1
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Katzir T, Shrem G, Meirow D, Berkowitz E, Elizur S, Cohen S, Burke Y, Retchkiman M, Or Y, Volodarsky-Perel A. Fertility preservation parameters in patients with haematologic malignancy: a systematic review and meta-analysis. Reprod Biomed Online 2024; 49:103978. [PMID: 38805862 DOI: 10.1016/j.rbmo.2024.103978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
Patients with haematologic malignancies represent one of the most common groups referred for fertility preservation before gonadotoxic oncological treatment. The aim of this systematic review and meta-analysis was to evaluate the effect of haematologic cancer on ovarian reserve and response to ovarian stimulation compared with healthy controls. A total of eight observative studies were included in the final quantitative analysis. Despite a younger age (mean difference -4.17, 95% CI -6.20 to -2.14; P < 0.0001), patients with haematologic malignancy had lower serum anti-Müllerian hormone levels compared with the control group (MD -1.04, 95% CI -1.80 to -0.29; P = 0.007). The marginally higher total recombinant FSH dose (MD 632.32, 95% CI -187.60 to 1452.24; P = 0.13) and significantly lower peak oestradiol serum level (MD -994.05, 95% CI -1962.09 to -26.02; P = 0.04) were demonstrated in the study group compared with the healthy controls. A similar number of retrieved oocytes were achieved in both groups (MD 0.20, 95% CI -0.80 to 1.20; P = 0.69). In conclusion, haematologic malignancies may detrimentally affect ovarian function manifesting in decreased AMH serum levels despite a younger age compared with healthy controls. This effect can be overcome by the application of relevant IVF protocols and stimulation doses to achieve an adequate oocyte yield.
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Affiliation(s)
- Tamar Katzir
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Guy Shrem
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dror Meirow
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Berkowitz
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Elizur
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yechiel Burke
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Retchkiman
- Soroka Medical Center, Be'er Sheva, Israel; The Faculty of Medicine, Ben Gurion University, Be'er Sheva, Israel
| | - Yuval Or
- Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alexander Volodarsky-Perel
- Sheba Medical Center, Ramat Gan, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel..
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Villarreal-Garza C, Mesa-Chavez F, Plata de la Mora A, Miaja-Avila M, Garcia-Garcia M, Fonseca A, de la Rosa-Pacheco S, Cruz-Ramos M, García Garza MR, Mohar A, Bargallo-Rocha E. Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico. J Natl Compr Canc Netw 2021; 19:1-8. [PMID: 34153944 DOI: 10.6004/jnccn.2020.7692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The "Joven & Fuerte: Program for Young Women With Breast Cancer" strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. METHODS Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. RESULTS In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. CONCLUSIONS By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.
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Affiliation(s)
- Cynthia Villarreal-Garza
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Fernanda Mesa-Chavez
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Alejandra Plata de la Mora
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | - Melina Miaja-Avila
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Marisol Garcia-Garcia
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Alan Fonseca
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | | | - Marlid Cruz-Ramos
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | | | - Alejandro Mohar
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 6Unidad de Epidemiologia e Investigacion Biomedica en Cancer, Instituto Nacional de Cancerologia, and
- 7Instituto de Biomedicas, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, México
| | - Enrique Bargallo-Rocha
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
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Lee S, Ozkavukcu S, Ku SY. Current and Future Perspectives for Improving Ovarian Tissue Cryopreservation and Transplantation Outcomes for Cancer Patients. Reprod Sci 2021; 28:1746-1758. [PMID: 33791995 PMCID: PMC8144135 DOI: 10.1007/s43032-021-00517-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
Although advances in cancer treatment and early diagnosis have significantly improved cancer survival rates, cancer therapies can cause serious side effects, including ovarian failure and infertility, in women of reproductive age. Infertility following cancer treatment can have significant adverse effects on the quality of life. However, established methods for fertility preservation, including embryo or oocyte cryopreservation, are not always suitable for female cancer patients because of complicated individual conditions and treatment methods. Ovarian tissue cryopreservation and transplantation is a promising option for fertility preservation in pre-pubertal girls and adult patients with cancer who require immediate treatment, or who are not eligible to undergo ovarian stimulation. This review introduces various methods and strategies to improve ovarian tissue cryopreservation and transplantation outcomes, to help patients and clinicians choose the best option when considering the potential complexity of a patient's situation. Effective multidisciplinary oncofertility strategies, involving the inclusion of a highly skilled and experienced oncofertility team that considers cryopreservation methods, thawing processes and devices, surgical procedures for transplantation, and advances in technologies, are necessary to provide high-quality care to a cancer patient.
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Affiliation(s)
- Sanghoon Lee
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA.
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Sinan Ozkavukcu
- Center for Assisted Reproduction, Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Calvo C, Ronceray L, Dhédin N, Buechner J, Troeger A, Dalle JH. Haematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukaemia: Special Considerations and Challenges. Front Pediatr 2021; 9:796426. [PMID: 35087777 PMCID: PMC8787274 DOI: 10.3389/fped.2021.796426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Adolescents and young adults (AYAs) represent a challenging group of acute lymphoblastic leukaemia (ALL) patients with specific needs. While there is growing evidence from comparative studies that this age group profits from intensified paediatric-based chemotherapy, the impact and optimal implementation of haematopoietic stem cell transplantation (HSCT) in the overall treatment strategy is less clear. Over recent years, improved survival rates after myeloablative allogeneic HSCT for ALL have been reported similarly for AYAs and children despite differences in transplantation practise. Still, AYAs appear to have inferior outcomes and an increased risk of treatment-related morbidity and mortality in comparison with children. To further improve HSCT outcomes and reduce toxicities in AYAs, accurate stratification and evaluation of additional or alternative targeted treatment options are crucial, based on specific molecular and immunological characterisation of ALL and minimal residual disease (MRD) assessment during therapy. Age-specific factors such as increased acute toxicities and poorer adherence to treatment as well as late sequelae might influence treatment decisions. In addition, educational, social, work, emotional, and sexual aspects during this very crucial period of life need to be considered. In this review, we summarise the key findings of recent studies on treatment approach and outcomes in this vulnerable patient group after HSCT, turning our attention to the different approaches applied in paediatric and adult centres. We focus on the specific needs of AYAs with ALL regarding social aspects and supportive care to handle complications as well as fertility issues. Finally, we comment on potential areas of future research and concisely debate the capacity of currently available immunotherapies to reduce toxicity and further improve survival in this challenging patient group.
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Affiliation(s)
- Charlotte Calvo
- Pediatric Hematology and Immunology Department, Robert Debré Academic Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Leila Ronceray
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Nathalie Dhédin
- Hematology for Adolescents and Young Adults, Saint-Louis Academic Hospital GHU APHP Nord - Université de Paris, Paris, France
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Anja Troeger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Robert Debré Academic Hospital, GHU APHP Nord - Université de Paris, Paris, France
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Cho HW, Lee S, Min KJ, Hong JH, Song JY, Lee JK, Lee NW, Kim T. Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity. Int J Mol Sci 2020; 21:ijms21207792. [PMID: 33096794 PMCID: PMC7589665 DOI: 10.3390/ijms21207792] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility preservation options including established and experimental techniques that take into consideration the patient’s age, marital status, chemotherapy regimen, and the possibility of treatment delay should be provided. In addition, effective multidisciplinary oncofertility strategies that involve a highly skilled and experienced oncofertility team consisting of medical oncologists, gynecologists, reproductive biologists, surgical oncologists, patient care coordinators, and research scientists are necessary to provide cancer patients with high-quality care.
