201
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Czyzyk A, Podfigurna-Stopa A, Katulski K, Breborowicz GH, Genazzani AR, Meczekalski B. Pregnancy after oocyte donation in 45, X Turner syndrome women, complicated by gestational diabetes and polyhydramnios. Case report and mini-review of literature. Gynecol Endocrinol 2016; 32:609-611. [PMID: 26942946 DOI: 10.3109/09513590.2016.1153057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from Turner syndrome (TS) demonstrate characteristic clinical features, with a short stature and gonadal dysgenesis causing infertility in most patients. Spontaneous pregnancies in women with TS are quite rare and pregnancy outcomes involving an increased risk of miscarriage and stillbirths are observed. In this case report, we present a 28 years old pregnant woman with the diagnosis of TS. Due to hypergonadotrophic hypogonadism, she was proposed an in vitro fertilization (IVF) program with an oocyte donor from unrelated anonymous women. After the second transfer, implantation occurred. In the 24th week of gestation, gestational diabetes class 1 was diagnosed. In the 31st week of gestation, polyhydramnios was diagnosed, although other parameters were reassuring. Considering the polyhydramnios, along with the diagnosis of Turner syndrome in the mother, we decided to perform an elective cesarean section. Subsequently, a healthy term male was born. For most women with the diagnosis of TS, the only way to become pregnant is through oocyte donation. The aim of this work was to characterize the course of pregnancy in TS patient and review literature addressing this issue.
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Affiliation(s)
- Adam Czyzyk
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | | | - Krzysztof Katulski
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Grzegorz H Breborowicz
- b Department of Perinatology and Gynaecology , Poznan University of Medical Sciences , Poznan , Poland , and
| | - Andrea R Genazzani
- c Department of Reproductive Medicine and Child Development , Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
| | - Blazej Meczekalski
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
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202
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Ayuandari S, Winkler-Crepaz K, Paulitsch M, Wagner C, Zavadil C, Manzl C, Ziehr SC, Wildt L, Hofer-Tollinger S. Follicular growth after xenotransplantation of cryopreserved/thawed human ovarian tissue in SCID mice: dynamics and molecular aspects. J Assist Reprod Genet 2016; 33:1585-1593. [PMID: 27465301 PMCID: PMC5171895 DOI: 10.1007/s10815-016-0769-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose To study the influence of xenotransplantation on follicular recruitment and growth in cryopreserved/thawed human ovarian tissue. Method Two 3-mm pieces of cryopreserved/thawed human ovarian tissue obtained from female cancer patients (n = 11) were xenotransplanted into a subcutaneous neck pouch of 6-week-old ovarectomized SCID mice (n = 33) for 4 (n = 18) and 12 (n = 15) weeks. Result Thirty-two out of 33 mice survived the entire observation periods. Graft recovery rate was 95.58 % (65 of 68 grafts). The percentages of primordial follicles after 4 weeks (P < 0.001) and 12 weeks (P = 0.009) of grafting were significantly lower in comparison to pregraft controls. The percentage of secondary follicle was significantly higher after 4 weeks of grafting (P = 0.018) and after 12 weeks (P = 0.001) of grafting in comparison to pregraft controls. Ki67 immunohistochemistry showed that proliferative follicles were significantly higher after 4 and 12 weeks of grafting compared to pregraft controls (P < 0.001). All follicles analyzed by TUNEL staining appeared healthy after xenotransplantation. The expression level of PTEN was reduced by 2.47-fold after 4 weeks of xenotransplantation, and this result was significant when 2−ΔCt were analyzed (P = 0.042). Conclusion The higher proportion of growing follicles compared to resting follicles observed after xenotransplantation is most likely due to downregulation of PTEN gene expression followed by acceleration of follicular recruitment. Electronic supplementary material The online version of this article (doi:10.1007/s10815-016-0769-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarrah Ayuandari
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Department of Obstetrics and Gynecology, Faculty of Medicine, Gadjah Mada University, Jl. Farmako, 55281, Yogyakarta, Indonesia
| | - Katharina Winkler-Crepaz
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Monika Paulitsch
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Institute of Zoology, University of Innsbruck, Technikerstr. 25, 6020, Innsbruck, Austria
| | - Cora Wagner
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Claudia Zavadil
- Department of Pathology, Medical University of Innsbruck, Müllerstr. 44, 6020, Innsbruck, Austria
| | - Claudia Manzl
- Department of Pathology, Medical University of Innsbruck, Müllerstr. 44, 6020, Innsbruck, Austria
| | - Stephanie C Ziehr
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,A.R.T. Bogenhausen, Prinzregentenstr. 69, 81675, Munich, Germany
| | - Ludwig Wildt
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Susanne Hofer-Tollinger
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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203
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Mouttham L, Comizzoli P. The preservation of vital functions in cat ovarian tissues during vitrification depends more on the temperature of the cryoprotectant exposure than on the sucrose supplementation. Cryobiology 2016; 73:187-95. [PMID: 27475292 DOI: 10.1016/j.cryobiol.2016.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study was to better characterize the impact of cryoprotectant exposure (temperature and sucrose supplementation) on the health and function of preantral follicles in ovarian tissues during vitrification using the domestic cat model. Ovarian cortical pieces from peri-pubertal individuals were exposed to cryoprotectants at 4 °C or room temperature and supplemented with 0 or 0.5 M of sucrose, followed by vitrification. After rapid warming, cortical pieces were cultured in vitro and assessed for normal follicular morphology, viability and resumption of transcriptional activities for up to 7 days. Throughout the culture period, follicular morphology (up to 67.5% normal follicles) and global RNA transcription (up to 50.9% follicles with transcriptional activity) in warmed tissues were improved by cryoprotectant exposure at 4 °C compared to room temperature, but viability (up to 84.6% viable follicles) did not seem to be affected by exposure temperature. Sucrose supplementation did not have a consistent effect as it increased RNA transcription but decreased normal follicular morphology. For the first time, the study demonstrated that the preservation of critical tissue functions, such as the transcriptional activities, highly depends on the temperature of the cryoprotectant exposure and not necessarily on the presence of sucrose.
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Affiliation(s)
- Lara Mouttham
- Smithsonian Conservation Biology Institute, National Zoological Park, P.O. Box 37012, MRC 5502, Washington, DC 20008, USA; Department of Biomedical Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Pierre Comizzoli
- Smithsonian Conservation Biology Institute, National Zoological Park, P.O. Box 37012, MRC 5502, Washington, DC 20008, USA.
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204
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Feichtinger M, Rodriguez-Wallberg KA. Fertility preservation in women with cervical, endometrial or ovarian cancers. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:8. [PMID: 27468354 PMCID: PMC4962474 DOI: 10.1186/s40661-016-0029-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022]
Abstract
Background Although cancer in general affects an aged population, a significant number of women develop cancer at childbearing age. Long-term survival rates after gynecological cancer, especially in young patients are increasing and all quality-of-life aspects, including preservation of fertility have become of major relevance. Outcomes Surgical techniques aimed at sparing reproductive organs and preserving fertility have been developed for women presenting with gynecological cancer found at early stages. Indications for fertility-sparing surgery are in general restricted to women presenting with a well-differentiated low-grade tumor in its early stages or with low malignant potential. Up to now, use of fertility-sparing techniques in well-selected patients has not been shown to affect overall survival negatively and fertility outcomes reported have been favorable. Still larger amounts of data and longer follow-up periods are needed. Several current fertility-sparing cancer treatments may result in sub-fertility and in those cases assisted reproductive techniques are indicated. Overall quality of life has been satisfactory in cancer patients after fertility-sparing surgery. Conclusions Fertility-sparing surgery is a viable tool to enable gynecological cancer patients of young age to fulfill their family building without impairment of oncological outcome. Cancer patients of reproductive age should undergo fertility counseling to analyze this sensitive subject. Further studies are needed to investigate the role of fertility-sparing treatment and combined adjuvant therapy in higher-grade cancers.
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Affiliation(s)
- Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria ; Wunschbaby Institut Feichtinger, Vienna, Austria ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
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205
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Abtahi NS, Ebrahimi B, Fathi R, Khodaverdi S, Mehdizadeh Kashi A, Valojerdi MR. An Introduction to The Royan Human Ovarian Tissue Bank. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:261-3. [PMID: 27441061 PMCID: PMC4948080 DOI: 10.22074/ijfs.2016.4918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/18/2016] [Indexed: 12/04/2022]
Abstract
From December 2000 until 2010, the researchers at Royan Institute conducted a wide range
of investigations on ovarian tissue cryopreservation with the intent to provide fertility pres-
ervation to cancer patients that were considered to be candidates for these services. In 2010,
Royan Institute established the Royan Human Ovarian Tissue Bank as a subgroup of the
Embryology Department. Since its inception, approximately 180 patients between the ages
of 747 years have undergone consultations. Ovarian samples were cryopreserved from 47
patients (age: 7-35 years) diagnosed with cervical adenocarcinoma (n=9); breast carcinoma
(n=7), Ewing’s sarcoma (n=7), opposite side ovarian tumor (n=7), endometrial adenocarci-
noma (n=4), malignant colon tumors (n=3), as well as Hodgkin’s lymphoma, major thalas-
semia and acute lymphoblastic leukemia (n=1-2 patients for each disease). Additionally,
two patients requested ovarian tissue transplantation after completion of their treatments.
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Affiliation(s)
- Naeimeh Sadat Abtahi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Bita Ebrahimi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Rouhollah Fathi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Sepideh Khodaverdi
- Endometriosis Research Center, Iran University of Medical Science, Tehran, Iran
| | | | - Mojtaba Rezazadeh Valojerdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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206
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Abstract
Many prepubertal girls and young women suffer from premature ovarian insufficiency induced by chemotherapy given for treatment of cancer and autoimmune diseases. Autotransplantation of cryopreserved ovarian tissue could restore the lost ovarian endocrine function and fertility. Unfortunately, tissue ischemia, inconsistent graft quality and the risk of reintroducing malignant cells may stand in the way of the clinical translation of this approach. To address these risks and limitations, we engineered an artificial ovarian tissue from immature follicles using a synthetic hydrogel, poly(ethylene glycol) vinyl sulfone (PEG-VS), as a supportive matrix. Enzymatically isolated follicles from 6–7-day-old mice ovaries were encapsulated in 7% PEG-VS hydrogels modified with 0.5 mmol/l RGD and crosslinked with a trifunctional matrix metalloproteinase-sensitive peptide. PEG hydrogels with the encapsulated follicles were orthotopically implanted into ovariectomised mice to investigate whether PEG hydrogel supports folliculogenesis and steroidogenesis in vivo. After 30 days, grafts revealed multiple fully developed antral follicles and corpora lutea, which corresponded with regular ovulation cycles and follicle-stimulating hormone (FSH) levels. The elevated levels of FSH, caused by bilateral ovariectomy, were reversed by the implanted follicles and maintained at physiological levels for 60 days. Importantly, primordial and primary follicles still represented 60% of the follicular pool, demonstrating selective recruitment of primordial follicles into the growing pool. Functioning blood vessels in the grafts 30 and 60 days after implantation proved the capability of PEG hydrogels to undergo graft remodelling and revascularisation. Our results demonstrate that PEG hydrogels with encapsulated immature ovarian follicles successfully functioned as an artificial ovarian tissue for 60 days in vivo.
