Elective uterine preservation: a novel concept to tackle reproductive ageing. Fertility preservation beyond ovaries

Abstract

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.

Keywords: Adenomyosis; Endometriosis; Fertility preservation; Leiomyomas; Reproductive health; Uterine ageing.