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6
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Equal opportunity for all? An analysis of race and ethnicity in fertility preservation in New York City. J Assist Reprod Genet 2020; 37:3095-3102. [PMID: 33085025 PMCID: PMC7576106 DOI: 10.1007/s10815-020-01980-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare the racial and ethnic make-up of patients who accessed medically indicated fertility preservation services (MIFP) against the overall racial diversity (including Hispanic origin) across women of reproductive age diagnosed with cancer in New York City (NYC). Methods All patients who completed at least one MIFP between January 2017 and December 2018 were reviewed. Race was self-reported. A calculation of the expected racial distribution across women of reproductive age with cancer in NYC was determined using the most recent NYC census data. Statistical analysis included chi-square goodness of fit and test for independence and Kruskal-Wallis H test, with p < 0.05 considered significant. Results A total of 107 patients who accessed MIFP were included. A total of 55 (51.4%) identified as White, 3 (2.8%) as Black, 13 (12.2%) as Asian, 6 (5.6%) as Hispanic, 3 (2.8%) as other, and 27 (25.2%) did not report. A total of 78.5% of patients had insurance. There was no significant difference in racial distribution by cancer type (p = 0.255). A subgroup analysis excluding the BRCA+ patients and races not reported by the census (n = 69) was then performed, showing a statistically significant difference between observed (O) and expected (E) cases of fertility preservation (FP) by race at our center—White 47O/32E, Black 3O/15E, Asian 13O/7E, and Hispanic 6O/15E (p < 0.001). A statistically significant difference in racial distribution by FP type was observed. Conclusions There is a difference in the observed vs expected racial distribution of patients accessing MIFP. Further studies are needed to identify modifiable factors to better ensure equal opportunity to all patients.
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7
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Rodriguez-Wallberg KA, Anastacio A, Vonheim E, Deen S, Malmros J, Borgström B. Fertility preservation for young adults, adolescents, and children with cancer. Ups J Med Sci 2020; 125:112-120. [PMID: 32356507 PMCID: PMC7721046 DOI: 10.1080/03009734.2020.1737601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Options for fertility preservation (FP) through cryopreservation methods are currently available for young adults, adolescents, and children. Guidelines for FP have been provided by international clinical societies, and emergency procedures aimed at FP have been implemented into clinical practice worldwide. In this article, we review the current data on clinical standards of emergency FP in patients who are facing gonadotoxic effects of cancer treatment, and we also describe the methods that are still under development, usually denoted as experimental. In Sweden, programmes for FP have been established at large university hospitals, thus covering the whole country. The Swedish publicly financed health care covers both assisted reproduction for treatment of infertility and the cryopreservation of gametes or gonadal tissue when there is a medical indication, such as the risk to become infertile due to oncologic treatment; hence the access to FP is ensured for the whole population. At our centre at Karolinska University Hospital in Stockholm, methods for FP have been offered since 1988. In this article, we also review the oncologic indications for FP in our patient cohort of >3000 individuals during the period 1988-2018.
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Affiliation(s)
- Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- CONTACT Kenny A. Rodriguez-Wallberg Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital Huddinge, StockholmSE-141 86, Sweden
| | - Amandine Anastacio
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Vonheim
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Deen
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Malmros
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Birgit Borgström
- Department of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
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Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? JCO Glob Oncol 2020; 6:356-359. [PMID: 35275744 PMCID: PMC9812502 DOI: 10.1200/go.22.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Avner Hershlag
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY,Corresponding author: Avner Hershlag, MD, Northwell
Health Fertility, 300 Community Dr, Manhasset, NY 11030; e-mail:
| | - Christine Mullin
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
| | - Sara L. Bristow
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
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9
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Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? JCO Glob Oncol 2020; 6:1700213. [PMID: 32259161 PMCID: PMC7853872 DOI: 10.1200/jgo.17.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Avner Hershlag
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Christine Mullin
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Sara L Bristow
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
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Akel RA, Guo XM, Moravek MB, Confino R, Smith KN, Lawson AK, Klock SC, Tanner Iii EJ, Pavone ME. Ovarian Stimulation Is Safe and Effective for Patients with Gynecologic Cancer. J Adolesc Young Adult Oncol 2020; 9:367-374. [PMID: 31923372 DOI: 10.1089/jayao.2019.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To compare long-term outcomes of gynecologic cancer patients who pursued controlled ovarian hyperstimulation (COH) for fertility preservation (FP) with those who did not. Methods: Retrospective cohort, COH, and health outcomes in gynecologic cancer patients; data were analyzed by chi-square test, t-tests, and logistic regression. Results: Ninety patients with a gynecologic malignancy contacted the FP patient navigator: 45.6% (n = 41) had ovarian cancer, 25.6% (n = 23) endometrial cancer, 18.9% (n = 17) cervical cancer, 5.6% (n = 5) uterine cancer, and 4.4% (n = 4) multiple gynecologic cancers. From this cohort, 32 underwent COH, 43 did not, and 18 pursued ovarian tissue cryopreservation (OTC; 3 patients had both COH and OTC). Median age and type of cancer were not significantly different between the groups. COH patients had a range of 1-35 oocytes retrieved. Days to next cancer treatment in the COH group was 36 days; for those who declined COH, it was 22 days (not significant [NS], p > 0.05). There were two recurrences reported in the stimulation group and four in the no stimulation group (NS). Five deaths were reported, two in the stimulation group, none in the no stimulation group, and three in the OTC group (NS); 34% (n = 11) COH patients returned to use cryopreserved specimens, of which 45% (n = 5) had a live birth. Conclusion: Although time to next treatment was longer in the group of patients who underwent COH, this did not reach statistical significance. It appears that in selected patients with GYN malignancies, COH for oocyte or embryo cryopreservation is safe, with reasonable stimulation outcomes and no difference in long-term outcomes.
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Affiliation(s)
- Ruba A Akel
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xiaoyue M Guo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristin N Smith
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Angela K Lawson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan C Klock
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward J Tanner Iii
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Corkum KS, Rhee DS, Wafford QE, Demeestere I, Dasgupta R, Baertschiger R, Malek MM, Aldrink JH, Heaton TE, Weil BR, Madonna MB, Lautz TB. Fertility and hormone preservation and restoration for female children and adolescents receiving gonadotoxic cancer treatments: A systematic review. J Pediatr Surg 2019; 54:2200-2209. [PMID: 30773394 DOI: 10.1016/j.jpedsurg.2018.12.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this systematic review by the American Pediatric Surgical Cancer Committee was to summarize evidence from the current medical literature regarding fertility restoration and hormone replacement for female children and adolescents treated with gonadotoxic treatments. METHODS Using PRISMA guidelines, questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Eligible studies included those that addressed ovarian tissue cryopreservation (OTC), oocyte harvest, ovarian transposition, and ovarian tissue auto-transplantation for females under the age of 20. Four reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Study outcomes were summarized in a narrative synthesis. RESULTS Two thousand two hundred seventy-six studies were identified by database search and manual review and 2185 were eliminated based on defined exclusion criteria. Ninety-one studies served as the basis for the systematic review. There were 1019 patients who underwent OTC with ages ranging from 0.4 to 20.4 years old, with 298 under the age of 13. Twenty patients aged 13-20 years old underwent successful oocyte harvest. Thirty-seven children underwent ovarian transposition as a means of fertility preservation. Eighteen patients underwent auto-transplantation of thawed ovarian cortical tissue that was harvested before the age of 21 years resulting in 10 live births. CONCLUSIONS Clinically accepted and experimental fertility preservation options such as OTC, oocyte cryopreservation, and ovarian transposition are available to females aged 20 years and younger who are at risk for premature ovarian insufficiency and infertility due to gonadotoxic treatments. There is a large cohort of pediatric-aged patients, with a wide variety of diagnoses and treatments, who have undergone fertility preservation. Currently, fertility and hormone restoration experience for patients who were 20- years of age or younger at the time of fertility preservation remains limited. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kristine S Corkum
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isabelle Demeestere
- Research Laboratory in Human Reproduction, Université Libre de Bruxelles, (ULB), Brussels, Belgium
| | | | - Reto Baertschiger
- Division of Pediatric Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Todd E Heaton
- Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | | | - Timothy B Lautz
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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von Wolff M, Andersen CY, Woodruff TK, Nawroth F. FertiPROTEKT, Oncofertility Consortium and the Danish Fertility-Preservation Networks - What Can We Learn From Their Experiences? CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119845865. [PMID: 31068758 PMCID: PMC6495450 DOI: 10.1177/1179558119845865] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/27/2019] [Indexed: 01/18/2023]
Abstract
Fertility preservation is an increasingly important discipline. It requires close coordination between reproductive medicine specialists, reproductive biologists, and oncologists in various disciplines. In addition, it represents a particular health policy challenge, since fertility-protection measures are to be understood as a treatment for side effects of gonadotoxic treatments and would therefore normally have to be reimbursed by health insurance companies. Therefore, it is inevitable that fertility-preservation activities should organise themselves into a network structure both as a medical-logistic network and as a professional medical society. The necessary network structures can differ significantly at regional, national, and international level, as the size of the regions to be integrated and the local cultural and geographical conditions, as well as the political conditions are very different. To address these issues, the current review aims to point out the basic importance and the chances but also the difficulties of fertility-protection networks and give practical guidance for the development of such network structures. We will not only discuss network structures theoretically but also present them based on three established, different sized networks, such as the Danish Network (www.rigshospitalet.dk), representing a centralised network in a small country; the German-Austrian-Swiss network FertiPROTEKT® (www.fertiprotekt.com), representing a centralised as well as decentralised network in a large country; and the Oncofertility® Consortium (www.oncofertility.northwestern.edu), representing a decentralised, internationally oriented network, primarily serving the transfer of knowledge among its members.
