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Pomeroy KO, Comizzoli P, Rushing JS, Lersten IL, Nel-Themaat L. The ART of cryopreservation and its changing landscape. Fertil Steril 2022; 117:469-476. [DOI: 10.1016/j.fertnstert.2022.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
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102
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Bühler N. The making of 'old eggs': the science of reproductive ageing between fertility and anti-ageing technologies. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:169-181. [PMID: 35024473 PMCID: PMC8732751 DOI: 10.1016/j.rbms.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/09/2021] [Accepted: 07/29/2021] [Indexed: 06/14/2023]
Abstract
This article proposes going back in the history of reproductive medicine to shed light on the role of assisted reproductive technology (ART) in the making of 'old eggs'. Focusing on two key technologies - egg donation and cytoplasmic transfer - both of which contributed significantly to the production of scientific knowledge about reproductive ageing, the article suggests that ART can be analysed as 'in-vivo models' playing a pivotal role in the shift from age as a demographic variable to ageing understood in biological terms. It will shed light on the role of ART in locating age in the eggs and producing a cellular understanding of fertility decline. It argues that ART not only offers new means of reconfiguring the biological clock by extending fertility, but also reconfigures the biology of reproductive ageing itself. This becomes both the target and the means for new technological interventions, imaginaries and norms, anchored in women's bodies and a more plastic biology, and thereby illuminates hitherto underexplored aspects of the encounter between the science and technology of reproduction and anti-ageing.
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103
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Zaami S, Melcarne R, Patrone R, Gullo G, Negro F, Napoletano G, Monti M, Aceti V, Panarese A, Borcea MC, Scorziello C, Ventrone L, Mamedov SN, Meggiorini ML, Vergine M, Giacomelli L. Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study. J Clin Med 2022; 11:jcm11051311. [PMID: 35268402 PMCID: PMC8911138 DOI: 10.3390/jcm11051311] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction. Improving the prognosis of breast cancer patients is of utmost importance in terms of increasing survival rates. Modern medicine has therefore prioritized better quality of life for patients, even after the disease, through a better management of the potential long-term side effects induced by anticancer treatments. Fertility preservation and family planning are therefore crucial issues to be addressed in all cancer patients of reproductive age. Along those lines, a new branch of medicine with distinct multidisciplinary characteristics has developed over the years: oncofertility. Although both national and international guidelines value reproductive counseling as an essential aspect of the diagnostic-therapeutic pathway, part and parcel of the informed consent process, it is not included within the protocols adopted by the operating units for the care and management of neoplastic diseases. Objective. This study aimed to evaluate the activity of the Breast Unit of the Policlinico Umberto I Hospital, Rome, Italy, and the degree of compliance with guidelines. By knowing the strengths and weaknesses of such approaches, the standards of care offered to breast cancer patients can be improved. Materials and methods. A retrospective study based on a review of medical records was conducted between 2014 and 2021. Patients under 40 years of age diagnosed with non-metastatic malignancies were included who received chemotherapy treatment, namely neoadjuvant, adjuvant or adjuvant hormone therapy. Results. The data were extracted from the medical records of 51 patients who met the inclusion criteria, 41% of whom received reproductive counseling, and of these, 43% decided to undertake a path of fertility preservation. Factors such as the absence of children and young age reportedly favored both the interest in counseling proposals by the medical staff and the decision to undertake a path of fertility preservation. Conclusions. The study shows that there has been growing interest in the topic of oncofertility, especially in light of law 219/2017. Therefore, since 2018, multiple proposals for reproductive counseling have been set forth, but there was not an equally growing demand for fertility preservation practices, which can be explained by the invasive nature of such practices, the patients’ concern about their own state of health, and poor or inadequate information. Such impediments highlight the importance of standardized counseling and the need for a multidisciplinary medical team to support the patient in the decision-making process. The study also revealed a drop in the number of patients receiving counseling due to the COVID-19 pandemic, contrary to the positive trend that was recorded prior to the pandemic.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
- Correspondence:
| | - Rossella Melcarne
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Renato Patrone
- ICTUS, University of Naples Federico II, 80131 Naples, Italy;
| | - Giuseppe Gullo
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy;
| | - Francesca Negro
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Valerio Aceti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Alessandra Panarese
- General and Transplant Surgery Department, Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Carola Borcea
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Luca Ventrone
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Samira Nicole Mamedov
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Maria Letizia Meggiorini
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Massimo Vergine
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Laura Giacomelli
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
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Whynott RM, Summers KM, Ball GD, Van Voorhis BJ, Sparks A. Fresh embryo transfer after in vitro insemination of fresh vs. cryopreserved anonymous donor oocytes: which has a better live birth rate? A Society for Assisted Reproductive Technology Clinic Outcome Reporting System analysis. Fertil Steril 2022; 117:803-810. [PMID: 35216830 DOI: 10.1016/j.fertnstert.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine if transfer of fresh embryos derived from fresh or cryopreserved donor oocytes yields a higher live birth rate. DESIGN Historical cohort study. SETTING Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. PATIENT(S) A total of 24,663 fresh embryo transfer cycles of donor oocytes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome was live births per number of embryos transferred on day 5. The secondary outcomes included number of infants per embryo transfer, surplus embryos cryopreserved, and characterization of US oocyte recipients. RESULT(S) A total of 16,073 embryo transfers were from fresh oocytes and 8,590 were from cryopreserved oocytes. Recipient age, body mass index (BMI), gravidity, and parity were similar between the groups. Most recipients were of White non-Hispanic race (66.9%), followed by Asian (13.7%), Black non-Hispanic (9.3%), and Hispanic (7.2%). Fresh oocyte cycles were more likely to use elective single embryo transfer (42.5% vs. 37.8%) or double embryo transfer (53.2% vs. 50.4%) and resulted in more surplus embryos for cryopreservation (4.6 vs. 1.2). The live birth rate from fresh oocytes was 57.5% vs. 49.7% from cryopreserved oocytes. Negative predictors of live birth included the use of cryopreserved oocytes (odds ratio [OR] 0.731, 95% confidence interval [CI] 0.665-0.804), Black non-Hispanic race (OR 0.603, 95% CI 0.517-0.703), Asian race (OR 0.756, 95% CI 0.660-0.867), and increasing recipient BMI (OR 0.982, 95% CI 0.977-0.994) after controlling for recipient age, number of embryos transferred on day 5, and unexplained infertility diagnosis. The proportion of multifetal deliveries was greater in cycles utilizing fresh (26.4%) vs. cryopreserved (20.6%) oocytes. CONCLUSION(S) The live birth rate is higher with use of fresh oocytes vs. cryopreserved oocytes in fresh embryo transfer cycles. Negative live birth predictors include recipient Black non-Hispanic or Asian race and increasing BMI.
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Affiliation(s)
| | - Karen M Summers
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - G David Ball
- Seattle Reproductive Medicine, Seattle, Washington
| | - Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Amy Sparks
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
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105
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Oocyte vitrification for elective fertility preservation: a SWOT analysis. Reprod Biomed Online 2022; 44:1005-1014. [DOI: 10.1016/j.rbmo.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
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106
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The Impact of Oocyte Vitrification on Offspring: a Systematic Review. Reprod Sci 2022; 29:3222-3234. [DOI: 10.1007/s43032-022-00868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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107
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Wu D, Shen H. Fertility preservation in female patients with hematological disorders. BMC Pregnancy Childbirth 2022; 22:61. [PMID: 35065646 PMCID: PMC8783992 DOI: 10.1186/s12884-022-04385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to explore the effectiveness and safety of fertility counseling and fertility preservation using oocyte or embryo freezing prior to chemotherapy or bone marrow transplantation (BMT) in female patients with hematologic disorders. Methods Between 2016 and 2019, 29 patients with hematologic disorders, age range 12–38 years, were given preoperative fertility counseling prior to proposed BMT. Sixteen of these patients, age range 22–38 years, chose to undergo oocyte retrieval followed by ovum or embryo freezing at our Center for Reproductive Medicine. Results As the patients were in urgent need of chemotherapy or BMT, following the random-start controlled ovarian hyperstimulation (COH), an average of 8.2 oocytes were collected. Ten patients had an average of 6.9 oocytes frozen, while 6 patients had an average of 3.2 embryos frozen. There were no intra-operative or postoperative complications, although two patients experienced a blood transfusion reaction of the 11 transfused patients. Conclusion For patients with hematologic disorders, oocyte or embryo freezing prior to chemotherapy or BMT may offer hope for fertility preservation in female patients. However, in order to deliver this, a standardized, feasible, and effective treatment process is needed and should include every aspect of patient selection as well as protocols for ovulation promotion, perioperative management, and postoperative observation.
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108
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WGBS combined with RNA-seq analysis revealed that Dnmt1 affects the methylation modification and gene expression changes during mouse oocyte vitrification. Theriogenology 2022; 177:11-21. [PMID: 34653792 DOI: 10.1016/j.theriogenology.2021.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023]
Abstract
Understanding the molecular level changes of oocyte cryopreservation and the subsequent warming process is essential for improving the oocyte cryopreservation technologies. Here, we collected the mature metaphase II (MII) oocytes from mice and vitrified. After thawing, single-cell whole-genome bisulphite sequencing (scWGBS) and single-cell RNA sequencing (scRNA-seq) were used to investigate the molecular attributes of this process. Compared to the fresh oocytes, the vitrified oocytes had lower global methylation and gene expression levels, and 1426 genes up-regulated and 3321 genes down-regulated. The 1426 up-regulated differentially expressed genes (DEGs) in the vitrified oocytes were mainly associated with the histone ubiquitination, while the 3321 down-regulated genes were mainly enriched in the mitochondrion organisation and ATP metabolism processes. The differentially methylated regions (DMRs) were mainly located in promoter, intron and exon region of genes, and the length of DMRs in the vitrified oocytes were also significantly lower than that of the fresh oocytes. Notably, there were no significant difference in the expression levels of DNA demethylases (Tet1, Tet2 and Tet3) and methyltransferases (Dnmt3a and Dnmt3b) between two treatments of oocytes. However, Dnmt1 and kcnq1ot1, which are responsible for maintaining DNA methylation, were significantly down regulated in the vitrified oocytes. Gene regulatory network (GRN) analysis showed the Dnmt1 and kcnq1ot1 play a core role in regulating methylation and expression levels of downstream genes. Moreover, some genes associated with oocyte quality were significantly down-regulated in the vitrified oocytes. The present data provides a new perspective for understanding the impact of vitrification on oocytes.