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207
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Van der Ven H, Liebenthron J, Beckmann M, Toth B, Korell M, Krüssel J, Frambach T, Kupka M, Hohl MK, Winkler-Crepaz K, Seitz S, Dogan A, Griesinger G, Häberlin F, Henes M, Schwab R, Sütterlin M, von Wolff M, Dittrich R. Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates. Hum Reprod 2016; 31:2031-41. [PMID: 27378768 DOI: 10.1093/humrep/dew165] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 05/27/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the success rate in terms of ovarian activity (menstrual cycles) as well as pregnancy and delivery rates 1 year after orthotopic ovarian transplantations conducted in a three-country network? SUMMARY ANSWER In 49 women with a follow-up >1 year after transplantation, the ovaries were active in 67% of cases and the pregnancy and delivery rates were 33 and 25%, respectively. WHAT IS KNOWN ALREADY Cryopreservation of ovarian tissue in advance of cytotoxic therapies and later transplantation of the tissue is being performed increasingly often, and the total success rates in terms of pregnancy and delivery have been described in case series. However, published case series have not allowed either a more detailed analysis of patients with premature ovarian insufficiency (POI) or calculation of success rates based on the parameter 'tissue activity'. STUDY DESIGN, SIZE, DURATION Retrospective analysis of 95 orthotopic transplantations in 74 patients who had been treated for cancer, performed in the FertiPROTEKT network from 2008 to June 2015. Of those 95 transplantations, a first subgroup (Subgroup 1) was defined for further analysis, including 49 women with a follow-up period >1 year after transplantation. Of those 49 women, a second subgroup (Subgroup 5) was further analysed, including 40 women who were transplanted for the first time and who were diagnosed with POI before transplantation. PARTICIPANTS/MATERIALS, SETTING, METHODS Transplantation was performed in 16 centres and data were transferred to the FertiPROTEKT registry. The transplantations were carried out after oncological treatment had been completed and after a remission period of at least 2 years. Tissue was transplanted orthotopically, either into or onto the residual ovaries or into a pelvic peritoneal pocket. The success rates were defined as tissue activity (menstrual cycles) after 1 year (primary outcome) and as pregnancies and deliveries achieved. MAIN RESULTS AND THE ROLE OF CHANCE The average age of all transplanted 74 women was 31 ± 5.9 years at the time of cryopreservation and 35 ± 5.2 at the time of transplantation. Twenty-one pregnancies and 17 deliveries were recorded. In Subgroup 1, tissue was cryopreserved at the age of 30 ± 5.6 and transplanted at 34 ± 4.9 years. Ovaries remained active 1 year after transplantation in 67% of cases (n = 33/49), the pregnancy rate was 33% (n = 16/49) and the delivery rate was 25% (n = 12/49). In Subgroup 5, tissue was cryopreserved at the age 30 ± 5.9 years and transplanted at 34 ± 5.2 years. Ovaries remained active 1 year after transplantation in 63% of cases (n = 25/40), the pregnancy rate was 28% (n = 11/40) and the delivery rate was 23% (n = 9/40). The success rates were age dependant with higher success in women who cryopreserved at a younger age. In Subgroup 5, tissue was exclusively transplanted into the ovary in 10% (n = 4/40) of women and into a peritoneal pocket in 75% (n = 30/40), resulting in spontaneous conceptions in 91% of patients (n = 10/11). LIMITATIONS, REASONS FOR CAUTION The data were drawn from a retrospective analysis. The cryopreservation and transplantation techniques used have changed during the study period. The tissue was stored in many tissue banks and many surgeons were involved, leading to heterogeneity of the procedures. However, this does reflect the realistic situation in many countries. Although patients with POI were evaluated before transplantation to allow specific analysis of the transplanted tissue itself, the possibility cannot be excluded that residual ovarian tissue was also reactivated. WIDER IMPLICATIONS OF THE FINDINGS This is the largest case series worldwide to date and it confirms that cryopreservation and transplantation of ovarian tissue can be a successful option for preserving fertility. Persistent tissue activity 12 months after transplantation suggests that the pregnancy and delivery rates may increase further in the future. As transplantation into the peritoneum results in a high success rate, this approach may be an alternative to transplantation into the ovary. However, in order to establish the best transplantation site, a randomized study is required. STUDY FUNDING/COMPETING INTEREST This study was in part funded from the Deutsche Forschungsgemeinschaft (# DI 1525) and the Wilhelm Sander Foundation (2012.127.1) and did not receive any funding from a commercial company. No competing interests. TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- H Van der Ven
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - J Liebenthron
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - M Beckmann
- Department of Obstetrics and Gynaecology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - B Toth
- Department of Gynaecologic Endocrinology and Fertility Disorders, Medical University of Heidelberg, Heidelberg, Germany
| | - M Korell
- Department of Obstetrics and Gynaecology, Johanna Etienne Hospital of Neuss, Neuss, Germany
| | - J Krüssel
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - T Frambach
- Department of Obstetrics and Gynaecology, St. Joseph-Stift Hospital, Bremen, Germany
| | - M Kupka
- IVF Centre, Altonaer Strasse, Hamburg, Germany
| | - M K Hohl
- Baden Infertility Centre, Baden-Dättwil, Switzerland
| | - K Winkler-Crepaz
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - S Seitz
- Department of Obstetrics and Gynaecology, Caritas Hospital St. Josef, Regensburg, Germany
| | - A Dogan
- Department of Obstetrics and Gynaecology, University of Jena, Jena, Germany
| | - G Griesinger
- Division of Reproductive Medicine and Gynaecological Endocrinology, Department of Obstetrics and Gynecology, Schleswig-Holstein University Hospital, Lübeck, Germany
| | - F Häberlin
- Department of Obstetrics and Gynaecology, Kantonspital, St. Gallen, Switzerland
| | - M Henes
- Division of Gynaecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - R Schwab
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, University of Freiburg, Freiburg, Germany
| | - M Sütterlin
- Department of Obstetrics and Gynaecology, Mannheim University Hospital, Mannheim, Germany
| | - M von Wolff
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, Inselspital/Bern University Hospital, Effingerstrasse 102, 3010 Bern, Switzerland
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Rodriguez-Wallberg KA, Tanbo T, Tinkanen H, Thurin-Kjellberg A, Nedstrand E, Kitlinski ML, Macklon KT, Ernst E, Fedder J, Tiitinen A, Morin-Papunen L, Einarsson S, Jokimaa V, Hippeläinen M, Lood M, Gudmundsson J, Olofsson JI, Andersen CY. Ovarian tissue cryopreservation and transplantation among alternatives for fertility preservation in the Nordic countries - compilation of 20 years of multicenter experience. Acta Obstet Gynecol Scand 2016; 95:1015-26. [PMID: 27258933 PMCID: PMC5129549 DOI: 10.1111/aogs.12934] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 05/31/2016] [Indexed: 02/02/2023]
Abstract
Introduction The aim of this study is to report the current status of ovarian tissue cryopreservation among alternatives for fertility preservation in the Nordic countries. Material and methods A questionnaire was sent to 14 Nordic academic reproductive centers with established fertility preservation programs. It covered fertility preservation cases performed up to December 2014, standard procedures for ovarian tissue cryopreservation and oocyte cryopreservation and reproductive outcomes following ovarian tissue transplantation. Results Among the Nordic countries, Denmark and Norway practice ovarian tissue cryopreservation as a clinical treatment (822 and 164 cases, respectively) and their programs are centralized. In Sweden (457 cases), ovarian tissue cryopreservation is practiced at five of six centers and in Finland at all five centers (145 cases). Nearly all considered ovarian tissue cryopreservation to be experimental. In Iceland, embryo cryopreservation is the only option for fertility preservation. Most centers use slow‐freezing methods for ovarian tissue cryopreservation. Most patients selected for ovarian tissue cryopreservation were newly diagnosed with cancer and the tissue was predominantly retrieved laparoscopically by unilateral oophorectomy. Only minor complications were reported. In total, 46 women have undergone ovarian tissue transplantation aiming at recovering fertility, 17 healthy children have been born and several additional pregnancies are currently ongoing. Whenever patients’ clinical condition is permissive, oocyte cryopreservation after hormonal stimulation is preferred for fertility preservation. Between 2012 and 2014, a smaller proportion of females have undergone fertility preservation in the Nordic centers, in comparison to males (1:3). Conclusions Overall, ovarian tissue cryopreservation was reported to be safe. Slow freezing methods are still preferred. Promising results of recovery of fertility have been reported in Nordic countries that have initiated ovarian tissue transplantation procedures.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tom Tanbo
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | - Erik Ernst
- Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | | | | - Johannes Gudmundsson
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Claus Yding Andersen
- Rigshospitalet University Hospital, Copenhagen, Denmark.,Laboratory of Reproductive Biology, University of Copenhagen, Copenhagen, Denmark
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209
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Harada M, Osuga Y. Where are oncofertility and fertility preservation treatments heading in 2016? Future Oncol 2016; 12:2313-21. [PMID: 27328888 DOI: 10.2217/fon-2016-0161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An improvement in the survival rates of cancer patients and recent advancements in assisted reproductive technologies have led to remarkable progress in oncofertility and fertility preservation treatments. Although there are several available or emerging approaches for fertility preservation, the limited evidence for each strategy is the greatest concern. In this review, we discuss the concerns on currently available options, and propose new approaches for fertility preservation that may be available in the future.
