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Albamonte MI, Vitullo AD. Preservation of fertility in female and male prepubertal patients diagnosed with cancer. J Assist Reprod Genet 2023; 40:2755-2767. [PMID: 37770817 PMCID: PMC10656407 DOI: 10.1007/s10815-023-02945-2] [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: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Over the past two decades, the importance of fertility preservation has grown not only in the realm of medical and clinical patient care, but also in the field of basic and applied research in human reproduction. With advancements in cancer treatments resulting in higher rates of patient survival, it is crucial to consider the quality of life post-cure. Therefore, fertility preservation must be taken into account prior to antitumor treatments, as it can significantly impact a patient's future fertility. For postpubertal patients, gamete cryopreservation is the most commonly employed preservation strategy. However, for prepubertal patients, the situation is more intricate. Presently, ovarian tissue cryopreservation is the standard practice for prepubertal girls, but further scientific evidence is required in several aspects. Testicular tissue cryopreservation, on the other hand, is still experimental for prepubertal boys. The primary aim of this review is to address the strategies available for possible fertility preservation in prepubertal girls and boys, such as ovarian cryopreservation/transplantation, in vitro follicle culture and meiotic maturation, artificial ovary, transplantation of cryopreserved spermatogonia, and cryopreservation/grafting of immature testicular tissue and testicular organoids.
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Affiliation(s)
- María Itatí Albamonte
- Centro de Estudios Biomédicos Básicos, Aplicados y Desarrollo (CEBBAD), Universidad Maimónides, Hidalgo 775, C1405BCK, Buenos Aires, Argentina
| | - Alfredo D Vitullo
- Centro de Estudios Biomédicos Básicos, Aplicados y Desarrollo (CEBBAD), Universidad Maimónides, Hidalgo 775, C1405BCK, Buenos Aires, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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Ghodrati F, Akbarzadeh M. Jurisprudence Study of Muslim Rules and Effects of Ovarian Transplants in Women with Infertility; A Review. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666181015125406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The use of assisted reproductive techniques, in addition to mental and
emotional stress in different stages, made some jurists, as fatwa authorities, to investigate and
evaluate the problems of this type of transplantation.
Objective:
The aim of this study was the jurisprudence investigation of the rules and effects of ovarian
transplants in women with infertility.
Methods:
This study was conducted through review and library studies using the keywords ovarian
transplants, infertility, jurists’ opinions and religious rules as to ovarian transplantation.
Results:
Permission for transplanting one’s own ovarian tissue was issued through the consent of
most scholars of Islamic schools and according to some verses, traditions, legal rules, and logical
reasons. Although some of the Ancient religious scholars have dissenting opinions about transplantation,
for some jurists, ovarian transplant from a woman to an infertile woman has no legal problem
and the infant belongs to the recipient. However, some other jurists oppose this fatwa. They
believe that there is a problem in the oocytes and ovarian transplantation due to mixed parentage
and the holy legislator does not agree with this transplantation. So, they had opposing fatwa in this
regard.
Conclusion:
According to the consensus of some Muslim jurists on ovarian transplant from one’s
own ovary or from another woman, there is a new hope for infertile couples to use this method
which is done from a woman to another woman.</P>
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Affiliation(s)
- Fatemeh Ghodrati
- Department of Theology, Faculty of Humanities Science College, Yasouj University, Yasouj, Iran
| | - Marzieh Akbarzadeh
- Department of Midwifery, Maternal-Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Lau GA, Schaeffer AJ. Current standing and future directions in pediatric oncofertility: a narrative review. Transl Androl Urol 2018; 7:S276-S282. [PMID: 30159233 PMCID: PMC6087837 DOI: 10.21037/tau.2018.05.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/29/2018] [Indexed: 01/15/2023] Open
Abstract
In this narrative review, we discuss the epidemiology and pathophysiology of infertility in childhood and adolescent cancer. We also review the current guidelines and ethical issues related to pediatric oncofertility. Finally, we present recent advances in basic science and translational research in pediatric fertility preservation (FP).