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109
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Harada M, Kimura F, Takai Y, Nakajima T, Ushijima K, Kobayashi H, Satoh T, Tozawa A, Sugimoto K, Saji S, Shimizu C, Akiyama K, Bando H, Kuwahara A, Furui T, Okada H, Kawai K, Shinohara N, Nagao K, Kitajima M, Suenobu S, Soejima T, Miyachi M, Miyoshi Y, Yoneda A, Horie A, Ishida Y, Usui N, Kanda Y, Fujii N, Endo M, Nakayama R, Hoshi M, Yonemoto T, Kiyotani C, Okita N, Baba E, Muto M, Kikuchi I, Morishige KI, Tsugawa K, Nishiyama H, Hosoi H, Tanimoto M, Kawai A, Sugiyama K, Boku N, Yonemura M, Hayashi N, Aoki D, Osuga Y, Suzuki N. Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for fertility preservation in childhood, adolescent, and young adult cancer patients: part 1. Int J Clin Oncol 2022; 27:265-280. [PMID: 34973107 PMCID: PMC8816532 DOI: 10.1007/s10147-021-02081-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
In 2017, the Japan Society of Clinical Oncology (JSCO) published the JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients. These were the first Japanese guidelines to address issues of oncofertility. In this field of medicine, sustained close cooperation between oncologists and reproductive specialists is essential from the diagnosis of cancer until many years after completion of cancer treatment. These JSCO guidelines were intended to guide multidisciplinary medical staff in considering the availability of fertility preservation options and to help them decide whether to provide fertility preservation to childhood, adolescent, and young adult cancer patients before treatment starts, with the ultimate goal of improving patient survivorship. The guidelines are presented as Parts 1 and 2. This article (Part 1) summarizes the goals of the guidelines and the methods used to develop them and provides an overview of fertility preservation across all oncology areas. It includes general remarks on the basic concepts surrounding fertility preservation and explanations of the impacts of cancer treatment on gonadal function by sex and treatment modality and of the options for protecting/preserving gonadal function and makes recommendations based on 4 clinical questions. Part 2 of these guidelines provides specific recommendations on fertility preservation in 8 types of cancer (gynecologic, breast, urologic, pediatric, hematologic, bone and soft tissue, brain, and digestive).
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Affiliation(s)
- Miyuki Harada
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta Tsukinowa-Cho Otsu, Shiga, 520-2192, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Takeshi Nakajima
- Department of Endoscopy, Gastrointestinal Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akiko Tozawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kohei Sugimoto
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, Comprehensive Cancer Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoko Akiyama
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Kuwahara
- Ladies Clinic Cosmos Kochi, 6-27, Sugiiru, Kochi, Kochi, 780-0082, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Hiroshi Okada
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Koji Kawai
- Department of Urology, International University of Health and Welfare, 852, Hatakeda Narita, Chiba, 286-0124, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koichi Nagao
- Department of Urology, Toho University Faculty of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Michio Kitajima
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Souichi Suenobu
- Division of General Pediatrics and Emergency Medicine, Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-minamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoko Miyoshi
- Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women's University, 4-2-26 Hishiya-nishi, Higashi-Osaka, Osaka, 577-8550, Japan
| | - Akihiro Yoneda
- Division of Pediatric Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yasushi Ishida
- Pediatric Medical Center, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-city, Ehime, 790-0024, Japan
| | - Noriko Usui
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan
| | - Nobuharu Fujii
- Division of Transfusion, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Tsukasa Yonemoto
- Division of Orthopedic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Chikako Kiyotani
- Children's Cancer Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Natsuko Okita
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Medical Park Yokohama, 1-1-8, Sakuragi-cho, Yokohama, Kanagawa, 231-0062, Japan
| | - Ken-Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hajime Hosoi
- Department of Nursing, Doshisha Women's College of Liberal Arts, Kodo, Kyotanabe City, Kyoto, 610-0395, Japan
| | - Mitsune Tanimoto
- Chugoku Central Hospital, 148-13, Kamiiwanari, Miyuki-cho, Fukuyama-city, Hiroshima, 720-0001, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-Oncology Program, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Narikazu Boku
- Department of Medical Oncology and General Medicine, Institute of Medical Science, IMSUT Hospital, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Masato Yonemura
- Department of Pharmacy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-0882, Japan
| | - Naoko Hayashi
- Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
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Awareness, Intentions, and Attitudes Toward Planned Oocyte Cryopreservation Among Female Medical Staff. Reprod Biomed Online 2022; 44:1169-1176. [DOI: 10.1016/j.rbmo.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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111
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Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives. J Clin Med 2021; 10:jcm10235690. [PMID: 34884393 PMCID: PMC8658080 DOI: 10.3390/jcm10235690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
Recent advances in early detection and oncological therapies have ameliorated the survival rate of young cancer patients. Yet, ovarian impairment induced by chemotherapy and radiotherapy is still a challenging issue. This review, based on clinical and lab-based studies, summarizes the evidence of gonadotoxicity of chemoradiotherapy, the recent approaches, ongoing controversies, and future perspectives of fertility preservation (FP) in female patients who have experienced chemo- or radio-therapy. Existing data indicate that chemotherapeutic agents induce DNA alterations and massive follicle activation via the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Meanwhile, the radiation causes ionizing damage, leading to germ cell loss. In addition to the well-established methods, numerous therapeutic approaches have been suggested, including minimizing the follicle loss in cryopreserved ovarian grafts after transplantation, in vitro activation or in vitro growing of follicles, artificial ovarian development, or fertoprotective adjuvant to prevent ovarian damage from chemotherapy. Some reports have revealed positive outcomes from these therapies, whereas others have demonstrated conflictions. Future perspectives are improving the live birth rate of FP, especially in patients with adverse ovarian reserve, eliminating the risk of malignancy reintroducing, and increasing society’s awareness of FP importance.
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112
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Huynh M, Wang A, Ho J, Herndon CN, Aghajanova L. Fertility Preservation and Infertility Treatment in Medical Training: An Assessment of Residency and Fellowship Program Directors' Attitudes. WOMEN'S HEALTH REPORTS 2021; 2:576-585. [PMID: 35141706 PMCID: PMC8820404 DOI: 10.1089/whr.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
Background: Given the concurrence of medical residency and fellowship training with typical childbearing years, trainees often must make difficult decisions regarding family planning, requiring the support of their residency and fellowship program directors (PDs) to guide them. Objective: Our hypothesis was that PDs have knowledge gaps and varying levels of support in terms of their trainees' fertility, and the goal of our study was to assess the knowledge and support of residency and fellowship PDs in the United States toward trainees' reproductive needs. Methods: Cross-sectional survey distributed to all residency and fellowship PDs providing contact information through the Accreditation Council for Graduate Medical Education website in August 2019. Results: Of 299 respondents, the most common lengths of leave reported were 6–8 weeks of maternity leave and under 2 weeks of paternity leave. A total of 57.2% did not know their program's insurance for infertility treatment, and 68.6% did not know fertility preservation coverage. A total of 52.2% of PDs were unaware of if their trainees faced infertility. PDs supported residents' needs through moral support (68.2%) and time off for appointments (65.2%). Similarly, most PDs (66.2%) never had a trainee express interest in fertility preservation to them but offered moral support (59.2%) and time off (48.5%). Respondents felt it was important to increase resources for trainees by increasing their awareness of needs (47.5%) and establishing reproduction-related policies (34.1%). Conclusion: The study found variations regarding PDs' knowledge and support levels for trainees' fertility needs. Most were unaware of their trainees' fertility needs, and many PDs felt it would be important to improve resources by increasing personal awareness and creating policies for support to promote reproductive health equity for trainees.
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Affiliation(s)
- Megan Huynh
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Ange Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Ho
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Christopher N. Herndon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Sunnyvale, California, USA
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113
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De Proost M, Johnston M. The revision of the French bioethics law and the questions it raises for the future of funding for egg freezing. Reprod Biomed Online 2021; 44:591-593. [DOI: 10.1016/j.rbmo.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
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114
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Rimon-Zarfaty N, Kostenzer J, Sismuth LK, de Bont A. Between "Medical" and "Social" Egg Freezing : A Comparative Analysis of Regulatory Frameworks in Austria, Germany, Israel, and the Netherlands. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:683-699. [PMID: 34783957 PMCID: PMC8724162 DOI: 10.1007/s11673-021-10133-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 07/05/2021] [Indexed: 05/30/2023]
Abstract
Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between "medical" and "social" egg freezing (MEF and SEF)-contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the "regulatory boundary-work" around the "medical"-"social" distinction in different egg freezing regulations. Based on systematic documents' analysis we present a cross-national comparison of the way the "medical"-"social" differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness-highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between "medical" and "social" are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects.
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Affiliation(s)
- Nitzan Rimon-Zarfaty
- Department of Medical Ethics and History of Medicine, University Medical Centre Göttingen, Humboldtallee 36, 37073, Göttingen, Lower Saxony, Germany.
- Department of Human Resource Management Studies, Sapir Academic College, D.N. Hof Ashkelon, 7915600, Hof Ashkelon, Israel.
| | - Johanna Kostenzer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, P.O. Box 1738, 3000 DR, The Netherlands
| | - Lisa-Katharina Sismuth
- Department of Medical Ethics and History of Medicine, University Medical Centre Göttingen, Humboldtallee 36, 37073, Göttingen, Lower Saxony, Germany
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, P.O. Box 1738, 3000 DR, The Netherlands
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115
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Williams RS, Ellis DD, Wilkinson EA, Kramer JM, Datta S, Guzick DS. Factors affecting live birth rates in donor oocytes from commercial egg banks vs. program egg donors: an analysis of 40,485 cycles from the Society for Assisted Reproductive Technology registry in 2016-2018. Fertil Steril 2021; 117:339-348. [PMID: 34802685 DOI: 10.1016/j.fertnstert.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the differences in live birth rates (LBRs), with single embryo transfer (SET), using oocytes from program generated egg donors vs. commercial egg bank donors and other factors affecting LBRs using donor oocytes. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) A total of 40,485 in vitro fertilization cycles using donor oocytes reported to the Society for Assisted Reproductive Technology registry in 2016-2018. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth rate and cumulative LBR for SET using donor oocytes. RESULT(S) Multivariate results from the first SET from 19,128 cycles, including 15,429 from program generated egg donors and 3,699 from commercial egg banks, showed, when controlling for all other variables, the following: the LBR in the first SET cycle using commercial egg banks was 53.3% compared with 55.4% using program recruited egg donors (odds ratio [OR], 0.92); a reduction in the LBR with increasing recipient age, ages 40-44 years (OR, 0.80), 45-49 years (OR, 0.77), and >49 years (OR, 0.65); a steady decline in the LBR with increases in recipient body mass index above normal; and a steady increase in the LBR in association with >16 oocytes retrieved. Double embryo transfer increased the LBR (SET, 52%, vs. double embryo transfer, 58%) but also significantly increased the multiple pregnancy LBR, with 43% twins and 0.9% triplets. Blastocyst transfer had a higher LBR than cleavage stage embryos (52.5% vs. 39.5%). Intracytoplasmic sperm injection vs. conventional insemination when using fresh oocytes from program donors had similar LBRs. CONCLUSION(S) When performing in vitro fertilization using donor oocytes with SET, the LBR is affected by oocyte source, recipient age, recipient body mass index, stage of embryo at transfer, and number of oocytes retrieved.