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Affiliation(s)
- Miyuki Harada
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
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210
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Peters IT, Stegehuis PL, Peek R, Boer FL, van Zwet EW, Eggermont J, Westphal JR, Kuppen PJ, Trimbos JB, Hilders CG, Lelieveldt BP, van de Velde CJ, Bosse T, Dijkstra J, Vahrmeijer AL. Noninvasive Detection of Metastases and Follicle Density in Ovarian Tissue Using Full-Field Optical Coherence Tomography. Clin Cancer Res 2016; 22:5506-5513. [DOI: 10.1158/1078-0432.ccr-16-0288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/26/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
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211
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Sonigo C, Simon C, Boubaya M, Benoit A, Sifer C, Sermondade N, Grynberg M. What threshold values of antral follicle count and serum AMH levels should be considered for oocyte cryopreservation after in vitro maturation? Hum Reprod 2016; 31:1493-500. [PMID: 27165625 DOI: 10.1093/humrep/dew102] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/12/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What threshold values of ultrasonographic antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) levels should be considered for ensuring the cryopreservation of sufficient number of in vitro matured (IVM) oocytes, in cancer patients seeking fertility preservation (FP)? SUMMARY ANSWER AFC and serum AMH values >20 follicles and 3.7 ng/ml, respectively, are required for obtaining at least 10 IVM oocytes for cryopreservation. WHAT IS KNOWN ALREADY IVM of cumulus oocyte complexes (COCs) followed by oocyte cryopreservation has emerged recently as an option for urgent FP. Recent data have reported that, in healthy patients, 8-20 cryopreserved oocytes after ovarian stimulation would maximize the chance of obtaining a live birth. Although both AFC and AMH have been reported as predictive factors of IVM success in infertile patients with polycystic ovary syndrome (PCOS), there is a dramatic lack of data regarding the values of these parameters in oncological patients as candidates for FP. STUDY DESIGN, SIZE, DURATION From January 2009 to April 2015, we prospectively studied 340 cancer patients, aged 18-41 years, as candidates for oocyte cryopreservation following IVM. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients had AFC and AMH measurements, 48-72 h before oocyte retrieval, regardless of the phase of the cycle. COCs were recovered under ultrasound guidance 36 h after hCG priming. Logistic regression allowed the determination of threshold values of AFC and AMH, for obtaining at least 8, 10 or 15 matures oocytes frozen after the IVM procedure. Similar analyses were performed for a final number of mature oocytes ≤2. MAIN RESULTS AND THE ROLE OF CHANCE Among the 340 cancer patients included, 300 were diagnosed with breast cancers, 14 had hematological malignancies and 26 underwent the procedure for others indications. Overall, the mean age of the population was 31.8 ± 4.5 years. Mean AFC and serum AMH levels were 21.7 ± 13.3 follicles and 4.4 ± 3.8 ng/ml, respectively. IVM was performed in equal proportions during the follicular or luteal phase of the cycle (49 and 51%, respectively). Statistical analysis showed that AFC and AMH values above 28 follicles and 3.9 ng/ml, 20 follicles and 3.7 ng/ml and 19 follicles and 3.5 ng/ml are required, respectively, for obtaining at least 15, 10 or 8 frozen IVM oocytes with a sensitivity ranging from 0.82 to 0.90. On the contrary, ≤2 IVM oocytes were cryopreserved when AFC and AMH were <19 follicles and 3.0 ng/ml, respectively. LIMITATIONS, REASONS FOR CAUTION Although the potential of cryopreserved IVM oocytes from cancer patients remains unknown, data obtained from infertile PCOS women have shown a dramatically reduced competence of these oocytes when compared with that of oocytes recovered after ovarian stimulation. As a consequence, the optimal number of IVM oocytes frozen in candidates for FP is currently unpredictable. WIDER IMPLICATIONS OF THE FINDINGS Cryopreservation of oocytes after IVM should be considered in the FP strategy when ovarian stimulation is unfeasible, in particular when markers of the follicular ovarian status are at a relatively high range. Further investigation is needed to objectively assess the real potential of these IVM oocytes after cryopreservation. Therefore, even when a good COCs yield is expected, we should systematically encourage IVM in combination with ovarian tissue cryopreservation. STUDY FUNDING/COMPETING INTERESTS No external funding was obtained for the present study. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- C Sonigo
- AP-HP, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France INSERM, U1185, Université Paris-Sud, Le Kremlin-Bicêtre 94270, France Université Paris XIII, Bobigny 93000, France
| | - C Simon
- AP-HP, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France
| | - M Boubaya
- Unité de Recherche Clinique, Hôpital Avicenne, Bobigny 93009, France
| | - A Benoit
- AP-HP, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France
| | - C Sifer
- AP-HP, Service de Cytogénétique et Biologie de la Reproduction, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France
| | - N Sermondade
- AP-HP, Service de Cytogénétique et Biologie de la Reproduction, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France
| | - M Grynberg
- AP-HP, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean Verdier, Avenue du 14 Juillet, Bondy 93143, France Université Paris XIII, Bobigny 93000, France INSERM, U1133, Université Paris-Diderot, Paris 75013, France
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212
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Female fertility preservation strategies: cryopreservation and ovarian tissue in vitro culture, current state of the art and future perspectives. ZYGOTE 2016; 24:635-53. [PMID: 27141985 DOI: 10.1017/s096719941600006x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the present review, the main strategies of female fertility preservation are covered. Procedures of fertility preservation are necessary for women who suffer from diseases whose treatment requires the use of aggressive therapies, such as chemotherapy and radiotherapy. These kinds of therapy negatively influence the health of gametes and their progenitors. The most commonly used method of female fertility preservation is ovarian tissue cryopreservation, followed by the retransplantation of thawed tissue. Another approach to female fertility preservation that has been actively developed lately is the ovarian tissue in vitro culture. The principal methods, advantages and drawbacks of these two strategies are discussed in this article.
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213
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Lambertini M, Del Mastro L. Fertility preservation in BRCA-mutated breast cancer patients. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A possible side effect of anticancer treatments in premenopausal women is the occurrence of premature ovarian failure and subsequent infertility. The inheritance of a deleterious genetic mutation in the BRCA1 or 2 genes generates the hereditary breast and ovarian cancer syndrome. Additional fertility counseling for breast cancer patients with BRCA mutations is warranted to educate them about the available fertility preservation options in the context of their unique concerns (i.e., prophylactic gynecologic surgery, pre-implantation genetic diagnosis and risk of developing long-term treatment-related premature ovarian failure). In this report we discuss the available options for fertility preservation in women with breast cancer, with a particular focus on the specific issues in breast cancer patients with BRCA mutations.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genova, Italy
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, & l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy
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Morphometrical analysis of preantral follicular survival of VEGF-treated bovine ovarian cortex tissue following xenotransplantation in an immune deficient mouse model. Anim Reprod Sci 2016; 168:73-85. [DOI: 10.1016/j.anireprosci.2016.02.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 02/05/2016] [Accepted: 02/27/2016] [Indexed: 12/13/2022]
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215
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Lavery SA, Islam R, Hunt J, Carby A, Anderson RA. The medical and ethical challenges of fertility preservation in teenage girls: a case series of sickle cell anaemia patients prior to bone marrow transplant. Hum Reprod 2016; 31:1501-7. [DOI: 10.1093/humrep/dew084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 11/13/2022] Open
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216
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Chambon F, Brugnon F, Grèze V, Grémeau AS, Pereira B, Déchelotte P, Kanold J. Cryopreservation of ovarian tissue in pediatric patients undergoing sterilizing chemotherapy. HUM FERTIL 2016; 19:23-31. [PMID: 27008573 DOI: 10.3109/14647273.2016.1151561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Significantly improved survival rates in children and adolescents with cancer have put fertility preservation high on the pediatric oncology agenda. Here we report a retrospective single-center study of 13 years experience of ovarian tissue cryopreservation (OTC) before sterilizing treatment in order to define the safety/benefits of OTC and study clinical/hormonal outcomes in girls. From 2000 to 2013, OTC was performed in 36 girls: eight had non-malignant disease and 28 had malignant disease. Laparoscopy was used to collect a third of each ovary that was frozen by a slow cooling protocol. Indications for OTC were 13 auto-, 19 allo-stem-cell-transplantation and 4 sterilizing chemotherapy. Ovarian tissue harvested by intraumbilical laparoscopy led to no major postoperative complications and did not delay chemotherapy. Histological analysis of ovarian tissue showed an average of 9 primordial follicles/mm(2) [0-83] and no malignant cells were identified. Median post-harvest follow-up was 36 months [1-112]: 26 girls were alive in complete remission and 10 had died. Hormonal results were evaluable for 27 patients (median age 17 yrs [5-26]): 16 patients were in premature ovarian insufficiency. OTC sampling one third of each ovary appears to be an appropriate approach to preserve fertility in children without consequences on subsequent therapeutic program.
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Affiliation(s)
- Fanny Chambon
- a Centre Régional De Cancérologie Et Thérapie Cellulaire Pédiatrique, Hôpital Estaing , Clermont-Ferrand , France ;,b INSERM-CIC 1405, Unite CRECHE , Clermont-Ferrand , France ;,c Faculté De Médecine, Clermont Université, Université Clermont1 , Clermont-Ferrand , France
| | - Florence Brugnon
- d CHU Clermont-Ferrand, Assistance Médicale À La Procréation, CECOS, CHU Clermont-Ferrand , Clermont-Ferrand , 63001 , France ;,e Laboratoire Génétique Reproduction Et Développement, Université D'auvergne , INSERM U1103 , Clermont-Ferrand , France
| | - Victoria Grèze
- a Centre Régional De Cancérologie Et Thérapie Cellulaire Pédiatrique, Hôpital Estaing , Clermont-Ferrand , France ;,c Faculté De Médecine, Clermont Université, Université Clermont1 , Clermont-Ferrand , France
| | - Anne-Sophie Grémeau
- c Faculté De Médecine, Clermont Université, Université Clermont1 , Clermont-Ferrand , France ;,d CHU Clermont-Ferrand, Assistance Médicale À La Procréation, CECOS, CHU Clermont-Ferrand , Clermont-Ferrand , 63001 , France ;,e Laboratoire Génétique Reproduction Et Développement, Université D'auvergne , INSERM U1103 , Clermont-Ferrand , France
| | - Bruno Pereira
- f CHU De Clermont-Ferrand, Unité De Biostatistiques, Délégation À La Recherche Clinique Et L'innovation , Clermont-Ferrand , France
| | - Pierre Déchelotte
- c Faculté De Médecine, Clermont Université, Université Clermont1 , Clermont-Ferrand , France ;,g Service D'anatomopathologie, Hôpital Estaing , Clermont-Ferrand , France
| | - Justyna Kanold
- a Centre Régional De Cancérologie Et Thérapie Cellulaire Pédiatrique, Hôpital Estaing , Clermont-Ferrand , France ;,b INSERM-CIC 1405, Unite CRECHE , Clermont-Ferrand , France ;,c Faculté De Médecine, Clermont Université, Université Clermont1 , Clermont-Ferrand , France
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Bénard J, Calvo J, Comtet M, Benoit A, Sifer C, Grynberg M. [Fertility preservation in women of the childbearing age: Indications and strategies]. ACTA ACUST UNITED AC 2016; 45:424-44. [PMID: 27021926 DOI: 10.1016/j.jgyn.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
Advances on cryopreservation techniques now allow considering oocyte, embryo or ovarian tissue freezing for female fertility preservation. Originally developed for patients suffering from cancer, fertility preservation has rapidly invaded others medical fields, and represents now the standard of care for all young patient diagnosed with a disease that could impair fertility or having to receive possibly gonadotoxic treatment. As a result, autoimmune diseases, some genetic pathologies or iterative pelvic surgeries, at risk of premature ovarian failure, have become common indications of fertility preservation. In addition, the social egg freezing aiming at preventing the age-related fertility decline is still debated in France, although authorized in numerous countries. This review will discuss the different strategies of fertility preservation in young girls and women of reproductive age, regarding different medical or non-medical indications.
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Affiliation(s)
- J Bénard
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France
| | - J Calvo
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Comtet
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benoit
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Sifer
- Service de cytogénétique et biologie de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Grynberg
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France; Unité Inserm U1133, université Paris-Diderot, 75013 Paris, France.