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Affiliation(s)
- Michael von Wolff
- University Women’s Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University Hospital, Bern, Switzerland
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Faculty of Health Science, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Frank Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes group, Hamburg, Germany
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Rodriguez-Wallberg KA, Marklund A, Lundberg F, Wikander I, Milenkovic M, Anastacio A, Sergouniotis F, Wånggren K, Ekengren J, Lind T, Borgström B. A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. Acta Obstet Gynecol Scand 2019; 98:604-615. [PMID: 30723910 DOI: 10.1111/aogs.13559] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/29/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary-care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients' choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications. MATERIAL AND METHODS Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi-square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications. RESULTS Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre-pubertal (n = 48) and 73% of post-pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002). CONCLUSIONS Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Marklund
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Frida Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ida Wikander
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Milan Milenkovic
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Amandine Anastacio
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fotios Sergouniotis
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kjell Wånggren
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Ekengren
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tekla Lind
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Birgit Borgström
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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14
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Melo C, Moura-Ramos M, Canavarro MC, Almeida-Santos T. The time is now: An exploratory study regarding the predictors of female cancer patients' decision to undergo fertility preservation. Eur J Cancer Care (Engl) 2019; 28:e13025. [PMID: 30809894 DOI: 10.1111/ecc.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/07/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This cross-sectional exploratory study aimed to examine the female cancer patients' personal and health care-related variables mostly associated with their decision whether to preserve or not their fertility, in order to know more about the influence of attitudinal and health care-related variables on this decision where fertility preservation (FP) is fully covered by the National Health System. METHODS Childbearing attitudes, health care-related information, FP motivations and childbearing motivations were assessed, in a clinical setting, to female cancer patients in childbearing age, who were undergoing the FP decision-making process. RESULTS This study included 89 participants (82% response rate). Those who decided to undergo FP attributed more value to the reasons for FP and less value to the reasons against FP than those who decided not to undergo FP. Not having children, strongly valuing pregnancy after cancer and attributing low value to the implications of the postponement of cancer treatments were significant and independently associated with deciding to preserve fertility. CONCLUSION The decision to pursue FP is mainly influenced by three factors: the absence of children, attributing high value to trying to ensure future pregnancy and attributing low value to the possible postponement of cancer therapy in order to have time to preserve fertility.
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Affiliation(s)
- Cláudia Melo
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Portuguese Centre for Fertility Preservation, Reproductive Medicine Department, Coimbra Hospital and University Centre, Coimbra, Portugal
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15
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Smith KL, Gracia C, Sokalska A, Moore H. Advances in Fertility Preservation for Young Women With Cancer. Am Soc Clin Oncol Educ Book 2018; 38:27-37. [PMID: 30231357 DOI: 10.1200/edbk_208301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.
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Affiliation(s)
- Karen Lisa Smith
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Clarisa Gracia
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Anna Sokalska
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Halle Moore
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
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16
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Cosgrove CM, Salani R. Ovarian effects of radiation and cytotoxic chemotherapy damage. Best Pract Res Clin Obstet Gynaecol 2018; 55:37-48. [PMID: 30166215 DOI: 10.1016/j.bpobgyn.2018.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 01/31/2023]
Abstract
Oncologic therapy including chemotherapy and radiation can have a significant impact on ovarian function for young women and girls. Poor health outcomes and loss of fertility are major considerations. The effect of radiation and chemotherapy on ovarian function varies depending on patient age, therapy type and dosage, and cancer type. Surgical and medical interventions are available to reduce the morbidity of premature ovarian failure associated with cancer-directed therapy. Fertility preservation is an important consideration, and several options are available for it; therefore, early consultation with a reproductive or oncofertility specialist is an essential part of oncologic care in young women or girls. This chapter will focus on the effects of radiation and chemotherapy on ovarian function and strategies to improve the reproductive care in women with cancer.
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Affiliation(s)
- Casey M Cosgrove
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ritu Salani
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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17
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von Wolff M, Germeyer A, Liebenthron J, Korell M, Nawroth F. Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques. Arch Gynecol Obstet 2017; 297:257-267. [PMID: 29181578 PMCID: PMC5762782 DOI: 10.1007/s00404-017-4595-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 12/24/2022]
Abstract
Purpose In addition to guidelines focusing on scientific evidence, practical recommendations on fertility preservation are also needed. Methods A selective literature search was performed based on the clinical and scientific experience of the authors. This article (Part II) focuses on fertility preservation techniques. Part I, also published in this journal, provides information on disease prognosis, disease-specific therapy, and risks for loss of fertility. Results Ovarian stimulation including double stimulation and freezing of oocytes is the best-established therapy providing live birth chances in women < 35 years with high ovarian reserve of around 30–40%. Ovarian tissue freezing is especially useful in young women with good ovarian, if spontaneous conception is favoured and if < 1 week until chemotherapy is provided. Data on success rates are still limited, but this further evolving technique will possibly reach similar success rates as ovarian stimulation. GnRH agonists seem to reduce the risk of premature ovarian failure up to 50%; however, the effect is possibly not long-lasting. Ovarian transposition can easily be combined with freezing of ovarian tissue and is the preferred technique before pelvic radiotherapy. Other techniques, such as in vitro maturation, are limited to women with high ovarian reserve and remain less effective. In addition, procedures such as in vitro growth of follicles, etc. are still experimental. Conclusions Fertility preservation in women provides realistic chances of becoming pregnant. The choice of technique needs to be based on the time required, the woman’s age, its risks and efficacy, and the individual preference of the patient.
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Affiliation(s)
- Michael von Wolff
- Division of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Berne, Berne, Switzerland.