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Affiliation(s)
- Robert Stan Williams
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida.
| | - Dorothy D Ellis
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Elizabeth A Wilkinson
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
| | - Joseph M Kramer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
| | - Susmita Datta
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - David S Guzick
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
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116
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Carneiro MM, Filho JSLDC, Petta CA, Lino CAPC, Castro CLAD, Schor E, Neto JN, Oliveira MAPD, Tcherniakovsky M, Abrão MS, Neto OBP, Quintairos RDA, Pearce S, Abdalla HS, Silva JCRE. Fertility preservation in women with endometriosis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:796-802. [PMID: 34784639 PMCID: PMC10183860 DOI: 10.1055/s-0041-1739234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Márcia Mendonça Carneiro
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Carlos Alberto Petta
- Universidade Estadual de Campinas, Campinas, SP, Brazil. Clínica Fertilidade & Vida, Campinas, SP, Brazil. Serviço de Reprodução Assistida, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | | | - Eduardo Schor
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Sociedade Brazileira de Endometriose e Cirurgia Minimamente Invasiva
| | | | | | - Marcos Tcherniakovsky
- Setor de Videoendoscopia Ginecológica e Endometriose, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Maurício Simões Abrão
- Divisão de Ginecologia, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil. Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Omero Benedicto Poli Neto
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Sidney Pearce
- Centro Universitário Christus, Fortaleza, CE, Brazil
| | | | - Julio Cesar Rosa E Silva
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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117
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Fu X, Liu X, Li J, Zhang M, Jiang J, Chen Q, Li M, Gao S, Ma J. An Eight Year Experience of Autologous Oocyte Vitrification for Infertile Patients Owing to Unavailability of Sperm on Oocyte Retrieval Day. Front Med (Lausanne) 2021; 8:663287. [PMID: 34765611 PMCID: PMC8575774 DOI: 10.3389/fmed.2021.663287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to provide a descriptive analysis of the clinical outcomes achieved in oocyte vitrification in cases where sperm was unavailable on oocyte retrieval day, and to identify predictors of oocyte survival. Methods: This retrospective cohort study used data from a university-affiliated reproductive medical center. There were 321 cycles in which some of, or all oocytes were vitrified owing to the unavailability of sperm between March 2009 and October 2017. A descriptive analysis of the clinical outcomes including both fresh embryo transfers and cryopreserved embryo transfers was provided. The ability of an individual parameter to forecast oocyte survival per thawing cycle was assessed by binary logistic regression analysis. The cumulative probability of live birth (CPLB) was estimated by using the Kaplan-Meier method according to the total number of oocytes thawed in consecutive procedures. Results: The average survival rate was 83.13%. High-quality embryo rate and blastocyst rate decreased significantly decreased significantly in vitrification oocyte group compared to fresh control oocytes. The comparison of sibling oocytes in part-oocyte-vitrified cycles shows fewer high-quality embryos developed in the vitrified group. The live birth rate per warmed-oocyte was 4.3%. Reasons for lack of sperm availability on oocyte retrieval day and serum cholesterol levels were found to be associated with oocyte survival rate in the present study. Kaplan-Meier analysis showed no significant difference in CPLB between patients ≤35 vs. >35 years. Conclusions: Oocyte vitrification is an indispensable and effective alternative when sperm are not available on oocyte retrieval day. The present study provided evidence that oocytes from infertile couples were more likely to suffer oocyte/embryo vitrification injury. Clinicians need to take this into account when advising patients in similar situations. Further studies will be necessary to clarify the correlation between serum metabolism parameters and human oocyte survival after vitrification.
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Affiliation(s)
- Xiao Fu
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Xiaojie Liu
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Jing Li
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Meng Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Jingjing Jiang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Qianqian Chen
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Mei Li
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Shanshan Gao
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Jinlong Ma
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
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118
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Gianaroli L, Ferraretti AP, Perruzza D, Terzuoli G, Azzena S, Crippa A, Dworakowska A, Tabanelli C, Magli MC. Oocyte donation: not all oocyte cryobanks are the same. Reprod Biomed Online 2021; 44:271-279. [PMID: 35031239 DOI: 10.1016/j.rbmo.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION Is the efficacy of imported vitrified oocyte donation affected by the cryobank of origin? DESIGN Longitudinal cohort study, including 249 completed oocyte warming cycles from 200 recipients (January 2016-July 2020). No severe male factor was included. Vitrified oocytes were provided by three Spanish cryobanks. Primary outcome was cumulative live birth delivery rate (CLBR) per completed oocyte warming cycle. RESULTS After warming 1535 oocytes, 1244 survived (81.0%) and 945 fertilized (76.0%); embryo utilization rate was 65.3%. The overall CLBR per completed cycle was 47.0% but was lower in cryobank 1 (31.2%) versus cryobank 2 (56.0%, P = 0.0010) and cryobank 3 (50.8%, P = 0.0241). Multivariate logistic regression analysis identified survival of four or more oocytes as the strongest predictor for delivery (P = 0.0282). Only 202 out of 249 oocyte warming cycles had four or more survived oocytes in a proportion that was significantly lower in cryobank 1 versus cryobank 2 (70.1% versus 89.0%, P = 0.0020); comparison with cryobank 3 (81.0%) was not significant. In the 202 oocyte warming cycles, CLBR in cryobank 1 (37.0%) was lower versus cryobank 2 (58.8%, P = 0.0115) and cryobank 3 (60.8%, P = 0.0019), suggesting a reduced viability in oocytes from cryobank 1 that survived warming. CONCLUSIONS Differences were found in the efficacy of imported vitrified oocytes in relation to the cryobank of origin. Each centre needs to evaluate the results internally when starting a collaboration with an oocyte cryobank to establish the necessary measures to maximize treatment efficacy.
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Affiliation(s)
- Luca Gianaroli
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy.
| | | | - Davide Perruzza
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - Gaia Terzuoli
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - Silvia Azzena
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - Andor Crippa
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - Aneta Dworakowska
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - Carla Tabanelli
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
| | - M Cristina Magli
- SISMER, Reproductive Medicine Unit, Via Mazzini 12, Bologna 40138, Italy
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119
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Multidisciplinary consensus on the criteria for fertility preservation in cancer patients. Clin Transl Oncol 2021; 24:227-243. [PMID: 34635959 PMCID: PMC8794945 DOI: 10.1007/s12094-021-02699-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
Infertility is one of the main sequelae of cancer and its treatment in both children and adults of reproductive age. It is, therefore, essential that oncologists and haematologists provide adequate information about the risk of infertility and the possibilities for its preservation before starting treatment. Although many international clinical guidelines address this issue, this document is the first Spanish multidisciplinary guideline in paediatric and adult oncological patients. Experts from the Spanish Society of Medical Oncology, the Spanish Fertility Society, the Spanish Society of Haematology and Haemotherapy, the Spanish Society of Paediatric Haematology and Oncology and the Spanish Society of Radiation Oncology have collaborated to develop a multidisciplinary consensus.
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120
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Agarwal S, Trolice MP, Madeira JL, Lindheim SR. Boutique Egg Freezing: Empowering Technology or Marketing Phenomenon? A Word of Caution. J Obstet Gynaecol India 2021; 71:560-561. [PMID: 34602772 DOI: 10.1007/s13224-021-01528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
The introduction of oocyte vitrification has propelled the field of oncofertility. However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of a partner or other personal issues. The aim of this article is to discuss the pros and cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies. This article further encourages obstetricians and gynecologists to discuss these issues of planned oocyte cryopreservation with their patients to empower them to make an educated decision based on research and science rather than be susceptible to entities that stand to gain monetarily by prompting women to fear a childless future.
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Affiliation(s)
- Shruti Agarwal
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827 USA
| | - Mark P Trolice
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827 USA.,Fertility CARE: The IVF Center, 5901 Brick Court, Winter Park, FL 32792 USA
| | - Jody Lyneé Madeira
- Maurer School of Law, Indiana University, 211 S. Indiana Avenue, Bloomington, IN 47405 USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple Street, Suite 3800 Weber CHE, Dayton, OH 45409 USA.,Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Lingshan Road, Shanghai, 200135 People's Republic of China
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121
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Poli M, Capalbo A. Oocyte Cryopreservation at a Young Age Provides an Effective Strategy for Expanding Fertile Lifespan. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:704283. [PMID: 36304057 PMCID: PMC9580690 DOI: 10.3389/frph.2021.704283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
With an upward trend in delaying parenthood, women across the world face an increasing risk of age-related infertility and involuntary childlessness. Elective oocyte banking strategies offer women the possibility to protect part of their reproductive potential until personal finances, personal relationship, or career have stabilized. Timely collection and cryopreservation of oocytes when they are most competent and chromosomal abnormality rates have not yet escalated are crucial for achieving high live births through in vitro fertilization (IVF) treatment at a later stage. To promote reproductive autonomy, women shall be informed about the decrease in fertility rates that sharply intensifies from the age of 35 years and the strategies available to maintain their reproductive potential. Together with this information, women should also recognize the limitations of available strategies including expected live birth rates, costs of the procedures, and overall approach performance, which is mainly associated with age at cryopreservation, number of oocytes banked, and age at accessing the banked oocytes. Evidence-based statistics are not yet available due to the relatively short period in which oocyte cryopreservation has been offered for elective purposes and the scarce number of patients returning for accessing their oocytes. However, to evaluate the applicability of fertility cryopreservation on a large scale, several theoretical models have been proposed to assess the expected efficacy and overall cost-effectiveness of different oocyte banking strategies. In this study, we review current oocyte cryopreservation methodologies, their applications, and outcomes. Moreover, we summarize current evidence regarding known parameters affecting oocyte banking efficacy. Finally, we discuss key points that could play a role in improving access to the service and optimization of oocyte banking frameworks.