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218
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Peters ITA, Hilders CGJM, Sier CFM, Vahrmeijer AL, Smit VTHBM, Baptist Trimbos J, Kuppen PJK. Identification of cell-surface markers for detecting breast cancer cells in ovarian tissue. Arch Gynecol Obstet 2016; 294:385-93. [PMID: 26946151 PMCID: PMC4937067 DOI: 10.1007/s00404-016-4036-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE The safety of ovarian tissue autotransplantation in oncology patients cannot be ensured, as current tumor-detection methods compromise the ovarian tissue viability. Although non-destructive methods (for instance near-infrared fluorescence imaging) can discriminate malignant from healthy tissues while leaving the examined tissues unaffected, they require specific cell-surface tumor markers. We determined which tumor markers are suitable targets for tumor-specific imaging to exclude the presence of breast cancer cells in ovarian tissue. METHODS Immunohistochemistry was performed on formalin-fixed, paraffin-embedded specimens of ten ovaries from premenopausal patients. Additionally, we screened a tissue microarray containing tumor tissue cores from 24 breast cancer patients being eligible for ovarian tissue cryopreservation. The following cell-surface tumor markers were tested: E-cadherin, EMA (epithelial membrane antigen), Her2/neu (human epidermal growth factor receptor type 2), αvβ6 integrin, EpCAM (epithelial cell adhesion molecule), CEA (carcinoembryonic antigen), FR-α (folate receptor-alpha), and uPAR (urokinase-type plasminogen activator receptor). For each tumor, the percentage of positive breast tumor cells was measured. RESULTS None of the ten ovaries were positive for any of the markers tested. However, all markers (except CEA and uPAR) were present on epithelial cells of inclusion cysts. E-cadherin was present in the majority of breast tumors: ≥90 % of tumor cells were positive for E-cadherin in 17 out of 24 tumors, and 100 % of tumor cells were positive in 5 out of 24 tumors. CONCLUSIONS Of the markers tested, E-cadherin is the most suitable marker for a tumor-specific probe in ovarian tissue. Methods are required to distinguish inclusion cysts from breast tumor cells.
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Affiliation(s)
- Inge T A Peters
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Baptist Trimbos
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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219
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Morphometric characteristics of preantral and antral follicles and expression of factors involved in folliculogenesis in ovaries of adult baboons (Papio anubis). J Assist Reprod Genet 2016; 33:617-626. [PMID: 26945754 DOI: 10.1007/s10815-016-0681-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/22/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Baboons are commonly utilized as an animal model for studies of human reproduction. However, folliculogenesis in this species has not been fully documented. The aim of this study was to assess follicle morphometry and expression of essential proteins involved in folliculogenesis in baboons. METHODS Ovaries were recovered from four adult baboons and processed for histological evaluation and immunohistochemical analyses. Follicle proportion, follicle and oocyte diameter, theca layer thickness, number of granulosa cells, and follicle density were calculated. Immunohistochemical staining was also carried out for connexin 43 (Cx43), aromatase, and zona pellucida 3 (ZP3). RESULTS A total of 2221 follicles were counted and measured. Proportions of primordial, primary, secondary, small antral, and large antral follicles were 49, 26, 23, 1, and 1 %, respectively. The increase in follicle diameter was due not only to the increase in oocyte diameter but also to granulosa cell proliferation. Almost all antral follicles were positive for Cx43 (89.8 %), aromatase (84.8 %), and ZP3 (100 %). Most secondary follicles were positive for Cx43 (65 %) and ZP3 (64.5 %), and some primary follicles were positive only for Cx43. No primordial follicles stained positive in any of these immunohistochemical analyses. Only antral follicles showed aromatase activity. CONCLUSIONS On the basis of these results, we can conclude that folliculogenesis in baboons appears to be similar to that in humans, and this animal therefore constitutes a valuable model.
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220
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von Wolff M, Giesecke D, Germeyer A, Lawrenz B, Henes M, Nawroth F, Friebel S, Rohde A, Giesecke P, Denschlag D. Characteristics and attitudes of women in relation to chosen fertility preservation techniques: a prospective, multicenter questionnaire-based study with 144 participants. Eur J Obstet Gynecol Reprod Biol 2016; 201:12-7. [PMID: 27039248 DOI: 10.1016/j.ejogrb.2016.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/28/2015] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE What are the patients attitudes about their fertility and about the counselling process at the time when fertility preservation counselling is performed? STUDY DESIGN A survey regarding fertility concerns and counselling performance in relation to the chosen fertility preservation procedure such as no treatment, GnRH agonists, and freezing of ovarian tissue or oocytes/zygotes was prospectively conducted in four university centres and one private centre, all belonging to the network FertiPROTEKT in Germany and Switzerland. RESULTS All women (n=145) received a questionnaire at the first counselling appointment. The mean age of the patients was 30 years (±5.8, range 17-43 years). 91% were referred by their treating oncologists. Single patients preferred invasive strategies, such as freezing of oocytes/zygotes (44.3%) or freezing of ovarian tissue (36%), whereas only 19.7% opted for no treatment/GnRH agonists. In married couples, the proportions were 28.9%, 31.1% and 40.0% respectively. Women without children also opted more frequently for invasive strategies, such as freezing of oocytes/zygotes (84.5%) or freezing of ovarian tissue (74.1%), and less frequently for no treatment/GnRH agonists (63.3%). Physical and psychological status, current and future fertility concerns and satisfaction with the counselling process were equal in all treatment groups. CONCLUSION As fertility concerns and attitudes about the counselling process were independent from the fertility preservation procedure chosen, the preferred treatment can hardly be predicted and therefore all women should be counselled about all possible fertility preservation techniques.
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Affiliation(s)
- Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Berne, Switzerland.
| | - Dagmar Giesecke
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
| | - Ariane Germeyer
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Heidelberg, Germany
| | - Barbara Lawrenz
- University Women's Hospital, University of Tübingen, Tübingen, Germany
| | - Melanie Henes
- University Women's Hospital, University of Tübingen, Tübingen, Germany
| | - Frank Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Hamburg, Germany
| | - Stefanie Friebel
- University Women's Hospital, University of Freiburg, Freiburg, Germany
| | - Anke Rohde
- University Women's Hospital, University of Bonn, Division of Psychosomatic Medicine, Gynaecological Psychosomatics, Bonn, Germany
| | - Peter Giesecke
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
| | - Dominik Denschlag
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
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221
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Póvoa A, Xavier P, Calejo L, Soares S, Sousa M, Silva J, Sousa S, Barros A, Beires J. First transplantation of cryopreserved ovarian tissue in Portugal, stored for 10 years: an unexpected indication. Reprod Biomed Online 2016; 32:334-6. [DOI: 10.1016/j.rbmo.2015.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022]
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Silber S. How ovarian transplantation works and how resting follicle recruitment occurs: a review of results reported from one center. ACTA ACUST UNITED AC 2016; 12:217-27. [PMID: 26900727 DOI: 10.2217/whe.15.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ovarian freezing and transplantation has garnered increasing interest as a potential way of preserving fertility in cancer patients. This special report aims to identify the success rate of frozen compared with fresh ovarian cortex transplantation (in one single series from one center for the sake of consistency), as well as potentially provides insight into the mechanism behind ovarian follicle recruitment. A comparison of fresh versus frozen transplantation techniques is presented, highlighting the similarity and differences between the fresh and frozen transplantation procedures. Much of the literature is scattered case reports with different patient populations and different techniques. This represents an effort to simplify and popularize an approach that has yielded favorable results (all cases recovered ovulation and 75% had successful spontaneous pregnancy) in one single, disciplined study.
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Affiliation(s)
- Sherman Silber
- Infertility Center of St. Louis, 224 S. Woods Mill Road, Suite 730, St. Louis, MO 63017, USA.,Department of Obstetrics & Gynecology, University of Amsterdam, 1012 WX Amsterdam, The Netherlands.,Sun Yat-Sen Medical School, No.74 Zhongshan Rd.2, Guangzhou, P.R. China
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223
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Talevi R, Barbato V, Fiorentino I, Braun S, De Stefano C, Ferraro R, Sudhakaran S, Gualtieri R. Successful slush nitrogen vitrification of human ovarian tissue. Fertil Steril 2016; 105:1523-1531.e1. [PMID: 26902858 DOI: 10.1016/j.fertnstert.2016.01.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To study whether slush nitrogen vitrification improves the preservation of human ovarian tissue. DESIGN Control vs. treatment study. SETTING University research laboratory. PATIENT(S) Ovarian biopsies collected from nine women (aged 14-35 years) during laparoscopic surgery for benign gynecologic conditions. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Ovarian cortical strips of 2 × 5 × 1 mm were vitrified with liquid or slush nitrogen. Fresh and vitrified cortical strips were analyzed for cryodamage and viability under light, confocal, and transmission electron microscopy. RESULT(S) Compared with liquid nitrogen, vitrification with slush nitrogen preserves [1] follicle quality (grade 1 follicles: fresh control, 50%; liquid nitrogen, 27%; slush nitrogen, 48%); [2] granulosa cell ultrastructure (intact cells: fresh control, 92%; liquid nitrogen, 45%; slush nitrogen, 73%), stromal cell ultrastructure (intact cells: fresh control, 59.8%; liquid nitrogen, 24%; slush nitrogen, 48.7%), and DNA integrity (TUNEL-positive cells: fresh control, 0.5%; liquid nitrogen, 2.3%; slush nitrogen, 0.4%); and [3] oocyte, granulosa, and stromal cell viability (oocyte: fresh control, 90%; liquid nitrogen, 63%; slush nitrogen, 87%; granulosa cells: fresh control, 93%; liquid nitrogen, 53%; slush nitrogen, 81%; stromal cells: fresh control, 63%; liquid nitrogen, 30%; slush nitrogen, 52%). CONCLUSION(S) The histology, ultrastructure, and viability of follicles and stromal cells are better preserved after vitrification with slush nitrogen compared with liquid nitrogen.
