & Gamble Company Cincinnati USA

Colposcopic inspection of the vagina is a routine component of the safety assessment of intravaginal products. However, colposcopic findings occur frequently in healthy women, raising questions about their relevance to intravaginal product safety. Practical disadvantages limit the utility of colposcopy for evaluating menstrual tampons, among them the presence of background microtrauma, the inability to assess effects during menstruation, and, importantly, the question of whether post-hoc assessments are sufficiently sensitive to detect small inflammatory changes. The Behind-the-knee (BTK) test is an alternative for evaluating inflammatory and tissue dryness effects of physical articles by their repeated application to the popliteal fossa under an elastic bandage. It enables concurrent parallel comparisons of experimental and control articles over time and substantially increases the sensitivity of detecting small changes in tissue inflammation. With this protocol, uncompressed experimental and control tampons yielded comparable relative and absolute erythema scores (after overnight recovery) as did colposcopic assessment of the lower genital tract 3 to 48 hours after menstrual use. Scoring erythema in the BTK test immediately after product removal increased the level of visually discernible inflammation 6-fold. In a study of commercial menstrual pads, subclinical inflammation visualized with cross-polarized light correlated with the frequency of subjective reports of discomfort during the test and discriminated the relative tolerability of the two products determined by market surveillance, providing added confidence in the predictive value of the test. We believe the BTK test to be a valuable alternative to colposcopy for assessing inflammation and dryness associated with menstrual tampons.

关键词： Colposcopy Behind-the-Knee Menstrual Tampons

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10分钟会诊：可疑早绝经

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英国医学杂志中文版 2008年第5期11卷 315-316页

作者： Georgina Louise Jones william ledger Caroline Mitchell 王涛(译) 郁琦(译) 不详北京协和医院

一位34岁女性因月经不规则（月经周期延长）12个月就诊，她从未怀过孕，其母不到40岁就开始绝经，患者对于自己目前和未来的生育能力表示担心。

关键词：早绝经月经周期延长会诊生育能力

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