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Affiliation(s)
- Maurizio Poli
- Igenomix Italy, Marostica, Italy
- Centrum voor Kinderwens, Dijklander Hospital, Purmerend, Netherlands
- *Correspondence: Maurizio Poli
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122
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Nomogram to predict pregnancy outcomes of emergency oocyte freeze-thaw cycles. Chin Med J (Engl) 2021; 134:2306-2315. [PMID: 34561337 PMCID: PMC8509984 DOI: 10.1097/cm9.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle, and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes. This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles. Methods: Data were collected from the Reproductive Center, Peking University Third Hospital of China. Multivariable logistic regression model was used to derive the nomogram. Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test and calibration plots. Results: The predictors in the model of “no transferable embryo cycles” are female age (odds ratio [OR] = 1.099, 95% confidence interval [CI] = 1.003–1.205, P = 0.0440), duration of infertility (OR = 1.140, 95% CI = 1.018–1.276, P = 0.0240), basal follicle-stimulating hormone (FSH) level (OR = 1.205, 95% CI = 1.051–1.382, P = 0.0084), basal estradiol (E2) level (OR = 1.006, 95% CI = 1.001–1.010, P = 0.0120), and sperm from microdissection testicular sperm extraction (MESA) (OR = 7.741, 95% CI = 2.905–20.632, P < 0.0010). Upon assessing predictive ability, the AUC for the “no transferable embryo cycles” model was 0.799 (95% CI: 0.722–0.875, P < 0.0010). The Hosmer–Lemeshow test (P = 0.7210) and calibration curve showed good calibration for the prediction of no transferable embryo cycles. The predictors in the cumulative live birth were the number of follicles on the day of human chorionic gonadotropin (hCG) administration (OR = 1.088, 95% CI = 1.030–1.149, P = 0.0020) and endometriosis (OR = 0.172, 95% CI = 0.035–0.853, P = 0.0310). The AUC for the “cumulative live birth” model was 0.724 (95% CI: 0.647–0.801, P < 0.0010). The Hosmer–Lemeshow test (P = 0.5620) and calibration curve showed good calibration for the prediction of cumulative live birth. Conclusions: The predictors in the final multivariate logistic regression models found to be significantly associated with poor pregnancy outcomes were increasing female age, duration of infertility, high basal FSH and E2 level, endometriosis, sperm from MESA, and low number of follicles with a diameter >10 mm on the day of hCG administration.
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Leung AQ, Baker K, Vaughan D, Shah JS, Korkidakis A, Ryley DA, Sakkas D, Toth TL. Clinical outcomes and utilization from over a decade of planned oocyte cryopreservation. Reprod Biomed Online 2021; 43:671-679. [PMID: 34474973 DOI: 10.1016/j.rbmo.2021.06.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION What is the clinical experience of patients who have undergone planned oocyte cryopreservation and oocyte thawing and warming? DESIGN Retrospective observational cohort study. All women who completed planned oocyte cryopreservation at a single large university-affiliated fertility centre between June 2006 and October 2020 were identified, including the subset who returned to use their oocytes. Patients who underwent oocyte cryopreservation for medical reasons were excluded. Baseline demographics, oocyte cryopreservation and thawing-warming cycle parameters, and clinical outcomes, were extracted from the electronic medical record. The primary outcome was cumulative live birth rate (LBR), and secondary outcomes were cumulative clinical pregnancy rate (CPR), and CPR and LBR per transfer. Results were stratified by age at time of cryopreservation (<38 and ≥38 years). RESULTS Of 921 patients who underwent planned oocyte cryopreservation, 68 (7.4%) returned to use their oocytes. Forty-six patients (67.6%) completed at least one embryo transfer. The CPR per transfer was 47.5% and LBR was 39.3%. The cumulative LBR per patient who initiated thawing-warming was 32.4%. Cycle outcomes were not significantly different in patients aged younger than 38 years and those aged 38 years or over. No patient aged 40 years or older (n = 6) was successful with their cryopreserved oocytes. Ten patients (14.7%) who were unsuccessful with their cryopreserved oocytes achieved a live birth using donor oocytes, with most (7/10) of these patients aged 38 years and older. CONCLUSION Only a small percentage of patients returned to use their oocytes, and 32% of those were able to achieve a live birth.
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Affiliation(s)
- Angela Q Leung
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA.
| | - Katherine Baker
- Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Denis Vaughan
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Jaimin S Shah
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Ann Korkidakis
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - David A Ryley
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA
| | - Denny Sakkas
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA
| | - Thomas L Toth
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
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Tsafrir A, Holzer H, Miron-Shatz T, Eldar-Geva T, Gal M, Ami IB, Dekel N, Weintruab A, Goldberg D, Schonberger O, Srebnik N, Hyman J. 'Why have women not returned to use their frozen oocytes?': a 5-year follow-up of women after planned oocyte cryopreservation. Reprod Biomed Online 2021; 43:1137-1145. [PMID: 34686418 DOI: 10.1016/j.rbmo.2021.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION What are the reproductive choices and retrospective reflections of women at least 4 years after planned oocyte cryopreservation (POC)? DESIGN This was an internet survey, using the REDCap application, of women who underwent POC, at a single-centre university-affiliated IVF unit, 4-8 years before the survey. The questionnaire addressed reproductive choices and outcomes following POC. RESULTS Seventy-nine women who underwent POC during 2011-2014 were invited to participate, and 70 (89%) responded. Mean age at cryopreservation was 37.1 ± 2.4 (range 30-41) years, mean age at study participation 42.6 ± 2.6 (range 35-48) years, and mean time from first cryopreservation cycle to study participation 5.5 ± 1.3 (range 4-8) years. The main retrospectively reported reason for POC was not wanting to become pregnant without a partner (59, 84%). During the follow-up period, 44 women (63%) attempted to conceive either naturally or by assisted reproductive technology using fresh or cryopreserved oocytes. Of those, 28 women achieved a live birth (64% of those who tried to conceive). Fourteen respondents (20% of all respondents) reported using their cryopreserved oocytes, and three (21%) achieved a birth using those oocytes. Fifteen women (34%) of those who tried to conceive used donor spermatozoa. CONCLUSIONS The most common reasons for not using frozen oocytes were achieving pregnancy without frozen oocytes or preferring not to have a child without a partner. A considerable proportion of women who had POC and were not interested in being a single parent by choice eventually try to conceive using donor spermatozoa several years later.
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Affiliation(s)
- A Tsafrir
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel.
| | - H Holzer
- Faculty of Medicine, Hebrew University of Jerusalem, Department of Obstetrics and Gynecology, Hadassah Medical Center Jerusalem, Israel
| | - T Miron-Shatz
- Ono Academic College, Center for Medical Decision Making, Kiryat Ono, Israel; Winton Centre for Risk and Evidence Information, Cambridge University, Cambridge, UK
| | - T Eldar-Geva
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - M Gal
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - I Ben Ami
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - N Dekel
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - A Weintruab
- IVF Unit, Laniado Medical Center, Netanya, Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - D Goldberg
- Clalit Health Services, Fertility Clinic - Central district, Modi'in Illit, Israel
| | - O Schonberger
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - N Srebnik
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - J Hyman
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
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Chung EH, Lim SL, Myers E, Moss HA, Acharya KS. Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study. J Assist Reprod Genet 2021; 38:2435-2443. [PMID: 33977465 PMCID: PMC8490495 DOI: 10.1007/s10815-021-02222-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an alternative to oocyte cryopreservation (OC) for women receiving gonadotoxic therapy. Anticipating increased use of OTC, we compare the cost-effectiveness of OC versus OTC for fertility preservation in oncofertility patients. METHODS A cost-effectiveness model to compare OC versus OTC was built from a payer perspective. Costs and probabilities were derived from the literature. The primary outcome for effectiveness was the percentage of patients who achieved live birth. Strategies were compared using incremental cost-effectiveness ratios (ICER). All inputs were varied widely in sensitivity analyses. RESULTS In the base case, the estimated cost for OC was $16,588 and for OTC $10,032, with 1.56% achieving live birth after OC, and 1.0% after OTC. OC was more costly but more effective than OTC, with an ICER of $1,163,954 per live birth. In sensitivity analyses, OC was less expensive than OTC if utilization was greater than 63%, cost of OC prior to chemotherapy was less than $8100, cost of laparoscopy was greater than $13,700, or standardized discounted costs were used. CONCLUSIONS With current published prices and utilization, OC is more costly but more effective than OTC. OC becomes cost-saving with increased utilization, when cost of OC prior to chemotherapy is markedly low, cost of laparoscopy is high, or standardized discounted oncofertility pricing is assumed. We identify the critical thresholds of OC and OTC that should be met to deliver more cost-effective care for oncofertility patients.
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Affiliation(s)
- Esther H Chung
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Duke University, 200 Trent Drive (Baker House 236), Durham, NC, 27713, USA.