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Affiliation(s)
- Riccardo Talevi
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy.
| | - Vincenza Barbato
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Ilaria Fiorentino
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Sabrina Braun
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Cristofaro De Stefano
- Unità di Fisiopatologia della Riproduzione e Sterilità di Coppia, Azienda Ospedaliera San Giuseppe Moscati, Avellino, Italy
| | - Raffaele Ferraro
- Iatropolis, Genesis Day Surgery Sterilità della Coppia, Caserta, Italy
| | - Sam Sudhakaran
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Roberto Gualtieri
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
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Henry L, Fransolet M, Labied S, Blacher S, Masereel MC, Foidart JM, Noel A, Nisolle M, Munaut C. Supplementation of transport and freezing media with anti-apoptotic drugs improves ovarian cortex survival. J Ovarian Res 2016; 9:4. [PMID: 26868273 PMCID: PMC4751643 DOI: 10.1186/s13048-016-0216-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ovarian tissue preservation is proposed to patients at risk of premature ovarian failure, but this procedure still needs to be optimized. To limit injury during ovarian tissue cryopreservation, anti-apoptotic drugs were added to the transport and freezing media of ovarian cortex tissue. Methods Sheep ovaries were transported, prepared and frozen in solutions containing vehicle or anti-apoptotic drugs (Z-VAD-FMK, a pan-caspase inhibitor, or sphingosine-1-phosphate (S1P), a bioactive lipid). After the tissue was thawed, the ovarian cortex was cultured for 2 or 6 days. Follicular quantification and morphological and proliferation analyses were performed on histological sections. Results After 2 days of culture, S1P improved the quality of primordial follicles; higher densities of morphologically normal and proliferative primordial follicles were found. Z-VAD-FMK displayed similar effects by preserving global primordial follicular density, but this effect was evident after 6 days of culture. This drug also improved cell proliferation after 2 and 6 days of culture. Conclusions Our results showed that the addition of S1P or Z-VAD-FMK to the transport and freezing media prior to ovarian tissue cryopreservation improves primordial follicular quality and therefore improves global tissue survival. This should ultimately lead to improved fertility restoration after auto-transplantation. Electronic supplementary material The online version of this article (doi:10.1186/s13048-016-0216-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laurie Henry
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium. .,Department of Gynecology, University of Liège, Boulevard du XIIème de Ligne, B-4000, Liège, Belgium.
| | - Maïté Fransolet
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium.
| | - Soraya Labied
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium. .,Department of Gynecology, University of Liège, Boulevard du XIIème de Ligne, B-4000, Liège, Belgium.
| | - Silvia Blacher
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium.
| | - Marie-Caroline Masereel
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium. .,Department of Gynecology, University of Liège, Boulevard du XIIème de Ligne, B-4000, Liège, Belgium.
| | - Jean-Michel Foidart
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium.
| | - Agnès Noel
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium.
| | - Michelle Nisolle
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium. .,Department of Gynecology, University of Liège, Boulevard du XIIème de Ligne, B-4000, Liège, Belgium.
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA-R), Université de Liège, Tour de Pathologie (B23) Sart-Tilman, B-4000, Liège, Belgium.
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Wang TR, Yan J, Lu CL, Xia X, Yin TL, Zhi X, Zhu XH, Ding T, Hu WH, Guo HY, Li R, Yan LY, Qiao J. Human single follicle growth in vitro from cryopreserved ovarian tissue after slow freezing or vitrification. Hum Reprod 2016; 31:763-73. [PMID: 26851603 DOI: 10.1093/humrep/dew005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/08/2016] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION What is the effect of human ovarian tissue cryopreservation on single follicular development in vitro? SUMMARY ANSWER Vitrification had a greater negative effect on growth and gene expression of human ovarian follicles when compared with fresh follicles. WHAT IS KNOWN ALREADY For human ovarian cortex cryopreservation, the conventional option is slow freezing while more recently vitrification has been demonstrated to maintain good quality and function of ovarian tissues. STUDY DESIGN, SIZE, DURATION Ovarian tissues were collected from 11 patients. For every patient, the ovarian cortex was divided into three samples: Fresh, slow-rate freezing (Slow) and vitrification (Vit). Tissue histology was performed and follicles were isolated for single-cell mRNA analysis and in vitro culture (IVC) in 1% alginate for 8 days. PARTICIPANTS/MATERIALS, SETTING, METHODS Follicle morphology was assessed with hematoxylin-eosin analysis. Follicles were individually embedded in alginate (1% w/v) and cultured in vitro for 8 days. Follicle survival and growth were assessed by microscopy. Follicle viability was observed after Calcein-AM and ethidium homodimer-I (Ca-AM/EthD-I) staining. Expression of genes, including GDF9 (growth differentiation factor 9), BMP15 (bone morphogenetic protein 15) and ZP3 (zona pellucida glycoprotein 3) in oocytes and AMH (anti-Mullerian hormone), FSHR (FSH receptor), CYP11A (cholesterol side-chain cleavage cytochrome P450) and STAR (steroidogenic acute regulatory protein) in GCs, was evaluated by single-cell mRNA analysis. MAIN RESULTS AND THE ROLE OF CHANCE A total of 129 follicles were separated from ovarian cortex (Fresh n = 44; Slow n = 40; Vit n = 45). The percentage of damaged oocytes and granulosa cells was significantly higher in both the Slow and Vit groups, as compared with Fresh control (P< 0.05). The growth of follicles in vitro was significantly delayed in the Vit group compared with the Fresh group (P< 0.05). Both slow freezing (P< 0.05) and vitrification (P< 0.05) down-regulated the mRNA levels of ZP3 and CYP11A compared with Fresh group, while there was no significant difference between the Slow and Vit groups (P> 0.05). Vitrification also down-regulates AMH mRNA levels compared with Fresh group (P< 0.05). LIMITATIONS, REASONS FOR CAUTION Only short-term IVC studies (8 days) are reported. Further study should be performed to examine and improve follicular development in a long-term culture system after cryopreservation. WIDER IMPLICATIONS OF THE FINDINGS This is the first comparison of gene expression and growth of single human ovarian follicles in vitro after either slow freezing or vitrification. With the decreased gene expression and growth during IVC, damage by cryopreservation still exists and needs to be minimized during the long-term IVC of follicles in the future for eventual clinical application. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Natural Science Foundation of China (31230047, 81571386, 81471508, 31429004 and 81501247), National Natural Science Foundation of Beijing (7142166) and Mega-projects of Science Research for the 12th five-year plan (2012ba132b05). There are no conflicts of interest to declare.
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Affiliation(s)
- Tian-ren Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 100004, China
| | - Jie Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Cui-ling Lu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
| | - Xi Xia
- Center for Reproductive Medicine, Peking University Shenzhen Hospital, FuTian District, Shenzhen, Guangdong 518000, China
| | - Tai-lang Yin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
| | - Xu Zhi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Xiao-hui Zhu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
| | - Ting Ding
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
| | - Wei-hong Hu
- Department of Obstetrics and Gynecology, General Hospital of Chinese People's Armed Police Forces, Beijing 100191, China
| | - Hong-yan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Li-ying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing 100191, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing 100191, China
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Abstract
PURPOSE OF REVIEW This article aims to carefully evaluate a number of critical points related to ovarian tissue freezing and presents factual data in terms of live birth rates and risks. RECENT FINDINGS Reimplantation of frozen-thawed ovarian tissue remains an experimental procedure according to the American Society for Reproductive Medicine, despite almost 40 live births reported in the literature. Recent literature on the topic has focused on the risk of reimplanting malignant cells, so the present review assesses the risks according to disease. SUMMARY This manuscript emphasizes the crucial importance of not only preserving fertility in young women but also clearly explaining to patients the different available options and their respective success rates. Some previously published reviews have reported inaccurate reimplantation success rates. In this review, we report the true picture, with a live birth rate of 25%. Ovarian tissue freezing may be combined with pickup of immature oocytes (at the time of ovarian biopsy and tissue removal) or mature oocytes (if chemotherapy can be delayed).
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227
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Lotz L, Maktabi A, Hoffmann I, Findeklee S, Beckmann MW, Dittrich R. Ovarian tissue cryopreservation and retransplantation--what do patients think about it? Reprod Biomed Online 2016; 32:394-400. [PMID: 26825247 DOI: 10.1016/j.rbmo.2015.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
Cryopreservation of ovarian tissue has been successfully applied clinically, with over 60 live births to date. The aim of the present study was to perform a survey of patients who have had ovarian tissue cryopreserved in the Department of Obstetrics and Gynecology, Erlangen University Hospital, in order to obtain information about: why patients opt for fertility preservation; their current fertility; pregnancy attempts and outcomes; and their intended plans for the cryopreserved ovarian tissue. In total, 147 women took part in the survey (average age 25.0 ± 7.0 years; response rate 48%; mean follow-up period 6 years). Sixty-six reported regular menstrual cycles; 48 were amenorrhoeic. Sixty-two women had tried to conceive; 33 reported pregnancies. Twenty-five had delivered healthy children after conceiving naturally; eight had conceived with assisted reproduction. Five patients had had their ovarian tissue retransplanted. Although many patients continued to have ovarian function, none of them regretted choosing cryopreservation of ovarian tissue. Cryopreservation of ovarian tissue is an effective option and is very important for women diagnosed with cancer. Analyses of the clinical outcomes in these patients are essential in order to identify those patients capable of benefiting most from the procedure and in order to improve the technique.