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's hospital, Inselspital Bern, Effingerstrasse 102, 3010, Bern, Switzerland.
| | - A Germeyer
- Department of Gynaecological Endocrinology and Fertility Disorders, Medical University of Heidelberg, Heidelberg, Germany
| | - J Liebenthron
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - M Korell
- Department of Obstetrics and Gynaecology, Johanna Etienne Hospital of Neuss, Neuss, Germany
| | - F Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Hamburg, Hamburg, Germany
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18
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Beckmann MW, Dittrich R, Lotz L, van der Ven K, van der Ven HH, Liebenthron J, Korell M, Frambach T, Sütterlin M, Schwab R, Seitz S, Müller A, von Wolff M, Häberlin F, Henes M, Winkler-Crepaz K, Krüssel JS, Germeyer A, Toth B. Fertility protection: complications of surgery and results of removal and transplantation of ovarian tissue. Reprod Biomed Online 2017; 36:188-196. [PMID: 29198423 DOI: 10.1016/j.rbmo.2017.10.109] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Fertility-preserving measures are becoming important for patients receiving oncological treatment. One method involves cryopreservation of ovarian tissue and transplanting it when treatment is completed. We report complications resulting from surgical and fertility medicine, and the results of procedures for the removal and transplantation of ovarian tissue carried out within the FertiProtekt network. A survey using a structured questionnaire was conducted among the FertiProtekt network centres between November 2015 and June 2016. The analysis included surgical techniques used to remove and transplant ovarian tissue, surgical complications and results. Laparoscopic removal and transplantation of ovarian tissue have a low risk of complications. Surgical complications occurred in three of the network's 1373 ovarian tissue removals (n = 1302) and transplantations (n = 71); two complications (0.2%) occurred during removal and one during transplantation. Menstruation resumed in 47 out of 58 women (81%) who underwent ovarian tissue transplantation. Hormonal activity occurred in 63.2% of transplantations with a follow-up of 6 months or over. Sixteen pregnancies occurred in 14 patients, with nine births. The risks and complications of removal and transplantation of ovarian tissue are similar to those of standard laparoscopy. These procedures are becoming standard for fertility protection in cancer patients.
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Affiliation(s)
- Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany.
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Karin van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Hans H van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Jana Liebenthron
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne Hospital Neuss, 41462 Neuss, Germany
| | - Torsten Frambach
- Department of Obstetrics and Gynecology, St. Joseph Hospital Bremen, 28209 Bremen, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, Mannheim University Hospital, Ruprecht-Karls University of Heidelberg, 68167 Mannheim, Germany
| | - Roxana Schwab
- Department of Obstetrics and Gynecology, Freiburg University Hospital, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany (now Mainz University Hospital, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany)
| | - Stefan Seitz
- Department of Obstetrics and Gynecology, Caritas- Hospital St. Josef, University of Regensburg, 93053 Regensburg, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Hospital Karlsruhe, 76133 Karlsruhe, Germany
| | - Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, 3010 Berne, Switzerland
| | - Felix Häberlin
- Department of Obstetrics and Gynaecology, Kantonspital, 9007 St. Gallen, Switzerland
| | - Melanie Henes
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Katharina Winkler-Crepaz
- Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria
| | - Jan S Krüssel
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Ariane Germeyer
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
| | - Bettina Toth
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
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19
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Kyono K, Hashimoto T, Toya M, Koizumi M, Sasaki C, Shibasaki S, Aono N, Nakamura Y, Obata R, Okuyama N, Ogura Y, Igarashi H. A transportation network for human ovarian tissue is indispensable to success for fertility preservation. J Assist Reprod Genet 2017; 34:1469-1474. [PMID: 28866830 PMCID: PMC5699996 DOI: 10.1007/s10815-017-1022-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/11/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the efficacy of an ovarian tissue transportation network for fertility preservation (FP) for cancer patients in Japan. METHODS PubMed was searched for papers on transportation of human ovarian tissue for FP. We analyzed population, area, number of cancer patients for ovarian tissue cryopreservation (OTC), quality control/assessment and safety, cost of a cryopreservation center for the building for 30 years, and medical fees of cancer patients (operation, cryopreservation, and storage of ovarian tissue). RESULTS More than twenty babies have been born in Denmark and Germany through a transportation system. Up to 400 new patients a year need OTC. The fees for removal, cryopreservation, and storage for 5 years, and transplantation of ovarian tissue are around €5,000, €4,000, and €5,000, respectively. It costs more than €5 million to establish and maintain one cryopreservation center for 30 years. If we have a few cryopreservation centers in Japan, we can cryopreserve 400 patients' ovarian tissue per year by safer slow freezing and maintain quality control/assessment. We need to lighten the patients' burden for easy to use FP by a government subsidy and medical insurance coverage. CONCLUSIONS This model has been termed the Danish model ("the woman stays - the tissue moves"). This is truly patient-centered medicine. We can have maximum effects with the minimum burden. A transportation network like those of Denmark and Germany is the best strategy for FP in Japan. It may be the best system for cancer patients, medical staff, and the Ministry of Health, Labor, and Welfare.
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Affiliation(s)
- K Kyono
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan.
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan.
| | - T Hashimoto
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - M Toya
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - M Koizumi
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - C Sasaki
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - S Shibasaki
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - N Aono
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - Y Nakamura
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - R Obata
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - N Okuyama
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - Y Ogura
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
| | - H Igarashi
- Kyono ART Clinic Takanawa, Takanawa Court 5F, 3-13-1 Takanawa, Minatoku, Tokyo, 108-0074, Japan
- Kyono ART Clinic, 1-1-1-3F, Honcho, Aobaku, Sendai, Miyagi, 980-0014, Japan
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20
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Balduzzi A, Dalle JH, Jahnukainen K, von Wolff M, Lucchini G, Ifversen M, Macklon KT, Poirot C, Diesch T, Jarisch A, Bresters D, Yaniv I, Gibson B, Willasch AM, Fadini R, Ferrari L, Lawitschka A, Ahler A, Sänger N, Corbacioglu S, Ansari M, Moffat R, Dalissier A, Beohou E, Sedlacek P, Lankester A, De Heredia Rubio CD, Vettenranta K, Wachowiak J, Yesilipek A, Trigoso E, Klingebiel T, Peters C, Bader P. Fertility preservation issues in pediatric hematopoietic stem cell transplantation: practical approaches from the consensus of the Pediatric Diseases Working Party of the EBMT and the International BFM Study Group. Bone Marrow Transplant 2017; 52:1406-1415. [PMID: 28737775 DOI: 10.1038/bmt.2017.147] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/31/2017] [Accepted: 06/04/2017] [Indexed: 12/14/2022]
Abstract
Fertility preservation is an urgent challenge in the transplant setting. A panel of transplanters and fertility specialists within the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) and the International BFM Study Group provides specific guidelines. Patients and families should be informed of possible gender- and age-specific cryopreservation strategies that should be tailored according to the underlying disease, clinical condition and previous exposure to chemotherapy. Semen collection should be routinely offered to all postpubertal boys at the diagnosis of any disease requiring therapy that could potentially impair fertility. Testicular tissue collection might be offered to postpubertal boys; nevertheless, its use has been unsuccessful to date. Oocyte collection after hormonal hyperstimulation should be offered to postpubertal girls facing gonadotoxic therapies that could be delayed for the 2 weeks required for the procedure. Ovarian tissue collection could be offered to pre-/post-pubertal girls. Pregnancies have been reported after postpubertal ovarian tissue reimplantation; however, to date, no pregnancy has been reported after the reimplantation of prepubertal ovarian tissue or in vitro maturation of pre-/post-pubertal ovarian tissue. Possible future advances in reproductive medicine could change this scenario. Health authorities should prioritize fertility preservation projects in pediatric transplantation to improve patient care and quality of life.
