As survival rates among patients with gynaecological cancers continue to improve, fertility preservation has become an increasingly important aspect of comprehensive cancer care, particularly for younger women diagnosed during their reproductive years. The impact of treatment on fertility varies according to cancer type, stage, and modality, necessitating individualised preservation strategies. Fertility preservation is both feasible and safe in carefully selected patients with early-stage gynaecological cancers. Oocyte and embryo cryopreservation remain the most widely accepted techniques, particularly when time allows for ovarian stimulation. Fertility-sparing surgeries, such as radical trachelectomy and conservative management of early endometrial cancer, have shown promising oncological and reproductive outcomes. However, barriers including access, timing, and awareness continue to limit broader implementation. In modern society, fertility-preserving strategies should form an integral part of treatment planning for reproductive-aged women with gynaecological malignancies. Early referral to a fertility specialist, patient-centred counselling, and a coordinated multidisciplinary approach are essential to optimise both oncological and reproductive outcomes. Further research and education are required to refine guidelines and expand access to fertility-preserving care. This review presents the current fertility preservation options available to women with gynaecological cancers, including cervical, ovarian, and endometrial malignancies, and highlights the importance of early multidisciplinary intervention in delivering personalised care.

Background: Transseptal puncture is routinely performed to access the left atrium during catheter ablation of left atrial tachyarrhythmias. Although iatrogenic atrial septal defects (iASDs) frequently occur after the procedure, factors influencing delayed defect closure remain incompletely understood. Myocardial injury induced by radiofrequency (RF) ablation results in the release of cardiac troponin into the circulation and may reflect the extent of procedural tissue injury. Methods: This prospective study included patients who underwent RF ablation for left atrial arrhythmias at the Iraqi Center for Heart Diseases in collaboration with the College of medicine, University of Baghdad between March 2023 and April 2024. Serum troponin concentrations, procedural duration, and echocardiographic assessment of iASD size were evaluated prospectively to determine their association with delayed atrial septal defect closure over a period of 3–6 months. Results: Forty-seven patients were enrolled (mean age, 36.28 ± 10.34 years; 48.9% male). A significant positive association was observed between iASD size and serum troponin level (p < 0.001). For each unit increase in post-procedure troponin, the likelihood of ASD presence increases by more than two-fold at 3–6 months. Larger septal defects were also associated with longer procedural duration. Conclusions: Elevated serum troponin concentration following RF ablation is associated with larger iatrogenic atrial septal defects and may serve as a useful predictor of delayed iASD closure during the first six months of follow-up.

Background: Left ventricular diastolic dysfunction (LVDD) is associated with chronically elevated left ventricular filling pressures that promote left atrial (LA) remodeling and increase the risk of atrial fibrillation (AF). Because AF is frequently asymptomatic during its early stages, identifying echocardiographic markers that facilitate early risk stratification is of considerable clinical importance. This study investigated the association between LA enlargement and AF in elderly patients with LVDD using conventional echocardiographic LA size parameters. Methods: This prospective observational study enrolled 100 consecutive patients aged ≥ 60 years with echocardiographically confirmed LVDD and no documented history of AF between December 2023 and May 2024. Comprehensive transthoracic echocardiography was performed to assess LA diameter, biplane LA volume using Simpson’s method, LA volume by the area–length method, and indexed LA volume (LAVI). The presence of AF was determined by standard 12-lead electrocardiography and rhythm assessment. Echocardiographic parameters were compared between patients with and without AF using appropriate statistical analyses. Results: The study population had a mean age of 68.37 ± 6.31 years, and 52% were male. AF was identified in 15% of participants, while mild LA enlargement was observed in 18%. Among patients with LA enlargement, 72.2% had AF compared with only 2.4% of patients with a normal LA size (p < 0.001). Patients with AF demonstrated significantly greater biplane LA volume (69.10 ± 9.61 vs. 52.21 ± 6.28 mL), LA volume measured by the area–length method (71.42 ± 9.51 vs. 54.03 ± 6.53 mL), and indexed LA volume (37.33 ± 3.81 vs. 28.87 ± 3.65 mL/m²) than those without AF (all p < 0.001). Conclusions: Left atrial enlargement measured using echocardiographic assessment, particularly indexed LA volume, is strongly associated with atrial fibrillation in elderly patients with left ventricular diastolic dysfunction.