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Affiliation(s)
- Glen A Lau
- Division of Urology, University of Utah, Salt Lake City, UT, USA
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4
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Fisch B, Abir R. Female fertility preservation: past, present and future. Reproduction 2018; 156:F11-F27. [DOI: 10.1530/rep-17-0483] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
Anti-cancer therapy, particularly chemotherapy, damages ovarian follicles and promotes ovarian failure. The only pharmacological means for protecting the ovaries from chemotherapy-induced injury is gonadotrophin-releasing hormone agonist, but its efficiency remains controversial; ovarian transposition is used to shield the ovary from radiation when indicated. Until the late 1990s, the only option for fertility preservation and restoration in women with cancer was embryo cryopreservation. The development of other assisted reproductive technologies such as mature oocyte cryopreservation andin vitromaturation of oocytes has contributed to fertility preservation. Treatment regimens to obtain mature oocytes/embryos have been modified to overcome various limitations of conventional ovarian stimulation protocols. In the last decades, several centres have begun cryopreserving ovarian samples containing primordial follicles from young patients before anti-cancer therapy. The first live birth following implantation of cryopreserved-thawed ovarian tissue was reported in 2004; since then, the number has risen to more than 130. Nowadays, ovarian tissue cryopreservation can be combined within vitromaturation and vitrification of oocytes. The use of cryopreserved oocytes eliminates the risk posed by ovarian implantation of reseeding the cancer. Novel methods for enhancing follicular survival after implantation are presently being studied. In addition, researchers are currently investigating agents for ovarian protection. It is expected that the risk of reimplantation of malignant cells with ovarian grafts will be overcome with the putative development of an artificial ovary and an efficient follicle class- and species-dependentin vitrosystem for culturing primordial follicles.
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Medrano JV, Andrés MDM, García S, Herraiz S, Vilanova-Pérez T, Goossens E, Pellicer A. Basic and Clinical Approaches for Fertility Preservation and Restoration in Cancer Patients. Trends Biotechnol 2018; 36:199-215. [DOI: 10.1016/j.tibtech.2017.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/20/2022]
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Pacheco F, Oktay K. Current Success and Efficiency of Autologous Ovarian Transplantation: A Meta-Analysis. Reprod Sci 2017; 24:1111-1120. [PMID: 28701069 DOI: 10.1177/1933719117702251] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CONTEXT Ovarian cryopreservation followed by autotransplantation is still considered an experimental strategy for fertility preservation (FP) mainly because the success rates are unknown. OBJECTIVE To determine cohort epidemiologic characteristics and success rates of autologous ovarian tissue transplantation (OTT) with previously cryopreserved tissue. MATERIALS AND METHODS Literature review from 1999 to October 1, 2016. Additional cases were retrieved from meeting abstracts and own database. We selected studies that reported autologous OTT with previously banked tissue in humans. We did not include any cases involving fresh ovarian tissue transplantation or those performed to treat idiopathic premature ovarian failure/insufficiency. Both authors reviewed and selected studies for eligibility, which resulted in 59 full-text studies assessed for eligibility. Cases were extracted from original reports and reviews by the junior author, and the senior author reviewed and verified the extracted data. RESULTS Nineteen reports were included for qualitative synthesis. In 10 studies, detailed data were available to determine clinical and live birth + ongoing (LB + OG) pregnancy as well as endocrine restoration rates. Three hundred nine OTTs were performed with cryopreserved tissue, resulting in the birth of 84 children and 8 OG pregnancies. The cumulative clinical and LB + OG rates were 57.5% and 37.7%, respectively, and the endocrine restoration rate was 63.9%. CONCLUSION Success rates with cryopreserved OTT have reached promising levels. Given these recent data, ovarian tissue cryopreservation should be considered as a viable option for FP.
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Affiliation(s)
- Fernanda Pacheco
- 1 Innovation Fertility Preservation & IVF, New York, NY, USA.,2 Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.,3 Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kutluk Oktay
- 1 Innovation Fertility Preservation & IVF, New York, NY, USA.,2 Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Voultsos P, Raikos N, Vasileiadis N, Spiliopoulou C, Tarlatzis B. Ethico-legal issues related to ovarian tissue transplantation. MEDICINE, SCIENCE, AND THE LAW 2016; 56:293-304. [PMID: 27381404 DOI: 10.1177/0025802416657685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.
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Affiliation(s)
- P Voultsos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Raikos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Vasileiadis
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ch Spiliopoulou
- 2 Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - B Tarlatzis
- 3 Infertility and IVF Center, Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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Abstract
Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patient's sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning.