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Affiliation(s)
- A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - J-H Dalle
- Hemato-Immunology Department, Robert-Debre Hospital, APHP and Paris-Diderot University, Paris, France
| | - K Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M von Wolff
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Inselspital Bern, University Hospital, Bern, Switzerland
| | - G Lucchini
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, UK
| | - M Ifversen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K T Macklon
- The Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Poirot
- Adolescent and Young Adult Hematology Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France
| | - T Diesch
- Department of Pediatric Hematology/Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - A Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - D Bresters
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - I Yaniv
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Gibson
- Department of Paediatric Haematology, Royal Hospital for Children, Scotland, UK
| | - A M Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - R Fadini
- Centro di Medicina della Riproduzione Biogenesi, Istituti Clinici Zucchi, Monza, Italy
| | - L Ferrari
- Department of Gynecology and Obstetrics, Ospedale San Gerardo di Monza, Monza, Italy
| | - A Lawitschka
- St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria
| | - A Ahler
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland
| | - N Sänger
- Division of Reproductive Medicine, Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospital, JW Goethe University, Frankfurt, Germany
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital, University of Regensburg, Regensburg, Germany
| | - M Ansari
- Department of Pediatrics, Hémato-Oncologie Pédiatrique, CANSEARCH Research Laboratory, Université de Médecine de Genève, Geneva, Switzerland
| | - R Moffat
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland
| | - A Dalissier
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - E Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - A Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - C D De Heredia Rubio
- Pediatric Oncology and Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - K Vettenranta
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Yesilipek
- Bahcesehir University School of Medicine, Department of Pediatrics, Pediatric Stem Cell Transplantation Unit, Istanbul, Turkey
| | - E Trigoso
- Paediatric Oncology Unit, Paediatric Transplant Unit, Polytechnic and University Hospital 'LA FE', Valencia, Spain
| | - T Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - C Peters
- St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria
| | - P Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
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State-of-the-art fertility preservation in children and adolescents undergoing haematopoietic stem cell transplantation: a report on the expert meeting of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) in Baden, Austria, 29-30 September 2015. Bone Marrow Transplant 2017; 52:1029-1035. [PMID: 28287638 DOI: 10.1038/bmt.2017.21] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/30/2016] [Indexed: 12/26/2022]
Abstract
Nowadays, allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a well-established treatment procedure and often the only cure for many patients with malignant and non-malignant diseases. Decrease in short-term complications has substantially contributed to increased survival. Therefore long-term sequelae are reaching the focus of patient care. One of the most important risks of stem cell transplant survivors is infertility. As well as in the field of allo-HSCT also the field of reproductive medicine has achieved substantial advances to offer potential options for fertility preservation in both boys and girls. Access to these procedures as well as their financing differs significantly throughout Europe. As all European children and adolescents should have the same possibility, the Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation organised an expert meeting in September 2015. This manuscript describes the recommendations for the diagnosis and pre-emptive procedures that should be offered to all children and adolescents in Europe who have to undergo an allo-HSCT.
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Beckmann MW, Dittrich R, Lotz L, Oppelt PG, Findeklee S, Hildebrandt T, Heusinger K, Cupisti S, Müller A. Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience. Arch Gynecol Obstet 2017; 295:1033-1039. [PMID: 28197717 DOI: 10.1007/s00404-017-4311-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates. METHODS The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket. RESULTS Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels. CONCLUSIONS The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15-30%, can be expected to rise further in the near future.
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Affiliation(s)
- Matthia W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Sebastian Findeklee
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Susanne Cupisti
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Klinikum Karlsruhe, Karlsruhe, Germany
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Abstract
Breast cancer is the most common non-cutaneous malignancy among women, and there are over 3 million breast cancer survivors living in the United States today. Excellent cure rates with modern therapies are associated with substantial toxicities for many women; it is important that health care providers attend to the resulting symptoms and issues to optimize quality of life in this population. In this article, we review management options for potential long term toxicities in breast cancer survivors, with a particular focus on bone health, fertility preservation, premature menopause, cardiac dysfunction, and cognitive impairment.
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Beckmann MW, Dittrich R, Findeklee S, Lotz L. Surgical Aspects of Ovarian Tissue Removal and Ovarian Tissue Transplantation for Fertility Preservation. Geburtshilfe Frauenheilkd 2016; 76:1057-1064. [PMID: 27761026 PMCID: PMC5065421 DOI: 10.1055/s-0042-115017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction: The removal of ovarian tissue prior to starting oncologic treatment and the subsequent transplantation of this tissue after completing therapy have become increasingly important surgical fertility-preserving techniques. The aim of this review was to investigate the different surgical techniques used for this method reported in the literature to date and to discuss the advantages and disadvantages of the respective techniques. Review: A search was done in MEDLINE using a defined algorithm to find studies published between January 2004 and December 2015. All study designs were included in our review if they contained statements on the surgical technique used. We found 16 publications (8 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 1898 female patients which reported on the surgical technique used for ovarian biopsy and 15 publications (7 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 455 women which mentioned the surgical technique used for ovarian transplantation. Different surgical techniques can be used both for ovarian biopsy and for the transplantation of ovarian tissue. A number of different surgical routes have been used, and the amount of tissue extracted, the instruments used, the treatment of the ovary, the transplantation site, the blood supply to the transplanted ovarian tissue and the procedure used for simultaneous surgical interventions vary. Conclusion: In future, one of the tasks will be to establish a standard surgical method for ovarian extraction and transplantation which will have a low rate of complications and a high pregnancy and birth rate while ensuring that the transplanted tissue is fully functional.
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Affiliation(s)
- M. W. Beckmann
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R. Dittrich
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S. Findeklee
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - L. Lotz
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Fertility Preservation Decisions Among Newly Diagnosed Oncology Patients: A Single-Center Experience. Am J Clin Oncol 2016; 39:154-9. [PMID: 24441581 DOI: 10.1097/coc.0000000000000031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate fertility preservation decisions and compare controlled ovarian stimulation (COS) and assisted reproductive technology (ART) outcomes between newly diagnosed cancer patients and age-matched healthy controls. METHODS Our retrospective study was conducted at Columbia University's Center for Women's Reproductive Care between 2005 and 2012. Forty-nine women elected to undergo ART with COS for either oocyte or embryo cryopreservation before commencement of cancer therapy. Demographic and descriptive characteristics were collected from the cohort of patients. Treatment outcomes were compared with randomly selected, healthy, age-matched controls undergoing ART with COS during the same time period. RESULTS Single women began fertility preservation cycles in half the time of married women (10.4 vs. 22.9 d). All 21 married women chose embryo cryopreservation, whereas 17 of the 28 (61%) single women chose embryo over oocyte cryopreservation. Baseline anti-Mullerian hormone levels and body mass indices were similar among fertility preservation patients and controls. Despite elevated baseline estradiol (E2) levels and luteal phase cycle starts in some cycles to avoid delay of cancer treatment, no significant differences were noted when comparing days of stimulation, total gonadotropins prescribed, numbers of oocytes and mature oocytes retrieved, fertilization rate, or cancellation rate to controls. CONCLUSIONS Our experience shows that, with appropriate counseling and multidisciplinary care, newly diagnosed cancer patients desiring fertility preservation experience similar outcomes as age-matched healthy controls. These women can pursue oocyte or embryo cryopreservation with likely minimal disruption to the flow of their oncologic care.
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Boots CE, Meister M, Cooper AR, Hardi A, Jungheim ES. Ovarian stimulation in the luteal phase: systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:971-80. [PMID: 27146151 PMCID: PMC4974222 DOI: 10.1007/s10815-016-0721-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. METHODS A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. RESULTS Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39-1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489-1144). However, no differences were noted in peak estradiol levels (WMD -411 pg/ml, 95 % CI -906-84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI -0.74-1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21-1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03-0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56-1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power. CONCLUSION Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.