| | - Stephanie L Lim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Kelly S Acharya
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Duke University, 200 Trent Drive (Baker House 236), Durham, NC, 27713, USA
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126
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Caughey LE, Lensen S, White KM, Peate M. Disposition intentions of elective egg freezers toward their surplus frozen oocytes: a systematic review and meta-analysis. Fertil Steril 2021; 116:1601-1619. [PMID: 34452749 DOI: 10.1016/j.fertnstert.2021.07.1195] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. DESIGN A systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Actual EEFs (women with oocytes in storage), potential EEFs (women investigating elective oocyte cryopreservation or about to freeze their oocytes), and women of reproductive age (women in the community aged ≥18 years). INTERVENTION(S) A systematic review was undertaken and electronically searched MEDLINE, Embase, and PsycINFO on the Ovid platform for conference abstracts and peer-reviewed articles, published in English after January 1, 2010. A search strategy combined synonyms for oocyte, cryopreservation, donation, disposition, elective, and attitude. Eligible studies assessed disposition outcomes (how an oocyte was disposed of) and disposition intentions (how women intend to dispose of an oocyte) and/or the psychosocial determinants underlying disposition outcomes and intentions. The Joanna Briggs Institute Prevalence Tool was used to assess the risk of bias. A meta-analysis using random effects was applied to pool proportions of women with similar disposition intentions toward their oocytes. MAIN OUTCOME MEASURE(S) Disposition outcomes and intentions toward surplus frozen oocytes: donate to research; donate to others; discard; unsure. Psychosocial determinants (beliefs, attitudes, barriers, and facilitators) of disposition outcomes and intentions. RESULT(S) A total of 3,560 records were identified, of which 22 (17 studies) met the inclusion criteria (8 studies from Europe, 7 from North America, and 2 from Asia). No studies reported on past oocyte disposition outcomes. Seventeen studies reported on the future disposition intentions of 5,446 women. Only 2 of the 17 studies reported on the psychosocial determinants of oocyte disposition intentions. There was substantial heterogeneity in the pooled results, which was likely a result of the significant variation in methodology. Actual EEFs were included in eight studies (n = 873), of whom 53% (95% confidence interval [CI], 44-63; I2, 87%) would donate surplus oocytes to research, 31% (95% CI, 23-40; I2, 72%) were unsure, 26% (95% CI, 17-38; I2, 92%) would donate to others, and 12% (95% CI, 6-21; I2, 88%) would discard their eggs. Psychosocial determinants: One study reported that 50% of these women were aware of friends and/or family having difficulty conceiving, which may have contributed to their willingness to donate to others. Potential EEFs were included in 4 studies (n = 645), of whom 38% (95% CI, 28-50; I2, 84%) would donate to research, 32% (95% CI, 17-51; I2, 91%) would donate to others, 29% (95% CI, 17-44; I2, 89%) would discard, and 7% (95% CI, 1-27; I2, 77%) were unsure. Psychosocial determinants: No studies. Women of reproductive age were included in 5 studies (n = 3,933), of whom 59% (95% CI, 48-70; I2, 97%) would donate to research and 46% (95% CI, 35-57; I2, 98%) would donate to others. "Unsure" and "discard" were not provided as response options. Psychosocial determinants: One study reported that the facilitators for donation to others included a family member or friend in need, to help others create a family, financial gain, to further science, and control or input over the selection of recipients. Barriers for donation included fear of having a biological child they do not know or who is raised by someone they know. CONCLUSION(S) No studies reported on the disposition outcomes of past EEFs. Disposition intentions varied across the three groups; however, "donating to research" was the most common disposition preference. Notably, the second disposition preference for one-third of actual EEFs was "unsure" and for one-third of potential EEFs was "donate to others." There were limited studies for actual and potential EEFs, and only two studies that explored the psychosocial determinants of oocyte disposition intentions. Additionally, these data suggest that disposition decisions change as women progress on their egg freezing journey, highlighting the importance of ongoing contact with the fertility team as intentions may change over time. More research is needed to understand the psychosocial determinants of oocyte disposition decisions so fertility clinics can provide EEFs with the support and information they need to make informed decisions about their stored eggs and reduce the level of uncertainty reported among EEFs and the potential risk of psychological distress and regret. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO 2020: CRD42020202733.
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Affiliation(s)
- Lucy E Caughey
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia.
| | - Sarah Lensen
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
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127
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The Risk of Congenital Anomalies by Fertility Treatment Modality. Obstet Gynecol Surv 2021; 76:37-47. [PMID: 33506877 DOI: 10.1097/ogx.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Up to 4% of all births in developed nations involve assisted reproductive technology (ART), along with other fertility treatment modalities. Thus, ART pregnancies constitute an important epidemiologic population with a known increased risk of congenital anomalies. In this review, we summarize current fertility treatment modalities and their associated risk of congenital anomalies. Objective To review the risk of birth defects among pregnancies conceived with ART and other fertility treatments. Evidence Acquisition Articles were obtained from PubMed and the American College of Obstetricians and Gynecologists and American Society of Reproductive Medicine committee opinions. Results In vitro fertilization has been associated with a 25% to 50% increased risk of birth defects, including abnormalities of these organ systems: cardiovascular (25%-40% of anomalies), genitourinary (10%-60%), gastrointestinal (10%-20%), and musculoskeletal (10%-35%). Although the data are mixed, intracytoplasmic sperm injection has also been found to be associated with an increased risk of defects, particularly hypospadias, when compared with conventional in vitro fertilization. The risk among fresh versus frozen cycles and cleavage stage versus blastocyst transfers remains uncertain. There appears to be no significant added risk with preimplantation genetic testing, although more studies are needed. Ovulation induction with oral agents appears safe and not associated with an increased risk of anomalies. Oocyte cryopreservation also appears safe, but the data are still limited, requiring future investigation. Conclusions and Relevance While the relative risk of birth defects among ART pregnancies is increased when compared with spontaneous conceptions, the absolute risk remains low. There are no standard screening recommendations for ART pregnancies. Per the American College of Obstetricians and Gynecologists, patients who have undergone ART should be counseled regarding the risk of birth defects and available antenatal evaluation, including fetal echocardiogram and detailed ultrasound evaluation.
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128
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Fertility preservation for women with breast cancer before chemotherapy: a systematic review and meta-analysis. Reprod Biomed Online 2021; 44:357-369. [PMID: 34656436 DOI: 10.1016/j.rbmo.2021.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022]
Abstract
The preservation of fertility in women of childbearing age with breast cancer is challenging since the time for ovarian stimulation is restricted and only a limited amount of oocytes can be retrieved before gonadotoxic therapies. The aim of this meta-analysis is to evaluate the fertility preservation outcomes after ovarian stimulation with various protocols in women with breast cancer. PubMed, Embase, and the Cochrane Library were searched. Studies comparing the outcomes of women with breast cancer receiving random-start ovarian stimulation or conventional protocol; single or double ovarian stimulation cycles; and coadministration of aromatase inhibitors or tamoxifen were included. Twenty-two studies were included. Random-start ovarian stimulation resulted in a comparable number of retrieved oocytes to the conventional protocol. Two ovarian stimulation cycles had significantly higher numbers of total retrieved oocytes than one cycle (mean difference: 7.91, 95% CI: 3.42-12.4). Coadministration of letrozole and tamoxifen showed similar results of retrieved oocytes to those without. A significantly lower peak serum estradiol level was observed in letrozole-based groups than in letrozole-free groups. In conclusion, our study indicated that implementing random-start protocols to shorten the duration of waiting for ovarian stimulation, applying two ovarian stimulation cycles, and coadministering letrozole can lead to more desirable outcomes.
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129
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Mgboji GE, Cordeiro Mitchell CN, Bedrick BS, Vaidya D, Tao X, Liu Y, Maher JY, Christianson MS. Predictive factors for fertility preservation in pediatric and adolescent girls with planned gonadotoxic treatment. J Assist Reprod Genet 2021; 38:2713-2721. [PMID: 34370210 DOI: 10.1007/s10815-021-02286-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To characterize female pediatric and adolescent patients seen for fertility preservation consultation at an academic medical center and to describe the association between demographic or clinical factors and the use of fertility preservation treatment (FPT). METHODS This is a retrospective chart analysis of female pediatric and adolescent patients seen for fertility preservation consultation at an academic fertility center over a 14-year period from 2005 to 2019. RESULTS One hundred six females aged 3-21 years were seen for fertility preservation consultation with a mean age of 16.6 years. Diagnoses included hematologic malignancies (41.5%), gynecologic malignancies (9.4%), other malignancies (31.1%), non-malignant hematologic disease (14.2%), and non-malignant conditions (3.8%). Overall, 64.2% of subjects pursued fertility preservation, including oocyte cryopreservation (35.8%) and ovarian tissue cryopreservation (23.6%). Overall, age, minority race, diagnosis, time since diagnosis, and median household income were not significantly associated with odds of completing an FPT procedure. Among all patients, those who underwent gonadotoxic therapy prior to consultation had a lower odds of receiving FPT (OR= 0.24, 95% CI 0.10-0.55). Among patients without chemotherapy exposure, no factors were associated with FPT. CONCLUSIONS Among pediatric and adolescent patients at an academic center undergoing a fertility preservation consultation, there were no socioeconomic or clinical barriers to FPT use in those who had not yet undergone gonadotoxic therapy. The only factor that was negatively associated with odds of pursuing FPT was prior chemotherapy exposure.
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Affiliation(s)
- Glory E Mgboji
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Christina N Cordeiro Mitchell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,RADfertility, Newark, DE, USA.,Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Department of Internal Medicine/Biostatistics, Epidemiology, and Data Management, Johns Hopkins University School of Medicine/Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xueting Tao
- Department of Biostatistics, Epidemiology, and Data Management, Johns Hopkins University School of Medicine/Bloomberg School of Public Health, Baltimore, MD, USA.,Biostatistics Department, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Yisi Liu
- Department of Biostatistics, Epidemiology, and Data Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacqueline Y Maher
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.,Pediatric Gynecology Program, Children's National Hospital, Washington D.C., USA
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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130
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Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril 2021; 116:36-47. [PMID: 34148587 DOI: 10.1016/j.fertnstert.2021.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations to practicing physicians and others regarding the efficacy of oocyte cryopreservation (OC) for donor oocyte in vitro fertilization and planned OC. METHODS The American Society for Reproductive Medicine conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1986 to 2018. The American Society for Reproductive Medicine Practice Committee and a task force of experts used available evidence and through consensus developed evidence-based guideline recommendations. MAIN OUTCOME MEASURE(S) Outcomes of interest included live birth rate, clinical pregnancy rate, obstetrical and neonatal outcomes, and factors predicting reproductive outcomes. RESULT(S) The literature search identified 30 relevant studies to inform the evidence base for this guideline. RECOMMENDATION(S) Evidence-based recommendations were developed for predicting the likelihood of live births after planned OC, autologous OC in infertile women, and donor OC, as well as factors that may impact live birth rates. Recommendations were developed regarding neonatal outcomes after using fresh vs. cryopreserved oocytes in cases of autologous or donor oocytes. CONCLUSION(S) There is insufficient evidence to predict live birth rates after planned OC. On the basis of limited data, ongoing and live birth rates appear to be improved for women who undergo planned OC at a younger vs. older age. Although there are no significant differences in per transfer pregnancy rates with cryopreserved vs. fresh donor oocytes, there is insufficient evidence that the live birth rate is the same with vitrified vs. fresh donor oocytes. Neonatal outcomes appear similar with cryopreserved oocytes compared with fresh oocytes. Future studies that compare cumulative live birth rates are needed.
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Affiliation(s)
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- The American Society for Reproductive Medicine, Birmingham, Alabama
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131
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Ethical issues in oocyte banking for nonautologous use: an Ethics Committee opinion. Fertil Steril 2021; 116:644-650. [PMID: 34340832 DOI: 10.1016/j.fertnstert.2021.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
Ethical considerations for the banking of oocytes for nonautologous use are discussed.