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Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22:281-305. [PMID: 26759231 DOI: 10.1093/humupd/dmv066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. METHODS We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. RESULTS We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. CONCLUSIONS After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | | | - Maria D Diestro
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
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Damous LL, Silva SMD, Carbonel AAF, Simões MDJ, Baracat EC, Montero EFDS. Progressive Evaluation of Apoptosis, Proliferation, and Angiogenesis in Fresh Rat Ovarian Autografts Under Remote Ischemic Preconditioning. Reprod Sci 2015; 23:803-11. [PMID: 26674322 DOI: 10.1177/1933719115620493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study evaluated the remote ischemic preconditioning (R-IPC) early and late repercussion on fresh ovarian transplants, aiming to assess a probable protective effect in ovarian follicular pool. Sixty Wistar EPM-1 rats were used, divided in 2 study groups: ovarian transplantation (Tx) and Tx + R-IPC, submitted to ovary transplant with or without R-IPC, respectively. These groups were subdivided according to the date for euthanasia: 4th, 7th, 14th, 21st, and 30th days of the postoperatory period. Morphology, morphometry, neoangiogenesis (vascular endothelial growth factor [VEGF]), proliferative activity (Ki-67), and apoptosis (cleaved caspase-3) were evaluated. Remote ischemic preconditioning was performed in the common iliac artery. Fresh autologous ovarian tissue was implanted integrally in the retroperitoneum. All animals showed resumption of estrous phase after ovary transplantation. Remote ischemic preconditioning attenuated the lesions progressively from the 7th day, with greater number of the immature follicles (14 days, P < .05), but didn't affect mature follicles and corpora lutea (P > .05). Immunohistochemical analyzes, taken as a whole, show that R-IPC benefic effect is more evident in the later periods of evaluation, when a greater proliferative activity (14, 21, and 30 days, P < .05) and lesser cell apoptotic activity (21 and 30 days, P < .05). The VEGF expression was similar in all times (P > .05). Remote ischemic preconditioning could have a benefic effect in the progressive evaluation of freshly grafted ovarian, especially on the latest phases of the posttransplant period. The 14th day was a landmark in the recuperation of the graft. Further investigations are necessary to determine the role of R-IPC in this scenario and its effect in frozen-thawed ovarian tissue.
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Affiliation(s)
- Luciana Lamarão Damous
- Laboratory of Structural and Molecular Gynecology (LIM-58), Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
| | | | | | - Manuel de Jesus Simões
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Edmund Chada Baracat
- Laboratory of Structural and Molecular Gynecology (LIM-58), Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
| | - Edna Frasson de Souza Montero
- Laboratory of Surgical Physiopatology (LIM-62), Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brasil
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Rodríguez-Iglesias B, Novella-Maestre E, Herraiz S, Díaz-García C, Pellicer N, Pellicer A. New methods to improve the safety assessment of cryopreserved ovarian tissue for fertility preservation in breast cancer patients. Fertil Steril 2015; 104:1493-502.e1-2. [DOI: 10.1016/j.fertnstert.2015.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 12/16/2022]
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Novella-Maestre E, Herraiz S, Rodríguez-Iglesias B, Díaz-García C, Pellicer A. Short-Term PTEN Inhibition Improves In Vitro Activation of Primordial Follicles, Preserves Follicular Viability, and Restores AMH Levels in Cryopreserved Ovarian Tissue From Cancer Patients. PLoS One 2015; 10:e0127786. [PMID: 26024525 PMCID: PMC4449215 DOI: 10.1371/journal.pone.0127786] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/19/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction In vitro activation and growth of primordial dormant follicles to produce fertilizable oocytes would provide a useful instrument for fertility preservation. The employment of Phosphatase and TENsin homolog (PTEN) inhibitors, in combination with Protein kinase B (Akt) stimulating molecules, has been previously employed to increase follicular activation through the stimulation of the PTEN-Akt pathway. Methods We aim to establish improved in vitro activation also for cancer patients whose ovarian tissue has already been cryopreserved. Fresh and previously cryopreserved human ovarian cortex were exposed to short-term, low-concentration and ovary-specific treatment with only a PTEN inhibitor. Results Our in vitro activation protocol enhances the activation mechanisms of primordial follicles in both fresh and cryopreserved samples, and enlarges growing populations without inducing apoptosis in either follicles or the surrounding stroma. Treatment augments estradiol secretion and restores the expression levels of the previously diminished Anti-Müllerian hormone by means of cryopreservation procedures. Genomic modulation of the relative expression of PTEN pathway genes was found in treated samples. Conclusion The in vitro activation protocol offers new alternatives for patients with cryopreserved tissue as it increases the pool of viable activated follicles available for in vitro growth procedures. The combination of ovarian tissue cryopreservation and in vitro activation of primordial follicles, the main ovarian reserve component, will be a major advancement in fertility preservation.