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Affiliation(s)
- Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Amina Maktabi
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Findeklee
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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228
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Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22:281-305. [PMID: 26759231 DOI: 10.1093/humupd/dmv066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. METHODS We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. RESULTS We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. CONCLUSIONS After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | | | - Maria D Diestro
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
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229
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Grynberg M, Poulain M, le Parco S, Sifer C, Fanchin R, Frydman N. Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients. Hum Reprod 2016; 31:623-9. [PMID: 26759139 DOI: 10.1093/humrep/dev325] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 11/30/2015] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Are in vitro maturation (IVM) rates of cumulus-oocyte complexes (COCs), retrieved from breast cancer patients seeking urgent fertility preservation (FP) before neoadjuvant chemotherapy, different between those recovered in the follicular or in the luteal phase of the cycle? SUMMARY ANSWER The present investigation reveals no major difference in the number of COCs recovered or their IVM rates whatever the phase of the cycle at which egg retrieval is performed, suggesting that IVM is a promising tool for breast cancer patients seeking urgent oocyte cryopreservation. WHAT IS KNOWN ALREADY FP now represents a standard of care for young cancer patients having to undergo gonadotoxic treatment. Mature oocyte cryopreservation after IVM of COCs has been proposed for urgent FP, especially in women, who have no time to undergo ovarian stimulation, or when it is contraindicated. STUDY DESIGN, SIZE, DURATION From January 2011 to December 2014, we prospectively studied 248 breast cancer patients awaiting neoadjuvant chemotherapy, aged 18-40 years, candidates for oocyte vitrification following IVM, either at the follicular or the luteal phase of the cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Serum anti-Müllerian hormone and progesterone levels and antral follicle count (AFC) were measured prior to oocyte retrieval. Patients were sorted into two groups according to the phase of the cycle during which eggs were harvested (Follicular phase group, n = 127 and Luteal phase group, n = 121). Number of COCs recovered, maturation rates after 48 h of culture and total number of oocytes cryopreserved were assessed. Moreover, the oocyte retrieval rate (ORR) was calculated by the number of COCs recovered ×100/AFC. MAIN RESULTS AND THE ROLE OF CHANCE In the Follicular and the Luteal phase groups, women were comparable in terms of age, BMI and markers of follicular ovarian status. There was no significant difference in the number of COCs recovered (mean ± SEM), 9.3 ± 0.7 versus 11.1 ± 0.8, and ORR (median (range)) 43.1 (1-100) versus 47.8 (7.7-100)%. Moreover, maturation rates after 48 h of culture (median (range)) were comparable in the follicular and luteal phase groups, 66.7 (20-100) versus 64.5 (0-100)%. Finally, the total number of oocytes cryopreserved (mean ± SEM) was similar in both groups (6.2 ± 0.4 versus 6.8 ± 0.5). LIMITATIONS, REASONS FOR CAUTION Despite the intact meiotic competence of immature oocytes recovered during the follicular or the luteal phase, there is a dramatic lack of data regarding the outcome of IVM oocytes cryopreserved in cancer patients. WIDER IMPLICATIONS OF THE FINDINGS IVM of oocytes may be an interesting method of FP in urgent situations. Improving the culture conditions will be needed to increase the maturation rates and the overall potential of in vitro matured oocytes. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Grynberg
- Department of Reproductive Medicine, AP-HP, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France University Paris XIII, 93000 Bobigny, France Unit Inserm U1133, Université Paris-Diderot, 75013 Paris, France
| | - M Poulain
- Unit of Reproductive Biology, AP-HP, Hôpital Antoine Béclère, Clamart F-92141, France Univ Paris-Sud, Clamart F-92140, France
| | - S le Parco
- Department of Obstetric-Gynecology and Reproductive Medicine, Hôpital Antoine Béclère, Clamart F-92140, France
| | - C Sifer
- Department of Cytogenetic and Reproductive Biology, AP-HP, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - R Fanchin
- Unit Inserm U1133, Université Paris-Diderot, 75013 Paris, France Univ Paris-Sud, Clamart F-92140, France Department of Obstetric-Gynecology and Reproductive Medicine, Hôpital Antoine Béclère, Clamart F-92140, France
| | - N Frydman
- Unit of Reproductive Biology, AP-HP, Hôpital Antoine Béclère, Clamart F-92141, France Univ Paris-Sud, Clamart F-92140, France
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230
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Hickman LC, Uy-Kroh MJ, Chiesa-Vottero A, Desai N, Flyckt R. Ovarian Tissue Cryopreservation for Benign Gynecologic Disease: A Case of Ovarian Torsion and Review of the Literature. J Minim Invasive Gynecol 2016; 23:446-9. [PMID: 26742481 DOI: 10.1016/j.jmig.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/16/2022]
Abstract
Ovarian tissue cryopreservation (OTC) is an emerging method for fertility preservation. Although OTC has been previously proposed for benign indications, to our knowledge this is the first report highlighting the use of OTC for the indication of ovarian torsion. A 36-year-old nulligravid woman with a history of recurrent ovarian torsion presented with an acute episode of ovarian torsion confirmed by ultrasound. She requested a laparoscopic oophorectomy because her previous oophoropexy had failed, and in light of this was counseled to undergo concurrent OTC. On laparoscopy, 10 strips of ovarian cortex were obtained. A portion of this tissue was sent for pathological analysis, which revealed a primordial follicle density of 167 follicles/mm(3), a primary follicle density of 38 follicles/mm(3), and minimal ischemic damage. Although the clinical application of OTC continues to evolve and requires further investigation, the possibility of expanding the indications for benign gynecologic conditions is promising.
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Affiliation(s)
- Lisa C Hickman
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Mary Jean Uy-Kroh
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Nina Desai
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
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Lambertini M, Del Mastro L, Pescio MC, Andersen CY, Azim HA, Peccatori FA, Costa M, Revelli A, Salvagno F, Gennari A, Ubaldi FM, La Sala GB, De Stefano C, Wallace WH, Partridge AH, Anserini P. Cancer and fertility preservation: international recommendations from an expert meeting. BMC Med 2016; 14:1. [PMID: 26728489 PMCID: PMC4700580 DOI: 10.1186/s12916-015-0545-7] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/16/2015] [Indexed: 12/28/2022] Open
Abstract
In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians.In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of "cancer and fertility preservation". A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation.Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genoa, Italy.
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genoa, Italy
| | - Maria C Pescio
- Physiopathology of Human Reproduction, IRCCS AOU San Martino - IST, Genoa, Italy
| | - Claus Y Andersen
- Laboratory of Reproductive Biology, Section 5712, Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Hatem A Azim
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
| | - Mauro Costa
- Reproductive Medicine Department, International Evangelic Hospital, Genoa, Italy
| | - Alberto Revelli
- Physiopathology of Reproduction and In Vitro Fertilization Unit, S. Anna Hospital, University of Turin, Turin, Italy
| | - Francesca Salvagno
- Physiopathology of Reproduction and In Vitro Fertilization Unit, S. Anna Hospital, University of Turin, Turin, Italy
| | | | - Filippo M Ubaldi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Giovanni B La Sala
- Obstetric and Gynecology Department, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Cristofaro De Stefano
- Children and Women Health Department, Physiopathology of Human Reproduction Unit, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - W Hamish Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, and Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paola Anserini
- Physiopathology of Human Reproduction, IRCCS AOU San Martino - IST, Genoa, Italy
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Oktay K, Bedoschi G, Pacheco F, Turan V, Emirdar V. First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. Am J Obstet Gynecol 2016; 214:94.e1-9. [PMID: 26601616 DOI: 10.1016/j.ajog.2015.10.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ovarian tissue cryopreservation is an experimental fertility preservation method and the transplantation techniques are still evolving. OBJECTIVE We attempted to improve the technique with the utility of a human decellularized extracellular tissue matrix (ECTM) scaffold, robot-assisted minimally invasive surgery, and perioperative pharmacological support. STUDY DESIGN We prospectively studied 2 subjects with hemophagocytic lymphohistiocytosis (patient A) and non-Hodgkin lymphoma (patient B) who underwent ovarian tissue cryopreservation at the age of 23 years, before receiving preconditioning chemotherapy for hematopoietic stem cell transplantation. Both experienced ovarian failure postchemotherapy and we transplanted ovarian cortical tissues to the contralateral menopausal ovary 7 and 12 years later, using a human ECTM scaffold and robotic assistance. The ECTM scaffold tissue compatibility was shown in preclinical studies. Patients also received estrogen supplementation and baby aspirin preoperatively to aid in the revascularization process. RESULTS Ovarian follicle development was observed approximately 10 (patient A) and 8 (patient B) weeks after ovarian tissue transplantation. Following 8 and 7 cycles of in vitro fertilization, 9 and 10 day-3 embryos were cryopreserved (patients A and B, respectively). While the baseline follicle-stimulating hormone (range 3.6-15.4 mIU/mL) levels near normalized by 7 months and remained steady postovarian transplantation in patient A, patient B showed improved but elevated follicle-stimulating hormone levels throughout (range 21-31 mIU/mL). Highest follicle yield was achieved 14 (8 follicles; patient A) and 11 (6 follicles; patient B) months postintervention. Patient A experienced a chemical pregnancy after the third frozen embryo transfer attempt. She then conceived following her first fresh in vitro fertilization embryo transfer and the pregnancy is currently ongoing. Patient B conceived after the first frozen embryo transfer attempt and delivered a healthy girl at term. CONCLUSION We report the first pregnancies after the minimally invasive transplantation of previously cryopreserved ovarian tissue with an ECTM scaffold. This approach seems to be associated with steady ovarian function after a follow-up of up to 2 years.
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Affiliation(s)
- Kutluk Oktay
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - Giuliano Bedoschi
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Faculdade de Medicina de Ribeirao Preto-Universidade de Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernanda Pacheco
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Classiclinica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Volkan Turan
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Volkan Emirdar
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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233
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Cohen Y, Dafni H, Avni R, Fellus L, Bochner F, Rotkopf R, Raz T, Benjamin LE, Walsh K, Neeman M. Genetic and Pharmacological Modulation of Akt1 for Improving Ovarian Graft Revascularization in a Mouse Model1. Biol Reprod 2016; 94:14. [DOI: 10.1095/biolreprod.115.131987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 10/14/2015] [Indexed: 11/01/2022] Open
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234
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Kang BJ, Wang Y, Zhang L, Xiao Z, Li SW. bFGF and VEGF improve the quality of vitrified-thawed human ovarian tissues after xenotransplantation to SCID mice. J Assist Reprod Genet 2015; 33:281-9. [PMID: 26712576 DOI: 10.1007/s10815-015-0628-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/29/2015] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The aim of this research is to study whether basic fibroblast growth factor (bFGF) alone or in combination with vascular endothelial growth factor (VEGF) could improve the quality of vitrified-thawed human ovarian tissue xenotransplanted to severe combined immune deficiency (SCID) mice. METHODS After collection and cryopreservation, thawed human ovarian tissue were cultured in vitro for 2 days and then xenografted to severe combined immune deficiency (SCID) mice for 7 days. The in vitro culture medium was separated into six groups, including (A) the blank control group, (B) the human recombinant bFGF (150 ng/ml) group, (C) the bFGF (150 ng/ml)+human recombinant VEGF (25 ng/ml) group, (D) bFGF (150 ng/ml)+VEGF (50 ng/ml) group, (E) bFGF (150 ng/ml)+ VEGF (75 ng/ml) group and (F) bFGF (150 ng/ml) + VEGF (100 ng/ml) group. In addition, eight pieces of thawed ovarian tissue were transplanted without in vitro culture, which serve as the fresh control group. The effect of transplantation was assessed by histological analysis, immunohistochemical staining for CD34, Ki-67, and AC-3 expression, and microvessel density (MVD). RESULTS There was no significant difference between the fresh and blank control group. Compared to the blank control group, the number of follicles, MVD, and rate of Ki-67-positive cells increased significantly in groups B, C, D, E, and F, while apoptosis decreased significantly. Compared to the bFGF treatment group, no significant difference appeared in group C, D, E, and F. CONCLUSIONS The administration of bFGF alone or in combination with VEGF improved the quality of postgraft human ovarian tissue, though VEGF, regardless of different concentrations, did not influence effect of bFGF.
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Affiliation(s)
- Bei-Jia Kang
- Reproductive Medical Center of West China 2nd University Hospital, Sichuan University, Ren Min Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yan Wang
- Reproductive Medical Center of West China 2nd University Hospital, Sichuan University, Ren Min Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
| | - Long Zhang
- Reproductive Medical Center of West China 2nd University Hospital, Sichuan University, Ren Min Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zhun Xiao
- Reproductive Medical Center of West China 2nd University Hospital, Sichuan University, Ren Min Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
| | - Shang-Wei Li
- Reproductive Medical Center of West China 2nd University Hospital, Sichuan University, Ren Min Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China.