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132
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Kawwass JF, Crawford S, Hipp HS. Frozen eggs: national autologous oocyte thaw outcomes. Fertil Steril 2021; 116:1077-1084. [PMID: 34303511 DOI: 10.1016/j.fertnstert.2021.05.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize national outcomes of oocyte thaw (OT) cycles. DESIGN Retrospective descriptive study. SETTING All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2012 to 2018. PATIENT(S) All women undergoing OT cycles in the United States. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Absolute numbers of oocyte cryopreservation (OC) and OT cycles over time. Among OT cycles, patient and cycle characteristics, the ratio of the total number of oocytes thawed to the number of live births by maternal age at the time of cryopreservation (ATOC), and outcomes including pregnancy, miscarriage, live birth, and good perinatal outcome (GPO) by age ATOC. RESULT(S) From 2012 to 2018, 54,675 OC and 6,413 OT cycles were performed; the absolute numbers increased from 2,719 to 13,824 and from 348 to 1,810, respectively. The ratio of the total number of oocytes thawed to the number of live births increased significantly with increasing age ATOC, from 41.4 (age <35 years) to 122.4 (age >41 years). Among OT cycles resulting in embryo transfer, the live birth rate decreased with increasing age ATOC from 42.8% (age <35 years) to 10.8% (age >42 years). The live birth rate was higher when calculated per transfer (42.8% in women aged <35 years ATOC) rather than per thaw cycle (31.5% in women aged <35 years ATOC) because of the number of patients with no transfer. Among 1,124 cycles resulting in pregnancy, the chance of a GPO was highest among women aged <35 years ATOC (65.8%) and decreased as age at ATOC increased. CONCLUSION(S) Among reported OT cycles, the rates of pregnancy and live birth decreased as age ATOC increased. The number of oocytes thawed to achieve one live birth increased significantly with increasing age ATOC. In addition, among the resulting pregnancies, the rate of GPO decreased as age ATOC increased.
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Affiliation(s)
- Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia.
| | - Sara Crawford
- Department of Mathematics, University of Mount Union, Alliance, Ohio
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia
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Sfakianoudis K, Rapani A, Grigoriadis S, Retsina D, Maziotis E, Tsioulou P, Giannelou P, Pantos K, Koutsilieris M, Vlahos N, Mastorakos G, Simopoulou M. Novel Approaches in Addressing Ovarian Insufficiency in 2019: Are We There Yet? Cell Transplant 2021; 29:963689720926154. [PMID: 32686983 PMCID: PMC7563844 DOI: 10.1177/0963689720926154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Ovarian insufficiency is described as a multifaceted issue typically encountered in the field of assisted reproduction. The three main identified diagnoses of ovarian insufficiency include premature ovarian failure (POF), poor ovarian response (POR), and advanced maternal age (AMA). Patient heterogeneity in the era of individualized medicine drives research forward leading to the emergence of novel approaches. This plethora of innovative treatments in the service of adequately managing ovarian insufficiency is called to undertake the challenge of addressing infertile patients exploring their reproductive options. This review provides an all-inclusive presentation and critical analysis on novel treatments that have not achieved routine clinical practice status yet, but have recently emerged as promising. In light of the lack of randomized controlled trials conveying safety and efficiency, clinicians are left puzzled in addressing the "how" and "for whom" these approaches may be beneficial. From ovarian injection employing platelet-rich plasma (PRP) or stem cells to artificial gametes and ovaries, ovarian transplantation, and mitochondrial replacement therapy, this descriptive review provides insight toward assisting the practitioner in decision making regarding these cutting-edge treatments. Biological mechanisms, invasiveness levels, efficiency, as well as possible complications, the current status along with bioethical concerns are discussed in the context of identifying future optimal treatment.
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Affiliation(s)
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Retsina
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Unit of Endocrinology, Diabetes Mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petroula Tsioulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece.,Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlahos
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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134
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Sehring J, Hussain A, Grimm L, Rosen E, Esguerra J, Matevossian K, Louden E, Beltsos A, Jeelani R. A call to action: unified clinical practice guidelines for oncofertility care. J Assist Reprod Genet 2021; 38:1745-1754. [PMID: 33709343 PMCID: PMC8324617 DOI: 10.1007/s10815-021-02142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/03/2021] [Indexed: 12/01/2022] Open
Abstract
By 2030, WHO estimates that 1.4 million reproductive-aged women will be diagnosed with cancer annually. Fortunately, cancer is no longer considered an incurable disease in many cases. From 2008-2014, 85% of women under the age of 45 years diagnosed with cancer survived. This increase in survival rate has shifted attention from focusing exclusively on preserving life to focusing on preserving quality of life after treatment. One aspect of this is preserving the ability to have a biological family. Oncofertility, the field that bridges oncology and reproductive endocrinology with the goal of preserving fertility, offers these patients hope. Though it is clear that ASCO and ASRM recognize the importance of fertility preservation as an aspect of comprehensive oncology care, there are not yet unified guidelines for oncologists and fertility specialists for treating oncofertility patients. First, we identify the need for reproductive counseling prior to cancer treatment, as many patients report that their fertility preservation concerns are not addressed adequately. We then delineate multi-modal fertility preservation options that are available and appropriate for different patients with corresponding outcomes using different treatments. We discuss the unique challenges and considerations, including ethical dilemmas, for delivering timely and comprehensive care specifically for oncofertility patients. Finally, we address the multidisciplinary team that includes oncologists, reproductive endocrinologists, surgeons as well as their staff, nurses, genetic counselors, mental health professionals, and more. Since oncofertility patient care requires the coordination of both physician teams, one set of unified guidelines will greatly improve quality of care.
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Affiliation(s)
- Jacqueline Sehring
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA.
| | - Anisa Hussain
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | - Lauren Grimm
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | - Elisabeth Rosen
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | - Jody Esguerra
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | | | - Erica Louden
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | - Angeline Beltsos
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
| | - Roohi Jeelani
- Vios Fertility Institute, 1455 N Milwaukee Ave, Chicago, IL, 60622, USA
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135
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Doungkamchan C, Orwig KE. Recent advances: fertility preservation and fertility restoration options for males and females. Fac Rev 2021; 10:55. [PMID: 34195694 PMCID: PMC8204761 DOI: 10.12703/r/10-55] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fertility preservation is the process of saving gametes, embryos, gonadal tissues and/or gonadal cells for individuals who are at risk of infertility due to disease, medical treatments, age, genetics, or other circumstances. Adult patients have the options to preserve eggs, sperm, or embryos that can be used in the future to produce biologically related offspring with assisted reproductive technologies. These options are not available to all adults or to children who are not yet producing mature eggs or sperm. Gonadal cells/tissues have been frozen for several thousands of those patients worldwide with anticipation that new reproductive technologies will be available in the future. Therefore, the fertility preservation medical and research communities are obligated to responsibly develop next-generation reproductive technologies and translate them into clinical practice. We briefly describe standard options to preserve and restore fertility, but the emphasis of this review is on experimental options, including an assessment of readiness for translation to the human fertility clinic.
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Affiliation(s)
- Chatchanan Doungkamchan
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kyle E Orwig
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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136
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Multidisciplinary Management of Adolescent and Young Adult Patients with Hodgkin Lymphoma. Curr Treat Options Oncol 2021; 22:64. [PMID: 34097142 DOI: 10.1007/s11864-021-00861-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Successful management of adolescent and young adult patients with Hodgkin lymphoma (HL) requires a multidisciplinary approach to care with special attention paid to the unique medical, logistical, and psychosocial challenges faced by this group. The emotional and social changes and big life transitions that occur between the ages of 15 and 39 result in a broad scope of supportive care needs that differ from children or adults in similar circumstances. Currently, care of adolescent and young adult (AYA) patients with HL may be fractured across the pediatric-adult cancer care continuum resulting in this group being less well studied than pediatric or adult patients in general. In order to optimize outcomes, these patients need access to medical oncologists and radiation oncologists, advanced practice providers (APPs), psychologists/social work, financial support services, fertility specialists, survivorship care, and advocates with AYA expertise that can help navigate the healthcare system. A strong AYA support system established early with targeted education and resources may influence treatment compliance and likelihood of long-term follow-up. Surveys of the AYA cancer population have identified areas of opportunity for the healthcare team to collaborate to identify needs, design interventions to meet them, and ultimately develop evidence-based guidelines that will enable us to offer AYAs with HL the quality care they deserve.
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Plancha CE, Rodrigues P, Marques M, Almeida JM, Navarro-Costa P. The time is ripe for oocyte in vitro maturation. J Assist Reprod Genet 2021; 38:1281-1283. [PMID: 33963970 PMCID: PMC8105698 DOI: 10.1007/s10815-021-02209-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Carlos E Plancha
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
- Centro Médico de Assistência à Reprodução (CEMEARE), Lisboa, Portugal.
| | - Patrícia Rodrigues
- Centro Médico de Assistência à Reprodução (CEMEARE), Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona de Humanidade e Tecnologia, Lisboa, Portugal
| | - Mónica Marques
- Centro Médico de Assistência à Reprodução (CEMEARE), Lisboa, Portugal
| | - Joana M Almeida
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Navarro-Costa
- Instituto Gulbenkian de Ciência, Oeiras, Portugal.
