Treatment for cancer has the potential to significantly diminish fertility and, further, to negatively impact the obstetrical outcomes of pregnancies that do occur. Cancer survivors have decreased rates of fertility and increased rates of pregnancy complications, such as preterm birth and low birth weight, after exposure to chemotherapy. To date, research on the impact of chemotherapy and radiotherapy on fertility and pregnancy outcomes has focused largely on the gonadotoxic effect of cancer treatments on ovaries, while the uterus and endometrium have not been extensively studied. It is intuitive, however, that decreased fertility and poorer obstetrical outcomes may be substantially mediated through injury to a highly mitotic tissue like the endometrium, which is also central to embryo implantation and utero-placental exchange. Pregnancy complications in cancer survivors might be due to compromised blood supply to the endometrium and myometrium affecting placentation or altered remodeling of the pregnant uterus secondary to radiation fibrosis. Alterations in endometrial receptivity at the molecular level could affect pregnancy implantation and early pregnancy loss, but later complications also can occur. This review focuses on understanding the unintended effects of chemotherapy and radiotherapy on uterine function in female cancer survivors and the impact on pregnancy, and summarizes mechanisms to protect and treat the uterus before and after cancer chemotherapy and radiotherapy.

中文翻译：

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超越卵巢对女性的肿瘤生育护理：子宫损伤作为生育力保留治疗的潜在目标。

癌症治疗有可能显着降低生育能力，并进一步对妊娠的产科结果产生负面影响。接受化疗后，癌症幸存者的生育率下降，妊娠并发症发生率增加，例如早产和低出生体重。迄今为止，关于化疗和放疗对生育和妊娠结局影响的研究主要集中在癌症治疗对卵巢的性腺毒性作用上，而对子宫和子宫内膜的研究尚未广泛。然而，直觉上认为，生育能力下降和产科结局较差可能很大程度上是通过对子宫内膜等有丝分裂高度组织的损伤来介导的，子宫内膜也是胚胎植入和子宫胎盘交换的核心。癌症幸存者的妊娠并发症可能是由于子宫内膜和子宫肌层的血液供应受损影响胎盘或继发于放射性纤维化的妊娠子宫重塑改变所致。分子水平上子宫内膜容受性的改变可能会影响妊娠着床和早期妊娠流产，但也可能发生后期并发症。本综述重点了解化疗和放疗对女性癌症幸存者子宫功能的意外影响以及对妊娠的影响，并总结癌症化疗和放疗前后保护和治疗子宫的机制。