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235
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Damous LL, Silva SMD, Carbonel AAF, Simões MDJ, Baracat EC, Montero EFDS. Progressive Evaluation of Apoptosis, Proliferation, and Angiogenesis in Fresh Rat Ovarian Autografts Under Remote Ischemic Preconditioning. Reprod Sci 2015; 23:803-11. [PMID: 26674322 DOI: 10.1177/1933719115620493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study evaluated the remote ischemic preconditioning (R-IPC) early and late repercussion on fresh ovarian transplants, aiming to assess a probable protective effect in ovarian follicular pool. Sixty Wistar EPM-1 rats were used, divided in 2 study groups: ovarian transplantation (Tx) and Tx + R-IPC, submitted to ovary transplant with or without R-IPC, respectively. These groups were subdivided according to the date for euthanasia: 4th, 7th, 14th, 21st, and 30th days of the postoperatory period. Morphology, morphometry, neoangiogenesis (vascular endothelial growth factor [VEGF]), proliferative activity (Ki-67), and apoptosis (cleaved caspase-3) were evaluated. Remote ischemic preconditioning was performed in the common iliac artery. Fresh autologous ovarian tissue was implanted integrally in the retroperitoneum. All animals showed resumption of estrous phase after ovary transplantation. Remote ischemic preconditioning attenuated the lesions progressively from the 7th day, with greater number of the immature follicles (14 days, P < .05), but didn't affect mature follicles and corpora lutea (P > .05). Immunohistochemical analyzes, taken as a whole, show that R-IPC benefic effect is more evident in the later periods of evaluation, when a greater proliferative activity (14, 21, and 30 days, P < .05) and lesser cell apoptotic activity (21 and 30 days, P < .05). The VEGF expression was similar in all times (P > .05). Remote ischemic preconditioning could have a benefic effect in the progressive evaluation of freshly grafted ovarian, especially on the latest phases of the posttransplant period. The 14th day was a landmark in the recuperation of the graft. Further investigations are necessary to determine the role of R-IPC in this scenario and its effect in frozen-thawed ovarian tissue.
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Affiliation(s)
- Luciana Lamarão Damous
- Laboratory of Structural and Molecular Gynecology (LIM-58), Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
| | | | | | - Manuel de Jesus Simões
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Edmund Chada Baracat
- Laboratory of Structural and Molecular Gynecology (LIM-58), Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
| | - Edna Frasson de Souza Montero
- Laboratory of Surgical Physiopatology (LIM-62), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
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236
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Grynberg M, Bidet M, Benard J, Poulain M, Sonigo C, Cédrin-Durnerin I, Polak M. Fertility preservation in Turner syndrome. Fertil Steril 2015; 105:13-9. [PMID: 26677790 DOI: 10.1016/j.fertnstert.2015.11.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 01/15/2023]
Abstract
Premature ovarian insufficiency is a relatively rare condition that can appear early in life. In a non-negligible number of cases the ovarian dysfunction results from genetic diseases. Turner syndrome (TS), the most common sex chromosome abnormality in females, is associated with an inevitable premature exhaustion of the follicular stockpile. The possible or probable infertility is a major concern for TS patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The severely reduced follicle pool even during prepubertal life represents the major limit for fertility preservation and is the root of numerous questions regarding the competence of gametes or ovarian tissue crybanked. In addition, patients suffering from TS show higher than usual rates of spontaneous abortion, fetal anomaly, and maternal morbidity and mortality, which should be considered at the time of fertility preservation and before reutilization of the cryopreserved gametes. Apart from fulfillment of the desire of becoming genetic parents, TS patients may be potential candidates for egg donation, gestational surrogacy, and adoption. The present review discusses the different options for preserving female fertility in TS and the ethical questions raised by these approaches.
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Affiliation(s)
- Michaël Grynberg
- Department of Reproductive Medicine, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France; University Paris XIII, Bobigny, France; Unité Inserm (U1133), University Paris-Diderot, Paris, France.
| | - Maud Bidet
- Pediatric Endocrinology, Gynecology and Diabetology, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre des Maladies Endocrines Rares de la Croissance, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Julie Benard
- Department of Reproductive Medicine, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France; University Paris XIII, Bobigny, France
| | - Marine Poulain
- Department of Reproductive Biology, Hôpital Courbevoie-Neuilly-Puteaux, Neuilly sur Seine, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Isabelle Cédrin-Durnerin
- Department of Reproductive Medicine, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre des Maladies Endocrines Rares de la Croissance, Centre des Pathologies Gynécologiques Rares, Paris, France; Université Paris Descartes, Institut IMAGINE, Paris, France
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Abstract
Abstract
An essential component of a cancer patient's comprehensive care is addressing potential threats to his or her reproductive health. Providers should discuss the risk of infertility with newly diagnosed patients and offer the chance to consult with a reproductive specialist as early as possible. Standard fertility preservation options include embryo or oocyte cryopreservation for women and sperm banking for men; all options for pre-pubertal children are experimental. Patients with hematologic malignancies are a distinct population in whom standard options may present special challenges, and alternative management strategies are being explored. Unique approaches in hematologic malignancy patients include experimental techniques, such as hormonal therapy, referrals to reproductive specialists after cancer treatment, or discontinuation of tyrosine kinase inhibitor therapy in appropriate chronic myelogenous leukemia patients. Importantly, expedited communication between hematologists and reproductive specialists may greatly enhance the quality of care for these patients. Facilitation of referrals will both improve the quality-of-life and expand the prospect of parenthood in survivors. There are ample opportunities to advance the field of oncofertility through additional research, especially in hematologic malignancy patients.
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238
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Kniazeva E, Hardy AN, Boukaidi SA, Woodruff TK, Jeruss JS, Shea LD. Primordial Follicle Transplantation within Designer Biomaterial Grafts Produce Live Births in a Mouse Infertility Model. Sci Rep 2015; 5:17709. [PMID: 26633657 PMCID: PMC4668556 DOI: 10.1038/srep17709] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022] Open
Abstract
The gonadotoxic effects of chemotherapy and radiation may result in premature ovarian failure in premenopausal oncology patients. Although autotransplantation of ovarian tissue has led to successful live births, reintroduction of latent malignant cells inducing relapse is a significant concern. In this report, we investigated the design of biomaterial grafts for transplantation of isolated ovarian follicles as a means to preserve fertility. Primordial and primary ovarian follicles from young female mice were extracted and encapsulated into biomaterials for subsequent transplantation into adult mice. Among the formulations tested, aggregated follicles encapsulated within fibrin had enhanced survival and integration with the host tissue following transplantation relative to the fibrin-alginate and fibrin-collagen composites. All mice transplanted with fibrin-encapsulated follicles resumed cycling, and live births were achieved only for follicles transplanted within VEGF-loaded fibrin beads. The extent to which these procedures reduce the presence of metastatic breast cancer cells among the isolated follicles was evaluated, with significantly reduced numbers of cancer cells present relative to intact ovaries. This ability to obtain live births by transplanting isolated primordial and primary follicles, while also reducing the risk of re-seeding disease relative to ovarian tissue transplantation, may ultimately provide a means to preserve fertility in premenopausal oncology patients.
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Affiliation(s)
- E Kniazeva
- Department of Chemical and Biological Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Obstetrics and Gynecology, Institute for Women's Health Research, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - A N Hardy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - S A Boukaidi
- Department of Obstetrics and Gynecology and Reproductive Medicine, CHU de Nice, Archet 2 Hospital, Nice, France
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Institute for Women's Health Research, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - J S Jeruss
- Department of Obstetrics and Gynecology, Institute for Women's Health Research, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - L D Shea
- Department of Chemical and Biological Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Obstetrics and Gynecology, Institute for Women's Health Research, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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239
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Rodríguez-Iglesias B, Novella-Maestre E, Herraiz S, Díaz-García C, Pellicer N, Pellicer A. New methods to improve the safety assessment of cryopreserved ovarian tissue for fertility preservation in breast cancer patients. Fertil Steril 2015; 104:1493-502.e1-2. [DOI: 10.1016/j.fertnstert.2015.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 12/16/2022]
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240
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Findeklee S, Lotz L, Heusinger K, Hoffmann I, Dittrich R, Beckmann MW. Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled? Geburtshilfe Frauenheilkd 2015; 75:1243-1249. [PMID: 26726265 PMCID: PMC4686370 DOI: 10.1055/s-0035-1558184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022] Open
Abstract
Protecting the fertility of patients with oncologic disease is becoming more and more important, as fulfilling the wish to have children is increasingly occurring at a later stage in life and long-term survival rates after cancer are continuing to improve. A number of fertility-preserving options exist. In addition to techniques which have been around for some time such as medical ovarian suppression, ovarian transposition, and organ-preserving surgery, there are other, more recent, innovative methods which have developed over the last few years such as cryopreservation of oocytes or ovarian tissue transplantation after completing cancer therapy. As every procedure has its specific advantages and disadvantages, informed patient consent is essential. The physician's aim must be to select the optimal procedure for each patient. The extent of patients' information about the options to preserve fertility in women with oncologic disease remains limited. One of the main reasons for this is that clinicians are not sure how to inform patients about existing procedures and methods. The aim of this review article is to provide help in clinical practice.
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Affiliation(s)
- S. Findeklee
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen
| | - L. Lotz
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen
| | - K. Heusinger
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen
| | - I. Hoffmann
- Gynecologic Endocrinology and Reproductive Medicine, Universitätsklinikum Erlangen, Erlangen
| | - R. Dittrich
- Gynecologic Endocrinology and Reproductive Medicine, Universitätsklinikum Erlangen, Erlangen
| | - M. W. Beckmann
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen
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241
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Affiliation(s)
- Christopher L R Barratt
- Editor In Chief, MHR Reproductive and Developmental Biology, Medical School, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK Assisted Conception Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
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242
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Donnez J, Dolmans MM, Diaz C, Pellicer A. Ovarian cortex transplantation: time to move on from experimental studies to open clinical application. Fertil Steril 2015; 104:1097-8. [DOI: 10.1016/j.fertnstert.2015.08.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
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243
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Lotz L, Hauenstein T, Nichols-Burns SM, Strissel P, Hoffmann I, Findeklee S, Dittrich R, Beckmann MW, Oppelt PG. Comparison of Whole Ovary Cryotreatments for Fertility Preservation. Reprod Domest Anim 2015; 50:958-64. [PMID: 26446780 DOI: 10.1111/rda.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/26/2015] [Indexed: 11/28/2022]
Abstract
The goal of this study was to compare a traditional slow-freeze method (TF) with an open unidirectional slow freeze cooling system (UF) for whole ovary cryopreservation. Therefore, whole pig ovaries were randomly assigned to (A) fresh control, (B) traditional slow freeze (TF) or (C) unidirectional slow freeze (UF). Ovaries were perfused with 10% DMSO in Krebs-Ringer. For TF, whole ovaries were placed in specimen jars containing 10% DMSO and placed into a specialized container for freezing filled with propan-2-ol. For UF, whole ovaries were placed within a specially designed container containing 10% DMSO and transferred to a specialized freezing machine (CTE 920). Histological evaluation demonstrated intact morphology of follicles in all groups; however, an overall decrease of follicle numbers in TF (46%) and UF (50%) compared to fresh control. Live/dead assay indicated significantly lower populations of live cells in both TF (60%) and UF (58%) compared to fresh tissue (74%). TUNEL assay confirmed a difference in percentage of apoptotic follicles between fresh and TF, but there was no significant difference between fresh and UF. To improve the structural and functional integrity of whole ovaries, further investigation, especially into directional freezing, is needed. Whole ovary cryopreservation could provide opportunities for women facing fertility loss due to chemo- or radiotherapy treatment.