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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Mascarenhas M, Mehlawat H, Kirubakaran R, Bhandari H, Choudhary M. Live birth and perinatal outcomes using cryopreserved oocytes: an analysis of the Human Fertilisation and Embryology Authority database from 2000 to 2016 using three clinical models. Hum Reprod 2021; 36:1416-1426. [PMID: 33313698 DOI: 10.1093/humrep/deaa343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/11/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Are live birth (LB) and perinatal outcomes affected by the use of frozen own versus frozen donor oocytes? SUMMARY ANSWER Treatment cycles using frozen own oocytes have a lower LB rate but a lower risk of low birth weight (LBW) as compared with frozen donor oocytes. WHAT IS KNOWN ALREADY A rising trend of oocyte cryopreservation has been noted internationally in the creation of donor oocyte banks and in freezing own oocytes for later use in settings of fertility preservation and social egg freezing. Published literature on birth outcomes with frozen oocytes has primarily utilised data from donor oocyte banks due to the relative paucity of outcome data from cycles using frozen own oocytes. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study utilising the anonymised database of the Human Fertilisation and Embryology Authority, which is the statutory regulator of fertility treatment in the UK. We analysed 988 015 IVF cycles from the Human Fertilisation and Embryology Authority (HFEA) register from 2000 to 2016. Perinatal outcomes were assessed from singleton births only. PARTICIPANTS/MATERIALS, SETTING, METHODS Three clinical models were used to assess LB and perinatal outcomes: Model 1 compared frozen own oocytes (n = 632) with frozen donor oocytes (n = 922); Model 2 compared frozen donor oocytes (n = 922) with fresh donor oocytes (n = 24 706); Model 3 compared first cycle of fresh embryo transfer from frozen donor oocytes (n = 917) with first cycle of frozen embryo transfer created with own oocytes and no prior fresh transfer (n = 326). Preterm birth (PTB) was defined as LB before 37 weeks and LBW as birth weight <2500 g. Adjustment was performed for confounding variables such as maternal age, number of embryos transferred and decade of treatment. MAIN RESULTS AND THE ROLE OF CHANCE The LB rate (18.0% versus 30.7%; adjusted odds ratio (aOR) 0.61, 95% CI 0.43-0.85) and the incidence of LBW (5.3% versus 14.0%; aOR 0.29, 95% CI 0.13-0.90) was significantly lower with frozen own oocytes as compared with frozen donor oocytes with no significant difference in PTB (9.5% versus 15.7%; aOR 0.56, 95% CI 0.26-1.21). A lower LB rate was noted in frozen donor oocyte cycles (30.7% versus 34.7%; aOR 0.69, 95% CI 0.59-0.80) when compared with fresh donor oocyte cycles. First cycle frozen donor oocytes did not show any significant difference in LB rate (30.1% versus 19.3%; aOR 1.26, 95% CI 0.86-1.83) or PTB, but a higher incidence of LBW (17.7% versus 5.4%; aOR 3.77, 95% CI 1.51-9.43) as compared with first cycle frozen embryos using own oocytes. LIMITATIONS, REASONS FOR CAUTION The indication for oocyte freezing, method of freezing used (whether slow-freezing or vitrification) and age at which eggs where frozen were unavailable. We report a subgroup analysis of women using their own frozen oocytes prior to 37 years. Cumulative LB rate could not be assessed due to the anonymous nature of the dataset. WIDER IMPLICATIONS OF THE FINDINGS Women planning to freeze their own eggs for fertility preservation or social egg freezing need to be counselled that the results from frozen donor egg banks may not completely apply to them. However, they can be reassured that oocyte cryopreservation does not appear to have a deleterious effect on perinatal outcomes. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was sought for the study. The authors have no relevant conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Mascarenhas
- Glasgow Centre for Reproductive Medicine, Glasgow G51 4FD, UK
| | - H Mehlawat
- Department of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - R Kirubakaran
- Department of Biostatistics, Christian Medical College, Vellore 632004, India
| | - H Bhandari
- Department of Reproductive Medicine, Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK
| | - M Choudhary
- Department of Reproductive Medicine, Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4EP, UK
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139
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Johnston M, Richings NM, Leung A, Sakkas D, Catt S. A major increase in oocyte cryopreservation cycles in the USA, Australia and New Zealand since 2010 is highlighted by younger women but a need for standardized data collection. Hum Reprod 2021; 36:624-635. [PMID: 33367704 DOI: 10.1093/humrep/deaa320] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Indexed: 02/03/2023] Open
Abstract
STUDY QUESTION What are the cohort trends of women undergoing oocyte cryopreservation (OC)? SUMMARY ANSWER There has been a dramatic increase in OC cycles undertaken each year since 2010, and the demographics of women accessing OC has shifted to a younger age group, but so far very few women have returned to use their cryopreserved oocytes in treatments. WHAT IS KNOWN ALREADY Although OC, as a method of fertility preservation, is offered around the world, global data are lacking on who is accessing OC, who is returning to thaw oocytes and whether these trends are changing. STUDY DESIGN, SIZE, DURATION A trinational retrospective cohort study was performed of 31 191 OC cycles and 972 oocyte thaw (OT) cycles undertaken in the USA (2010-2016) and 3673 OC and 517 OT cycles undertaken in Australia/New Zealand (Aus/NZ; 2010-2015). PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the USA Society for Assisted Reproductive Technology (SART) national registry and the Australian and New Zealand Assisted Reproduction Database (ANZARD). De-identified data were requested on all autologous oocyte freeze-all cycles and all cycles where autologous oocytes were thawed to be used in a treatment cycle for the time periods of interest. MAIN RESULTS AND THE ROLE OF CHANCE In both the USA and Aus/NZ, there has been a dramatic rise in the number of OC cycles performed each year (+880% in the USA from 2010 to 2016 and +311% in Aus/NZ from 2010 to 2015). Across both regions, most women undergoing OC were aged in their late 30s, but the average age decreased over time (USA: 36.7 years vs 34.7 years in 2010 and 2016, respectively). The number of women returning for thaw cycles was low (USA: 413 in 2016, Aus/NZ: 141 in 2015) and most thaw cycles (47%) across both regions involved oocytes that were frozen for <6 months. In the USA, a higher proportion of cycles resulted in a live birth when only thawed oocytes were used, compared to cycles that combined thawed oocytes with fresh oocytes (25% vs 11%, respectively; P < 0.001). Age at retrieval influenced live birth rate in the USA; 38% of thaw cycles started in women who stored oocytes when aged ≤35 years resulted in a live birth, whereas only 16% resulted in a live birth for women who stored oocytes when aged ≥36 years. Similar data were unobtainable from Aus/NZ. LIMITATIONS, REASONS FOR CAUTION There were limitations associated with both the SART and ANZARD data outputs received. The format in which the ANZARD data were provided, and the inconsistencies seen amongst cycle reporting in the SART dataset, restricted data interpretation. For example, both datasets did not provide a clear indication as to why women were undergoing OC and it was not possible to accurately calculate duration of storage for thaw cycles in the USA. We also did not obtain details on embryo quality from either database and acknowledge that embryo quality and subsequent outcome (embryo freezing or discard) would be of interest, especially when considering the efficacy of OC. WIDER IMPLICATIONS OF THE FINDINGS The data show that there is widespread demand for OC, and it is increasingly undertaken by younger women; however, the limitations encountered in the dataset support the need for a shift to a more uniform approach to data collection and presentation by large databases, worldwide. STUDY FUNDING/COMPETING INTEREST(S) This study received funding from the Fertility Society of Australia to support the ANZARD data extraction. M.J. is supported by an Australian Government Research Training Program Scholarship stipend. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Nadine M Richings
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | | | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Xu J, Zhang D, Ju S, Sun L, Zhang S, Wu C, Rui R, Dai J. Mitophagy is involved in the mitochondrial dysfunction of vitrified porcine oocytes. Mol Reprod Dev 2021; 88:427-436. [PMID: 34032339 DOI: 10.1002/mrd.23472] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/08/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022]
Abstract
Mitochondrial dysfunction is considered a crucial factor aggravating oocyte viability after vitrification-warming. To clarify the role of mitophagy in mitochondrial extinction of vitrified porcine oocytes, mitochondrial function, ultrastructural characteristics, mitochondria-lysosomes colocalization, and mitophagic proteins were detected with or without chloroquine (CQ) treatment. The results showed that vitrification caused mitochondrial dysfunction, including increasing reactive oxygen species production, decreasing mitochondrial membrane potential, and mitochondrial DNA copy number. Damaged mitochondrial cristae and mitophagosomes were observed in vitrified oocytes. A highly fused fluorescence distribution of mitochondria and lysosomes was also observed. In the detection of mitophagic flux, mitophagy was demonstrated as increasing fluorescence aggregation of microtubule-associated protein light chain 3B (LC3B), enhanced colocalization between LC3B, and voltage-dependent anion channels 1 (VDAC1), and upregulated LC3B-II/I protein expression ratio. CQ inhibited the degradation of mitophagosomes in vitrified oocytes, manifested as decreased mitochondria-lysosomes colocalization, increased fluorescence fraction of VDAC1 overlapping LC3B, increased LC3B-II/I protein expression ratio, and p62 accumulation. The inhibition of mitophagosomes degradation by CQ aggravated mitochondrial dysfunction, including increased oxidative damage, reduced mitochondrial function, and further led to loss of oocyte viability and developmental potentiality. In conclusion, mitophagy is involved in the regulation of mitochondrial function during porcine oocyte vitrification.
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Affiliation(s)
- Jiehuan Xu
- College of Veterinary Medicine, Nanjing Agricultural University, Jiangsu, China.,Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China
| | - Defu Zhang
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China.,Division of Animal Genetic Engineering, Shanghai Municipal Key Laboratory of Agri-genetics and Breeding, Shanghai, China.,Shanghai Engineering Research Center of Breeding Pig, Shanghai, China
| | - Shiqiang Ju
- College of Veterinary Medicine, Nanjing Agricultural University, Jiangsu, China
| | - Lingwei Sun
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China.,Division of Animal Genetic Engineering, Shanghai Municipal Key Laboratory of Agri-genetics and Breeding, Shanghai, China.,Shanghai Engineering Research Center of Breeding Pig, Shanghai, China
| | - Shushan Zhang
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China.,Division of Animal Genetic Engineering, Shanghai Municipal Key Laboratory of Agri-genetics and Breeding, Shanghai, China.,Shanghai Engineering Research Center of Breeding Pig, Shanghai, China
| | - Caifeng Wu
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China.,Division of Animal Genetic Engineering, Shanghai Municipal Key Laboratory of Agri-genetics and Breeding, Shanghai, China.,Shanghai Engineering Research Center of Breeding Pig, Shanghai, China
| | - Rong Rui
- College of Veterinary Medicine, Nanjing Agricultural University, Jiangsu, China
| | - Jianjun Dai
- Institute of Animal Husbandry and Veterinary Science, Shanghai Academy of Agricultural Sciences, Shanghai, China.,Division of Animal Genetic Engineering, Shanghai Municipal Key Laboratory of Agri-genetics and Breeding, Shanghai, China.,Shanghai Engineering Research Center of Breeding Pig, Shanghai, China
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141
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Abstract
Demand for oocyte freezing in absence of a medical indication is growing as women delay childbirth and seek to extend the window of opportunity for parenthood. The optimum age for oocyte freezing is below 35 years, whereas currently the mean age of women undergoing oocyte freezing in the UK is 38 years. Nearly half of women undergoing oocyte freezing are not in a relationship. The treatment is not publicly funded and the average price for a complete oocyte freezing and thawing cycle, including annual storage fees, could reach over £7000. The live birth rate per oocyte thaw cycle is 18% and is influenced by age at the time of oocyte freezing. Women considering social oocyte freezing should be thoroughly counselled about the efficacy, limitations, cost implications and alternatives to oocyte freezing and provided with the appropriate support to enable a truly informed reproductive choice.
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Affiliation(s)
- Ung Lim Teo
- Women's Services, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Pragati Kakkar
- Women's Services, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Tarek El-Toukhy
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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142
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Successful in vivo retrieval of oocytes after ovarian stimulation for fertility preservation before oophorectomy by laparotomy for a young patient with ovarian cancer: Case report and review of literature. Gynecol Oncol Rep 2021; 37:100791. [PMID: 34095426 PMCID: PMC8167225 DOI: 10.1016/j.gore.2021.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 05/16/2021] [Indexed: 11/22/2022] Open
Abstract
Mature oocytes can be retrieved in-vivo during open surgery for gynecologic cancers. This approach should be considered when transvaginal access is contra-indicated. The technique is feasible, safe and avoids any time of ischemia for gametes.