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Affiliation(s)
- C E Boots
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA.
| | - M Meister
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A R Cooper
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| | - A Hardi
- Washington University, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - E S Jungheim
- Obstetrics & Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
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Kim J, Mersereau JE, Su HI, Whitcomb BW, Malcarne VL, Gorman JR. Young female cancer survivors' use of fertility care after completing cancer treatment. Support Care Cancer 2016; 24:3191-9. [PMID: 26939923 DOI: 10.1007/s00520-016-3138-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study is to investigate factors associated with female young adult cancer survivors' (YCSs) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment. METHODS In this cross-sectional study, females between that ages of 18 and 35 years who had been diagnosed with childhood, adolescent, or young adult cancers completed a 20-min web-based survey that included demographics, reproductive history, use of FC, fertility-related informational needs, and reproductive concerns. RESULTS A total of 204 participants completed the survey. Participants' mean age was 28.3 ± 4.5 years. Thirty (15 %) participants reported using FC after cancer treatment. The majority of participants recalled not receiving enough information about fertility preservation options at the time of cancer diagnosis (73 %). In multivariable analysis, those with higher concerns about having children because of perceived risk to their personal health (P = 0.003) were less likely to report use of FC after cancer treatment. Those who had used FC before cancer treatment (P = 0.003) and who felt less fertile than age-matched women (P = 0.02) were more likely to use FC after their cancer treatment. CONCLUSIONS While most YCSs in this cohort believed that they did not receive enough information about fertility and most wanted to have children, the vast majority did not seek FC. The findings of this study offer further evidence of the need for improved education and emotional support regarding reproductive options after cancer treatment is completed. Targeted discussions with YCSs about appropriate post-treatment FC options may improve providers' capacity to help YCSs meet their parenthood goals.
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Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University, Seoul, South Korea
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - H Irene Su
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 2250 SW Jefferson Way, Corvallis, OR, 97331-6406, USA.
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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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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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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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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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Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women. Reprod Biomed Online 2015; 31:605-12. [PMID: 26380870 DOI: 10.1016/j.rbmo.2015.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 11/24/2022]
Abstract
Fertility-preservation techniques for medical reasons are increasingly offered in national networks. Knowledge of the characteristics of counselled patients and techniques used are essential. The FertiPROTEKT network registry was analysed between 2007 and 2013, and included up to 85 university and non-university centres in Germany, Austria and Switzerland; 5159 women were counselled and 4060 women underwent fertility preservation. In 2013, fertility-preservation counselling for medical reasons increased significantly among nullipara and women aged between 21 and 35 years (n = 1043; P < 0.001). Frequency of GnRH applications slowly decreased, whereas tissue, oocytes and zygote cryopreservation increased. In 2013, women with breast cancer mainly opted for tissue freezing, whereas women with lymphoma opted for GnRH agonist. Women younger than 20 years predominantly opted for GnRH agonists and ovarian tissue cryopreservation; women aged between 20 and 40 years underwent a variety of techniques; and women over 40 years opted for GnRH agonists. The average number of aspirated oocytes per stimulation cycle decreased as age increased (< 30 years: 12.9; 31-35 years: 12.3; 36-46: 9.0; > 41 years: 5.7). For ovarian tissue cryopreservation, removal and cryopreservation of fewer than one ovary was preferred and carried out in 97% of cases in 2013.
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Furui T, Takenaka M, Makino H, Terazawa K, Yamamoto A, Morishige KI. An evaluation of the Gifu Model in a trial for a new regional oncofertility network in Japan, focusing on its necessity and effects. Reprod Med Biol 2015; 15:107-113. [PMID: 29259426 DOI: 10.1007/s12522-015-0219-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose We evaluated our 2-year experience of the regional oncofertility network in Gifu Prefecture (GPOFS) in order to establish a more sophisticated regional oncofertility networking model in Japan. Methods Questionnaires were distributed twice in January 2013 to 57 departments in 35 hospitals that provide cancer treatment in Gifu Prefecture, before the establishment of the regional oncofertility network. The number and type of disease of the referred adolescent and young adult (AYA) cancer patients who visited the oncofertility clinic in Gifu University Hospital via the GPOFS were analyzed. Results The majority of regional oncologists are aware of the need to provide information about oncofertility to their patients, but they cannot provide sufficient information due to their lack of knowledge about reproductive medicine. Eighty-one AYA patients were referred to our clinic for oncofertility counseling in the first 2 years after the establishment of the GPOFS. Conclusions The GPOFS as the first regional oncofertility network in Japan has just started and may be working to help both AYA cancer patients and their oncologists. The nationwide establishment of the regional oncofertility network model could help both AYA cancer patients and oncologists.
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Affiliation(s)
- Tatsuro Furui
- Department of Obstetrics and Gynecology Gifu University Graduate School of Medicine 1-6-1 Yanagido 501-1194 Gifu Gifu Japan
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Motoki Takenaka
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Hiroshi Makino
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Keiko Terazawa
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Akio Yamamoto
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Ken-Ichiro Morishige
- Department of Obstetrics and Gynecology Gifu University Graduate School of Medicine 1-6-1 Yanagido 501-1194 Gifu Gifu Japan
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
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de Pedro M, Otero B, Martín B. Fertility preservation and breast cancer: a review. Ecancermedicalscience 2015; 9:503. [PMID: 25729416 PMCID: PMC4335963 DOI: 10.3332/ecancer.2015.503] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Indexed: 12/29/2022] Open
Abstract
Breast cancer is the most common malignancy in women, and its incidence increases with age, with the majority of patients diagnosed after menopause. However, in 15–25% of cases, patients are premenopausal at the time of diagnosis, and about 7% of them are below the age of 40. Therefore, a considerable amount of young women are diagnosed with breast cancer during their reproductive life. Within this group, most cancer cases require cytotoxic chemotherapy and/or hormone therapy, which are responsible for a decrease in the patients’ reproductive function, along with their age. The efficacy of such treatments, among other factors, has led to a high five-year-survival rate, which results in an increasing number of young women who survive breast cancer before having fulfilled their reproductive wishes, especially considering the current trend to delay pregnancy until the late 30s or early 40s in developed countries. The combination of these factors justifies the importance of fertility preservation and reproductive counselling at the time of breast cancer diagnosis in young women. A wide range of fertility preservation techniques has been developed, such as ovarian suppression, oocyte and embryo cryopreservation, immature oocyte retrieval and in vitro maturation, and ovarian tissue cryopreservation. Early counselling and referral of these patients to fertility specialists are fundamental factors in order to maximise their chances of pregnancy. This review aims to update the knowledge about the influence of breast cancer in fertility, the influence of pregnancy and fertility preservation techniques in breast cancer patients and assessment of ovarian reserve for a better treatment choice. A special section dedicated to BRCA-mutation carriers has been included because of their specific features. A comprehensive literature search has been conducted, including publications from the last five years.
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Affiliation(s)
- María de Pedro
- Department of Obstetrics and Gynecology, HM Nuevo Belén University Hospital, HM Hospitales, José Silva 7, Madrid 28043, Spain
| | - Borja Otero
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Cruces University Hospital, Barakaldo 48903, Spain
| | - Belén Martín
- Department of Obstetrics and Gynecology, Getafe University Hospital, Getafe 28905, Spain
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Kim J, Mersereau JE. Early referral makes the decision-making about fertility preservation easier: a pilot survey study of young female cancer survivors. Support Care Cancer 2014; 23:1663-7. [PMID: 25421445 DOI: 10.1007/s00520-014-2526-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/14/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the study was to investigate the association between patients' decision-making about fertility preservation (FP) and time between cancer diagnosis and FP consultation in young female cancer survivors. METHODS This is a pilot survey study of women aged 18-43 years seen for FP consultation between April 2009 and December 2010. RESULTS Among 52 women who completed the survey, 15 (29 %) had their FP consultation more than 2 weeks after their cancer diagnosis (late referral group) and 37 (71 %) were within 2 weeks of their cancer diagnosis (early referral group). In univariate analysis, the only difference between the late referral and early referral groups was a higher decisional conflict scale (DCS) in late referral group (p = 0.04). In multivariable analysis, late referral group was more likely to have high DCS (>35) compared to early referral group (odds ratio 4.8, 95 % confidence interval 1.5, 21.6) after adjusting for age, center, and type of cancer. CONCLUSION Early referral to a fertility specialist can help patients make better decision about FP. This is the first study to suggest that early referral is important in patients' decision-making process about FP treatment. Our finding supports the benefit of early referral in patients who are interested in FP which is consistent with prior studies about FP referral patterns.
