Elective uterine preservation: a novel concept to tackle reproductive ageing. Fertility preservation beyond ovaries.
Attilio Di Spiezio Sardo, Christian M Becker, Silvia Vannuccini, Jasper Verguts, Joseph Estadella Tarriel, Pia A Suvitie, Serena Guerra, Stefan P Renner, Juan A Garcia Velasco
Author Information
Attilio Di Spiezio Sardo: Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy. Electronic address: attiliodispiezio@libero.it.
Christian M Becker: Endometriosis Care Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Silvia Vannuccini: Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy.
Jasper Verguts: Department of Obstetrics and Gynaecology, Jessa Hospital, Hasselt, Belgium, and Faculty of Medicine, Hasselt University, Hasselt, Belgium.
Joseph Estadella Tarriel: Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Ba, Universitat Aut��noma de Barcelona, Barcelona, Spain.
Pia A Suvitie: Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
Serena Guerra: Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy.
Stefan P Renner: Department of Gynecology and Obstetrics, Hospital B��blingen, Klinikverbund-Suedwest, Klinikum Sindelfingen-B��blingen, B��blingen, Germany.
Juan A Garcia Velasco: IVIRMA Global Research Alliance, IVIRMA Madrid, Spain; Instituto de Investigaci��n Sanitaria La Fe (IIS La Fe), Valencia, Spain, and Rey Juan Carlos University, Madrid, Spain.
With a growing number of women in developed countries having children later in life, it is time to rethink women's reproductive health. This trend of 'delayed parenthood' reflects a complex interplay of labour market rules, personal choices, rarefying social connections and the renowned possibilities of assisted reproductive technology (ART). While ART offers support, its success wanes with age, prompting a rise in additional strategies such as elective ovarian cryopreservation. However, the healthy ageing of the uterus is equally vital and often under-considered. Highly prevalent conditions such as leiomyomas and adenomyosis threaten fertility and can compromise or worsen physiological uterine ageing. The idea that the uterus can be surgically repaired any time or multiple times is a blind strategy that eventually wastes uterine reproductive potential. Oral gonadotrophin-releasing hormone (GnRH) antagonists with add-back therapy are a promising strategy for stabilizing the uterus while controlling symptoms of hormonally driven conditions, in long-term regimens (104 weeks' follow-up) as well. 'Uterine freezing' is a novel concept to delay uterine ageing and possibly preserve uterine reproductive potential. This article calls for a holistic approach that values both ovarian and uterine preservation strategies, encouraging healthcare providers to empower women in managing their fertility and support their complex journeys toward motherhood.