Objective To report a case of direct in vivo oocytes retrieval for fertility preservation before oophorectomy by open surgery in a young patient with ovarian cancer. Design case report and literature review. Setting University hospital. Patients A 29-year-old nulliparous patient, recently diagnosed with low grade serous ovarian carcinoma. The patient consented to the removal of her remaining ovary but wished to preserve oocytes and declined hysterectomy. Conventional trans-vaginal US-guided oocyte retrieval was contra-indicated because of the risk of malignant cell dissemination to the abdomen and the vaginal puncture sites. Interventions Controlled ovarian stimulation with gonadotrophins was realized. Comprehensive surgical staging was performed 35 h after ovulation triggering using rHCG. The oocytes retrieval was performed in vivo with ultrasound guidance at time of laparotomy before oophorectomy without any time of ischemia. Results Seven mature oocytes were obtained and vitrified. Conclusions This case highlights the feasibility of in vivo oocytes retrieval of mature oocytes during open surgery for gynecologic cancers. By avoiding transvaginal follicular retrieval, the risk of malignant cell contamination to vaginal and parametrial tissues is reduced, limiting cancer upstaging.
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143
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Ketterl TG. Closing the Gaps: Progress in the Care of Adolescents and Young Adults With Cancer. JCO Oncol Pract 2021; 17:302-304. [PMID: 34010020 DOI: 10.1200/op.21.00223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Chronopoulou E, Raperport C, Sfakianakis A, Srivastava G, Homburg R. Elective oocyte cryopreservation for age-related fertility decline. J Assist Reprod Genet 2021; 38:1177-1186. [PMID: 33608838 PMCID: PMC7894970 DOI: 10.1007/s10815-021-02072-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/11/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation. This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counselling. METHODS A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives. RESULTS Clinician-led counselling regarding reproductive aging and fertility preservation is often overlooked. Elective oocyte cryopreservation is not a guarantee of live birth, and the answer regarding cost-effectiveness needs to be individualized. The existing studies on obstetric and perinatal outcomes following the use of egg freezing are, until now, reassuring. Constant monitoring of short-term and long-term outcomes, uniform regulation and evidence-based, individualized counselling is of paramount importance. CONCLUSIONS Elective oocyte cryopreservation is one of the most controversial aspects of the world of assisted reproduction, and a lot of questions remain unanswered. However, women today do have this option which was not available in the past. Elective oocyte cryopreservation for age-related fertility decline should be incorporated in women's reproductive options to ensure informed decisions and reproductive autonomy.
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Affiliation(s)
- E Chronopoulou
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK.
| | - C Raperport
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
- Queen Mary University of London, Mile End Road, Bethnal Green, London, E1 4NS, UK
| | - A Sfakianakis
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - G Srivastava
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - R Homburg
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
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Cobo A, García-Velasco JA, Remohí J, Pellicer A. Oocyte vitrification for fertility preservation for both medical and nonmedical reasons. Fertil Steril 2021; 115:1091-1101. [DOI: 10.1016/j.fertnstert.2021.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
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146
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Moving innovation to practice: an Ethics Committee opinion. Fertil Steril 2021; 116:331-336. [PMID: 33926716 DOI: 10.1016/j.fertnstert.2021.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/20/2022]
Abstract
The introduction of new strategies, tests, and procedures into clinical practice raises challenging ethical issues involving evaluation of evidence, balancing benefits and harms, supporting patient autonomy, avoiding conflict of interest, and promoting advances in health-care. The purpose of this document is to assist reproductive health practitioners as they introduce new interventions into the clinical care that they provide to patients. This document replaces the previously published document of the same name, last published in 2016.
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147
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Live birth and clinical outcome of vitrification-warming donor oocyte programme: an experience of a single IVF unit. ZYGOTE 2021; 29:410-416. [PMID: 33818353 DOI: 10.1017/s0967199421000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medically assisted reproductive (MAR) treatments using donated oocytes are commonly applied in several countries to treat women who cannot conceive with their own gametes. Historically, in Italy, gamete donation has been prohibited but, in 2014, the law changed and gamete donation became allowed for couples undergoing MAR treatments. Consequently, in the last decade, there has been an increase in application of the oocyte donation programme. This study reports an egg-donation programme's clinical efficacy, based on importing donated vitrified oocytes from cryo-banks located in a foreign country. For this, we conducted a retrospective analysis of data from a single reproductive unit located in Italy (Donna Salus Women's Health and Fertility, Bozen). The study group consisted of 681 vitrified oocytes, which were warmed and culture to be replaced in 100 recipients. The survival rate after warming was 79.1% (n = 539/681), whereas the fertilization and blastulation rates were 90.2% (n = 486/539) and 47.9% (n = 233/486), respectively. Positive pregnancy test, clinical pregnancy rates, and live-birth rates per embryo transfer were 37.8%, 31.1% and 28.4%, respectively. The multiple pregnancy rate was 0.7%. This study is one of the first to report on the efficacy of a donor oocyte programme in Italy using imported vitrified oocytes. The above data may reassure women who are undertaking donation programmes using vitrified oocytes imported from commercial egg banks.
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148
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Birenbaum-Carmeli D, Inhorn MC, Vale MD, Patrizio P. Cryopreserving Jewish Motherhood: Egg Freezing in Israel and the United States. Med Anthropol Q 2021; 35:346-363. [PMID: 33813742 DOI: 10.1111/maq.12643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/16/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
Oocyte cryopreservation (i.e., egg freezing) is one of the newest forms of assisted reproduction and is increasingly being used primarily by two groups of women: (1) young cancer patients at risk of losing their fertility through cytotoxic chemotherapy (i.e., medical egg freezing); and (2) single professionals in their late 30s who are facing age-related fertility decline in the absence of reproductive partners (i.e., elective egg freezing). Based on a binational ethnographic study, this article examines the significance of egg freezing among Jewish women in Israel and the United States. As they face the Jewish maternal imperative, these women are turning to egg freezing to relieve both medical and marital uncertainties. In both secular and religious Jewish contexts, egg freezing is now becoming naturalized as acceptable and desirable precisely because it cryopreserves Jewish motherhood, keeping reproductive options open for Jewish women, and serving as a protective self-preservation technology within their pronatalist social environments.
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Affiliation(s)
| | | | - Mira D Vale
- Department of Sociology, University of Michigan
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149
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Mizobe Y, Kuwatsuru Y, Kuroki Y, Fukumoto Y, Tokudome M, Moewaki H, Watanabe M, Tabira T, Iwakawa T, Takeuchi K. The effect of repeated cryopreservation and thawing using cryotip on the clinical outcomes of embryos. Reprod Med Biol 2021; 20:176-181. [PMID: 33850450 PMCID: PMC8022090 DOI: 10.1002/rmb2.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/26/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of embryo transfers that were cryopreserved and thawed two or three times with those cryopreserved and thawed once by CryoTip. METHODS Data for 388 single cryopreserved-thawed blastocyst transfer cycles, performed from April 2012 to March 2014, were assessed. The blastocysts were classified into three groups: blastocysts (A) cryopreserved once, (B) cryopreserved twice, and (C) cryopreserved three times. RESULTS The pregnancy rate was 43.8% (134/306) in group A and 46.3% (38/82) in group B, while the miscarriage rate was 29.1% (39/134) in group A and 23.7% (9/38) in group B. The rate of improvement/maintenance of blastocyst grade was 84.0% (257/306) in group A and 80.5% (66/82) in group B. The pregnancy and miscarriage rates of the blastocysts that showed improvement/maintenance in the grade were 45.9% (118/257) and 29.7% (35/118) in group A and 48.5% (32/66) and 21.9% (7/32) in group B, respectively. The pregnancy rate was 33.3% (2/6), while the miscarriage rate was 0.0% (0/2) in group C. CONCLUSIONS Pregnancy rates achieved with re-cryopreserved and rethawed blastocyst transfer were comparable to those achieved with single cryopreserved-thawed blastocyst transfer.
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Affiliation(s)
- Yamato Mizobe
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Yukari Kuwatsuru
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Yuko Kuroki
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Yumiko Fukumoto
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Mari Tokudome
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Harue Moewaki
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Mia Watanabe
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Tatsunori Tabira
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Tokiko Iwakawa
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
| | - Kazuhiro Takeuchi
- Takeuchi Ladies Clinic/Center for Reproductive MedicineAira‐shiJapan
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Katler QS, Shandley LM, Hipp HS, Kawwass JF. National egg-freezing trends: cycle and patient characteristics with a focus on race/ethnicity. Fertil Steril 2021; 116:528-537. [PMID: 33795141 DOI: 10.1016/j.fertnstert.2021.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the trends and characteristics of oocyte cryopreservation (OC) cycles stratified by self-reported race/ethnicity in the United States DESIGN: Retrospective cohort analysis using the Society for Assisted Reproductive Technology Clinical Outcome Reporting System SETTING: US fertility clinics PATIENTS: All patients undergoing OC from 2012 through 2016 INTERVENTIONS: None MAIN OUTCOME MEASURES: The OC cycle trends were analyzed on the basis of race/ethnicity: non-Hispanic white, non-Hispanic black, Asian/Pacific islander, Hispanic, and other (American Indian, Alaskan native, or mixed race). RESULTS Between 2012 and 2016, there was a total of 29,631 OC cycles; the total number of cycles increased yearly from 2,925 in 2012 to 8,828 in 2016. When compared with the demographics of the United States, OC was underused by some minority patient groups because majority of the cycles (66.5%) were performed in white patients. The total number of OC cycles increased annually among all the ethnic groups, most notably among Asian patients. The patients of all the ethnic backgrounds were most commonly under 35 years of age and underwent 1 OC cycle, except for Asian patients, who most frequently underwent OC between the ages of 35 and 37 years and were more likely to have undergone ≥2 cycles than patients of other minority groups. After adjustment for cofounders, there were no clinically significant differences in oocyte yield and the percentage of maturation across the racial/ethnic groups. CONCLUSIONS Nationally, OC cycles have been increasing in number, most often in patients under the age of 35 years, with similar proportions of patients of minority groups pursuing OC over time. The oocyte yield was comparable across the ethnic groups. Future research regarding subsequent thawing outcomes is warranted.
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Affiliation(s)
- Quinton S Katler
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia.
| | - Lisa M Shandley
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia
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