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Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599-7570, USA
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De Pinho JC, Sauer MV. Infertility and ART after transplantation. Best Pract Res Clin Obstet Gynaecol 2014; 28:1235-50. [DOI: 10.1016/j.bpobgyn.2014.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/27/2022]
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Moffat R, Güth U. Preserving fertility in patients undergoing treatment for breast cancer: current perspectives. BREAST CANCER-TARGETS AND THERAPY 2014; 6:93-101. [PMID: 25114587 PMCID: PMC4108258 DOI: 10.2147/bctt.s47234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Invasive breast cancer (BC) is the most frequent cancer of young women. Considering the trend toward postponing childbearing until the later reproductive years, the number of childless women at diagnosis of BC will continue to increase. The American Society of Clinical Oncology and the American Society for Reproductive Medicine have recommended that the impact of cancer treatments on fertility should be addressed with all cancer patients of reproductive age and that options for fertility preservation, such as cryopreservation of embryos and oocytes, ovarian tissue, in vitro maturation of immature oocytes, and ovarian suppression with gonadotropin-releasing hormone analogs, should be discussed routinely. To optimally counsel patients on how to best weigh the risks and benefits of fertility preservation, both the health care provider and the patient must know about the options, their risks, and their likelihood of success. The aim of this review is to summarize current knowledge on fertility preservation options for young BC patients, surrogates of ovarian function, psychosocial aspects of infertility after cancer treatment, women’s attitudes towards childbearing after cancer treatment, and health care providers’ attitudes towards fertility preservation.
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Affiliation(s)
- Rebecca Moffat
- Women's Hospital, Clinic for Gynecologic Endocrinology and Reproductive Medicine, University Hospital Basel, Basel, Switzerland
| | - Uwe Güth
- Department of Gynecology and Obstetrics, Breast Center, SenoSuisse, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Efficacy of ovarian tissue cryopreservation in a major European center. J Assist Reprod Genet 2014; 31:1003-12. [PMID: 24928054 DOI: 10.1007/s10815-014-0239-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the effect of cryopreservation and thawing of ovarian tissue from oncological patients opting for fertility preservation on ovarian tissue viability. METHODS In this prospective cohort study, the ovarian tissue viability before and after cryopreservation and thawing was measured for 25 newly diagnosed oncological patients who had their ovarian tissue cryopreserved. Outcome measures were follicle integrity (histology), follicle viability (Calcein viability assay), steroid hormone production (estradiol and progesterone production in vitro) and overall tissue viability (glucose uptake in vitro). This study was conducted at a Cryobank for storage of ovarian tissue in a university hospital. RESULTS Cryopreserved/thawed ovarian tissue showed a decreased glucose uptake when compared to tissue that had not been cryopreserved. In addition, a diminished E2 and P4 production was observed after cryopreservation and thawing, despite the fact that numbers of viable follicles as determined by the Calcein viability assay were comparable. Histological examination revealed a higher percentage of degenerated follicles after cryopreservation and thawing. CONCLUSIONS Ovarian tissue cryopreservation and thawing impairs the viability of ovarian tissue in oncological patients opting for fertility preservation.
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Lambertini M, Pinto AC, Del Mastro L. Fertility issues in young breast cancer patients: what women want. J Thorac Dis 2014; 6:584-8. [PMID: 24976976 PMCID: PMC4073395 DOI: 10.3978/j.issn.2072-1439.2014.06.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 11/14/2022]
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Factors associated with pregnancy attempts among female young adult cancer survivors. J Cancer Surviv 2014; 8:571-9. [PMID: 24859010 DOI: 10.1007/s11764-014-0369-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Little is known about pregnancy attempts among female young cancer survivors (YCS). We sought to determine fertility preservation (FP), demographic, cancer, and reproductive characteristics associated with pregnancy attempts after cancer. METHODS We recruited 251 female YCS (ages 18-44) to complete a survey on reproductive health outcomes. We used log-binomial regression models to estimate relative risks (RR) for characteristics associated with pregnancy attempts. RESULTS For the entire cohort, median time since cancer diagnosis was 2.4 years (interquartile range 4.0). Fifty-two YCS (21%) attempted pregnancy after cancer diagnosis. In unadjusted analyses, lack of FP therapy prior to cancer treatment, older age, partnered relationship, higher income, no history of stem cell or bone marrow transplant, and longer duration of survivorship were significantly associated with pregnancy attempts. In multivariable analyses, YCS who did not undergo FP therapy were more than twice as likely to attempt pregnancy as those who did undergo FP therapy (RR 2.4, 95% confidence interval (CI) 1.3, 4.3). Partnered status (RR 7.1, 95% CI 2.5, 20.2) and >2 years since cancer diagnosis (RR 2.3, 95% CI 1.3, 4.1) were also significantly associated with attempts. CONCLUSIONS In YCS, milestones including partnered relationships and longer duration of cancer survivorship are important to attempting pregnancy. A novel, inverse association between FP therapy and pregnancy attempts warrants further study. IMPLICATIONS FOR CANCER SURVIVORS Pregnancy attempts after cancer were more likely after attaining both social- and cancer-related milestones. As these milestones require time, YCS should be made aware of their potential for concomitant, premature loss of fertility in order to preserve their range of fertility options.
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Klonoff-Cohen H. Establishing a fertility preservation database: no time like the present. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Senapati S, Morse CB, Sammel MD, Kim J, Mersereau JE, Efymow B, Gracia CR. Fertility preservation in patients with haematological disorders: a retrospective cohort study. Reprod Biomed Online 2013; 28:92-8. [PMID: 24140311 DOI: 10.1016/j.rbmo.2013.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 12/26/2022]
Abstract
This study investigated the factors associated with utilization of fertility preservation and the differences in treatments and outcomes by prior chemotherapy exposure in patients with haematological diseases. This study included all 67 women with haematological diseases seen for fertility preservation consultation at two university hospitals between 2006 and 2011. Of the total, 49% had lymphoma, 33% had leukaemia, 7% had myelodysplastic syndrome and 4% had aplastic anaemia; 46% had prior chemotherapy; and 33% were planning for bone marrow transplantation, 33% pursued ovarian stimulation and 7% used ovarian tissue banking; and 48% of patients did not pursue fertility preservation treatment. All five cycle cancellations were in the post-chemotherapy group: three patients with leukaemia and two with lymphoma. Patients with prior chemotherapy had lower baseline antral follicle count (10 versus 22) and received more gonadotrophins to achieve similar peak oestradiol concentrations, with no difference in oocyte yield (10.5 versus 10) after adjustment for age. Embryo yield was similar between those who had prior chemotherapy and those who had not. Half of the patients with haematological diseases who present for fertility preservation have been exposed to chemotherapy. While ovarian reserve is likely impaired in this group, oocyte yield may be acceptable.