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Affiliation(s)
- L Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - T Hauenstein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - S M Nichols-Burns
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Strissel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - I Hoffmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - S Findeklee
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - R Dittrich
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - P G Oppelt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Sonigo C, Sermondade N, Benard J, Benoit A, Shore J, Sifer C, Grynberg M. The past, present and future of fertility preservation in cancer patients. Future Oncol 2015; 11:2667-2680. [DOI: 10.2217/fon.15.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Fertility preservation strategies have been developed for men and women whose fertility is compromised for medical reasons, especially in case of cancer therapy. At present, many reliable options for preserving fertility are available. However, a part of these fertility preservation methods, despite being promising, are still considered experimental. Nevertheless, there are still situations where no methods can be offered. Remarkable scientific progress is currently underway to improve available techniques and to develop new technologies to solve problems with current fertility strategies. These new options may drastically change reproductive options for young patients facing germ cell loss and hence sterility. Therefore, oncofertility counseling by a specialist is recommended for all young cancer patients having to undergo treatment that may reduce fertility potential.
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Affiliation(s)
- Charlotte Sonigo
- Department of Reproductive Medicine, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
- University Paris XIII, 93000 Bobigny, France
- Unité Inserm U1185, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Nathalie Sermondade
- Department of Cytogenetic & Reproductive Biology, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Julie Benard
- Department of Reproductive Medicine, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
- University Paris XIII, 93000 Bobigny, France
| | - Alexandra Benoit
- Department of Reproductive Medicine, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Joanna Shore
- Department of Obstetrics & Gynecology, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Christophe Sifer
- Department of Cytogenetic & Reproductive Biology, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Michael Grynberg
- Department of Reproductive Medicine, Hôpital Jean-Verdier, Avenue du 14 Juillet, 93140 Bondy, France
- University Paris XIII, 93000 Bobigny, France
- Unité Inserm U1133, Université Paris-Diderot, 75013 Paris, France
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Hourvitz A, Yerushalmi G, Maman E, Raanani H, Elizur S, Brengauz M, Orvieto R, Dor J, Meirow D. Combination of ovarian tissue harvesting and immature oocyte collection for fertility preservation increases preservation yield. Reprod Biomed Online 2015; 31:497-505. [DOI: 10.1016/j.rbmo.2015.06.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 12/23/2022]
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246
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Damous LL, Nakamuta JS, Carvalho AETSD, Carvalho KC, Soares JM, Simões MDJ, Krieger JE, Baracat EC. Does adipose tissue-derived stem cell therapy improve graft quality in freshly grafted ovaries? Reprod Biol Endocrinol 2015; 13:108. [PMID: 26394676 PMCID: PMC4580300 DOI: 10.1186/s12958-015-0104-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/11/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A major concern in ovarian transplants is substantial follicle loss during the initial period of hypoxia. Adipose tissue-derived stem cells (ASCs) have been employed to improve angiogenesis when injected into ischemic tissue. This study evaluated the safety and efficacy of adipose tissue-derived stem cells (ASCs) therapy in the freshly grafted ovaries 30 days after injection. METHODS Rat ASCs (rASCs) obtained from transgenic rats expressing green fluorescent protein (GFP)-(5 × 10(4) cells/ovary) were injected in topic (intact) or freshly grafted ovaries of 30 twelve-week-old adult female Wistar rats. The whole ovary was grafted in the retroperitoneum without vascular anastomosis, immediately after oophorectomy. Vaginal smears were performed daily to assess the resumption of the estrous cycle. Estradiol levels, grafts morphology and follicular viability and density were analyzed. Immunohistochemistry assays were conducted to identify and quantify rASC-GFP(+), VEGF tissue expression, apoptosis (cleaved caspase-3 and TUNEL), and cell proliferation (Ki-67). Quantitative gene expression (qPCR) for VEGF-A, Bcl2, EGF and TGF-β1 was evaluated using RT-PCR and a double labeling immunofluorescence assay for GFP and Von Willebrand Factor (VWF) was performed. RESULTS Grafted ovaries treated with rASC-GFP(+) exhibited earlier resumption of the estrous phase (p < 0.05), increased VEGF-A expression (11-fold in grafted ovaries and 5-fold in topic ovaries vs. control) and an increased number of blood vessels (p < 0.05) in ovarian tissue without leading to apoptosis or cellular proliferation (p > 0.05). Estradiol levels were similar among groups (p > 0.05). rASC-GFP(+) were observed in similar quantities in the topic and grafted ovaries (p > 0.05), and double-labeling for GFP and vWF was observed in both injected groups. CONCLUSION rASC therapy in autologous freshly ovarian grafts could be feasible and safe, induces earlier resumption of the estrous phase and enhances blood vessels in rats. This pilot study may be useful in the future for new researches on frozen-thawed ovarian tissue.
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Affiliation(s)
- Luciana L Damous
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, 01246-903, São Paulo, Brazil.
| | - Juliana S Nakamuta
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, 05403-000, São Paulo, Brazil.
| | - Ana E T Saturi de Carvalho
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, 05403-000, São Paulo, Brazil.
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, 01246-903, São Paulo, Brazil.
| | - José Maria Soares
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, 01246-903, São Paulo, Brazil.
| | - Manuel de Jesus Simões
- Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), Botucatu St 740. Ed. Lemos Torres, 2nd floor, Vila Clementino, 04023-009, São Paulo, Brazil.
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, 05403-000, São Paulo, Brazil.
| | - Edmund Chada Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, 01246-903, São Paulo, Brazil.
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von Wolff M, Germeyer A, Nawroth F. Fertility preservation for non-medical reasons: controversial, but increasingly common. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:27-32. [PMID: 25657073 DOI: 10.3238/arztebl.2015.0027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fertility-preserving measures for women are increasingly being performed for non-medical reasons in Germany. This is now a controversial matter. METHODS The authors searched the PubMed database for pertinent publications on the basis of their clinical and scientific experience and evaluated relevant data from the registry of the German FertiPROTEKT network (www.fertiprotekt. com). The various fertility-preserving measures that are available are described and critically discussed. RESULTS In most cases, the creation of a fertility reserve currently involves the cryopreservation of unfertilized oocytes, rather than of ovarian tissue. Most of the women who decide to undergo this procedure are over 35 years old. According to data from the FertiPROTEKT registry, most such procedures carried out in the years 2012 and 2013 involved a single stimulation cycle. The theoretical probability of childbirth per stimulation is 40% in women under age 35 and 30% in women aged 35 to 39. If the oocytes are kept for use at a later date, rather than at once, the maternal risk is higher, because the mother is older during pregnancy. The risk to the child may be higher as well because of the need for in vitro fertilization (IVF). Pregnancy over age 40 often leads to complications such as gestational diabetes and pre-eclampsia. IVF may be associated with a higher risk of epigenetic abnormalities. Ethicists have upheld women's reproductive freedom while pointing out that so-called social freezing merely postpones social problems, rather than solving them. CONCLUSION Fertility preservation for non-medical reasons should be critically discussed, and decisions should be made on a case-by-case basis.
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Affiliation(s)
- Michael von Wolff
- Division of Gynecologic Endocrinology and Reproductive Medicine, University Women's Hospital, Bern, Switzerland, Department of Gynecologic Endocrinology and Fertility Disorders at Heidelberg University Women's Hospital, Center for Fertility, Prenatal Medicine, Endocrinology and Osteology, amedes Hamburg, FertiPROTEKT network
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248
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Meirow D, Roness H, Kristensen SG, Andersen CY. Optimizing outcomes from ovarian tissue cryopreservation and transplantation; activation versus preservation. Hum Reprod 2015; 30:2453-6. [PMID: 26345687 DOI: 10.1093/humrep/dev210] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
Ovarian tissue cryopreservation and transplantation (OTCP) is gaining increasing traction in the field of fertility preservation as a result of accumulated successes. We now have a decade of experience with the technique, with tens of live births and greater than 90% return of ovarian function in graft recipients. Recently, a novel method of OTCP has been described, termed in vitro activated OTCP which proposes significant changes to the standard protocol. This method aims to stimulate activation of dormant follicles within the grafts prior to transplantation and ensure that mature oocytes can be generated in the immediate short term after transplantation. By contrast, conventional OTCP seeks to maintain dormancy and thus preserve the follicle reserve in the graft with the aim of maximizing graft lifespan. This opinion paper will compare the two methods of OTCP, highlighting their respective advantages and disadvantages, and provide suggestions as to when to apply either one of these methods in a clinical setting.
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Affiliation(s)
- Dror Meirow
- Center for Fertility Preservation, IVF Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Hadassa Roness
- Center for Fertility Preservation, IVF Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Stine Gry Kristensen
- Laboratory of Reproductive Biology, University Hospital Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, University Hospital Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Kawamura K, Cheng Y, Sun YP, Zhai J, Diaz-Garcia C, Simon C, Pellicer A, Hsueh AJ. Ovary transplantation: to activate or not to activate. Hum Reprod 2015; 30:2457-60. [PMID: 26345683 DOI: 10.1093/humrep/dev211] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Yuan Cheng
- Department of Ob/Gyn, St. Mariana University, Kawasaki, Japan
| | - Ying-Pu Sun
- Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cesar Diaz-Garcia
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia University and Instituto Universitario IVI/INCLIVA/La Fe University Hospital, Paterna, Spain
| | - Carlos Simon
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia University and Instituto Universitario IVI/INCLIVA/La Fe University Hospital, Paterna, Spain Department of Ob/Gyn, Stanford University School of Medicine, Stanford, CA 94305-5317, USA
| | - Antonio Pellicer
- Fundación Instituto Valenciano de Infertilidad (FIVI), Valencia University and Instituto Universitario IVI/INCLIVA/La Fe University Hospital, Paterna, Spain
| | - Aaron J Hsueh
- Department of Ob/Gyn, Stanford University School of Medicine, Stanford, CA 94305-5317, USA
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Donnez J, Dolmans MM. Transplantation of ovarian tissue. Best Pract Res Clin Obstet Gynaecol 2015; 28:1188-97. [PMID: 25450187 DOI: 10.1016/j.bpobgyn.2014.09.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/20/2014] [Indexed: 11/24/2022]
Abstract
Since the first live birth after orthotopic transplantation of frozen-thawed ovarian tissue, >40 babies have been born. It is time to consider fertility preservation in women as one of the foremost challenges of the next decade and to offer women facing the risk of induced or iatrogenic premature menopause the best chances of becoming mothers. Heterotopic transplantation has also been attempted, with consistent restoration of endocrine function; nonetheless, its clinical value remains questionable as it may not provide an optimal environment for follicular development, possibly because of differences in temperature, pressure, paracrine factors and blood supply. Finally, orthotopic allo-transplantation of fresh human ovarian tissue has been successfully attempted between monozygotic twins and also between genetically different sisters. The next step in this field will be the development of an artificial ovary, using, as a support, a biodegradable scaffold made of an alginate matrigel matrix onto which isolated preantral follicles and ovarian cells can be grafted.
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Affiliation(s)
- Jacques Donnez
- SRI, Societe de Recherche pour l'Infertilite, Avenue Grandchamp 143, B-1150 Brussels, Belgium
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