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Affiliation(s)
- Suneeta Senapati
- Department of Obstetrics and Gynecology, University of Pennsylvania, United States.
| | - Christopher B Morse
- Department of Obstetrics and Gynecology, University of Pennsylvania, United States
| | - Mary D Sammel
- Department of Obstetrics and Gynecology, University of Pennsylvania, United States
| | - Jayeon Kim
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, United States
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, United States
| | - Brenda Efymow
- Department of Obstetrics and Gynecology, University of Pennsylvania, United States
| | - Clarisa R Gracia
- Department of Obstetrics and Gynecology, University of Pennsylvania, United States
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Mersereau JE, Goodman LR, Deal AM, Gorman JR, Whitcomb BW, Su HI. To preserve or not to preserve: how difficult is the decision about fertility preservation? Cancer 2013; 119:4044-50. [PMID: 24037854 DOI: 10.1002/cncr.28317] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/18/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS). METHODS The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables. RESULTS Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]). CONCLUSIONS In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions.
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Lambertini M, Anserini P, Levaggi A, Poggio F, Del Mastro L. Fertility counseling of young breast cancer patients. J Thorac Dis 2013; 5 Suppl 1:S68-80. [PMID: 23819030 DOI: 10.3978/j.issn.2072-1439.2013.05.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 05/29/2013] [Indexed: 12/11/2022]
Abstract
Approximately 6% of women with breast cancer are diagnosed before the age of 40. Young age is an independent predictor of adverse outcome and most young breast cancer patients receive systemic treatment with chemotherapy, hormonal therapy or both. The loss or impairment of fertility is a potential side effect of antineoplastic treatments. Due to the rising trend to delaying pregnancy in life, an increasing proportion of young cancer patients who are yet to have a pregnancy will face the problem of iatrogenic menopause in the future. The incidence of anticancer-treatment-related ovarian failure depends on the type of chemotherapy regimen administered, the use of tamoxifen and the age of patients. It rises with increasing age, in the range of 22-61% and 61-97% in women aged <40 years and >40 years respectively. Although there is a clear trend to increasing incidence of ovarian failure with the rise in aging, there may be a small proportion of patients who became amenorrhoeic despite the very young age, thus indicating that also individual factors still unknown may affect the probability of treatment-related ovarian failure. A prompt referral of patients to reproductive counseling and a multidisciplinary team including Oncology and Reproductive Units are essential to face the management of fertility issues in cancer patients. Fertility counseling should include a detailed description of all the available techniques to preserve fertility. The main available fertility preservation techniques, standard and experimental, for young breast cancer patients include: temporary ovarian suppression during chemotherapy with gonadotropin-releasing hormone analogues, embryo cryopreservation, cryopreservation of oocytes and cryopreservation of ovarian tissue. Research efforts are still necessary to improve the efficacy and safety of the available fertility preservation strategies as well as an efficient collaboration between oncologists and gynecologists is necessary to improve patients' access to the strategies themselves.
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Kim J, Deal AM, Balthazar U, Kondapalli LA, Gracia C, Mersereau JE. Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions? Reprod Biomed Online 2013; 27:96-103. [DOI: 10.1016/j.rbmo.2013.03.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/07/2013] [Indexed: 11/29/2022]
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Bastings L, Beerendonk CCM, Westphal JR, Massuger LFAG, Kaal SEJ, van Leeuwen FE, Braat DDM, Peek R. Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review. Hum Reprod Update 2013; 19:483-506. [PMID: 23817363 DOI: 10.1093/humupd/dmt020] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk of recurrent oncological disease due to the reintroduction of cancer cells via autotransplantation of cryopreserved ovarian tissue is unknown. METHODS A systematic review of literature derived from MEDLINE, EMBASE and the Cochrane Library was conducted. Studies on follow-up after autotransplantation; detection of cancer cells in ovarian tissue from oncological patients by histology, polymerase chain reaction or xenotransplantation; and epidemiological data on ovarian metastases were included. RESULTS A total of 289 studies were included. Metastases were repeatedly detected in ovarian tissue obtained for cryopreservation purposes from patients with leukaemia, as well as in one patient with Ewing sarcoma. No metastases were detected in ovarian tissue from lymphoma and breast cancer patients who had their ovarian tissue cryopreserved. Clinical studies indicated that one should be concerned about autotransplantation safety in patients with colorectal, gastric and endometrial cancer. For patients with low-stage cervical carcinoma, clinical data were relatively reassuring, but studies focused on the detection of metastases were scarce. Oncological recurrence has been described in one survivor of cervical cancer and one survivor of breast cancer who had their ovarian tissue autotransplanted, although these recurrences may not be related to the transplantation. CONCLUSIONS It is advisable to refrain from ovarian tissue autotransplantation in survivors of leukaemia. With survivors of all other malignancies, current knowledge regarding the safety of autotransplantation should be discussed. The most reassuring data regarding autotransplantation safety were found for lymphoma patients.
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Affiliation(s)
- L Bastings
- Department of Obstetrics and Gynaecology (791), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Ovarian tissue cryopreserved for fertility preservation from patients with Ewing or other sarcomas appear to have no tumour cell contamination. Eur J Cancer 2013; 49:1932-8. [DOI: 10.1016/j.ejca.2013.01.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 11/23/2022]
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Szatmári E, Máté S, Sipos N, Szánthó A, Silhavy M, Rigó J. [Methods and conditions of fertility preservation in early-stage ovarian tumors]. Orv Hetil 2013; 154:523-30. [PMID: 23545230 DOI: 10.1556/oh.2013.29581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1-2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be of primary importance. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended.
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Affiliation(s)
- Erzsébet Szatmári
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest.
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Dittrich R, Lotz L, Mueller A, Hoffmann I, Wachter DL, Amann KU, Beckmann MW, Hildebrandt T. Oncofertility: combination of ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval. Reprod Biol Endocrinol 2013; 11:19. [PMID: 23510640 PMCID: PMC3599192 DOI: 10.1186/1477-7827-11-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New anticancer treatments have increased survival rates for cancer patients, but often at the cost of sterility. Several strategies are currently available for preserving fertility. However, the chances of achieving a pregnancy with one technique are still limited. A combination of methods is therefore recommended in order to maximize women's chances of future fertility. In this retrospective study, ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval were combined and the quality of the ovarian tissue, the numbers and quality of oocytes, time requirements, and the safety of the strategy were examined. METHODS Fourteen female patients suffering from malignant diseases underwent one in vitro fertilization cycle. Different stimulation protocols were used, depending on the menstrual cycle. Transvaginal oocyte retrieval was scheduled 34-36 h after human chorionic gonadotropin administration. Immediately afterwards, ovarian tissue was extracted laparoscopically. RESULTS A mean of 10 oocytes were retrieved per patient, and 67% of the oocytes were successfully fertilized using intracytoplasmic sperm injection. No periprocedural complications and no complications leading to postponement of the start of chemotherapy occurred. The ovarian tissues were of good quality, with a normal age-related follicular distribution and without carcinoma cell invasion. CONCLUSIONS An approach using ovarian stimulation first, followed by laparoscopic collection of ovarian tissue, is a useful strategy for increasing the efficacy of fertility preservation techniques. The ovarian tissue is not affected by prior ovarian stimulation.
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Affiliation(s)
- Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Andreas Mueller
- Department of Obstetrics and Gynecology, Karlsruhe Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - David L Wachter
- Department of Pathology, Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Kerstin U Amann
- Department of Pathology, Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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Bastings L, Beerendonk CC, Westphal JR, Braat DD, Peek R. Cryopreservation and Autotransplantation of Ovarian Tissue in Cancer Patients: Is It Safe? J Adolesc Young Adult Oncol 2013. [DOI: 10.1089/jayao.2012.0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Lobke Bastings
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Catharina C.M. Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Johan R. Westphal
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Didi D.M. Braat
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ron Peek
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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