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Affiliation(s)
- Edurne Novella-Maestre
- Unidad de Genética, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Grupo de investigación de Medicina Reproductiva. Instituto de Investigación Sanitario La Fe. Valencia, Spain
- Unidad de Preservación de la Fertilidad, Área de Salud de la Mujer. Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sonia Herraiz
- Grupo de investigación de Medicina Reproductiva. Instituto de Investigación Sanitario La Fe. Valencia, Spain
- Unidad de Preservación de la Fertilidad, Área de Salud de la Mujer. Hospital Universitario y Politécnico La Fe, Valencia, Spain
- * E-mail:
| | - Beatriz Rodríguez-Iglesias
- Grupo de investigación de Medicina Reproductiva. Instituto de Investigación Sanitario La Fe. Valencia, Spain
- Unidad de Preservación de la Fertilidad, Área de Salud de la Mujer. Hospital Universitario y Politécnico La Fe, Valencia, Spain
- IGENOMIX, Parc Cientific Valencia University, Paterna, Valencia, Spain
| | - César Díaz-García
- Grupo de investigación de Medicina Reproductiva. Instituto de Investigación Sanitario La Fe. Valencia, Spain
- Unidad de Preservación de la Fertilidad, Área de Salud de la Mujer. Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Pellicer
- Grupo de investigación de Medicina Reproductiva. Instituto de Investigación Sanitario La Fe. Valencia, Spain
- Unidad de Preservación de la Fertilidad, Área de Salud de la Mujer. Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Sacco JJ, Cliff J, Green JA. Chemotherapy for gynaecological malignancies and fertility preservation. World J Obstet Gynecol 2014; 3:54-60. [DOI: 10.5317/wjog.v3.i2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/31/2013] [Accepted: 08/06/2013] [Indexed: 02/05/2023] Open
Abstract
Infertility is an increasingly important issue for patients surviving cancer. Significant improvements in cancer management have led to greater numbers of patients living healthy and fulfilling lives for many years after a diagnosis of cancer, and the ability to bear children is a major component of well-being. Infertility is particularly challenging in gynaecological cancer, where multiple treatment modalities are often employed. Surgery may involve the removal of reproductive organs and subsequent chemotherapy may also lead to infertility. Mitigation of this through the use of cryopreservation of embryos, oocytes or ovarian tissue before chemotherapy may enable subsequent pregnancy in the patient or a surrogate mother. Suppression of ovarian function during chemotherapy is less well established, but promises a reduction in infertility without the risks associated with surgery. Similarly, evolving chemotherapy regimens with replacement of alkylating agents will reduce the incidence of infertility. With a combination of these techniques, an increasing proportion of patients may be able to conceive after completion of treatment, and there is no evidence of an increase in congenital abnormalities. This review discusses chemotherapy-induced infertility, interventions and success rates, and demonstrates that individualisation of management is required for optimum outcome.
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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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Rodriguez-Wallberg K, Oktay K. Fertility preservation in young breast cancer patients: addressing individual patient needs. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.12.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In female patients, infertility may be regarded as an essential loss of femininity and infertility after cancer, and is known to be associated with psychosocial distress. Fertility preservation is thus an important issue for young women diagnosed with breast cancer. Nevertheless, breast cancer patients have traditionally not been offered the most well-established methods for fertility preservation, such as embryo and oocyte freezing, as a rise in estradiol during standard stimulation protocols has been regarded as potentially deleterious in these patients. Alternative protocols for stimulation, such as those using tamoxifen and aromatase inhibitors, have therefore been developed. Protocols including aromatase inhibitors have been demonstrated to be more effective than those using tamoxifen in terms of the number of oocytes and embryos obtained, while maintaining estradiol levels within the normal range of a menstrual cycle. Cryopreservation of immature oocytes and ovarian cortical tissue are methods that are still under development. Reports of children born after application of these experimental methods are currently increasing and these methods are thus gaining a place within the options for fertility preservation in breast cancer patients.
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Affiliation(s)
- Kenny Rodriguez-Wallberg
- Laboratory of Molecular Reproduction, Institute for Fertility Preservation, Departments of Obstetrics & Gynecology & Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA
- Karolinska Institutet & Karolinska University Hospital, Fertility Unit, Stockholm, Sweden
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction, Institute for Fertility Preservation, Departments of Obstetrics & Gynecology & Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA.
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Abstract
Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol whereas similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.
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Maman E, Meirow D, Brengauz M, Raanani H, Dor J, Hourvitz A. Luteal phase oocyte retrieval and in vitro maturation is an optional procedure for urgent fertility preservation. Fertil Steril 2011; 95:64-7. [DOI: 10.1016/j.fertnstert.2010.06.064] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
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Chimiothérapie et préservation de la fertilité féminine. Presse Med 2010; 39:786-93. [DOI: 10.1016/j.lpm.2010.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 01/04/2010] [Indexed: 11/23/2022] Open
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Fertility preservation for cancer patients: a review. Obstet Gynecol Int 2010; 2010:160386. [PMID: 20379357 PMCID: PMC2850134 DOI: 10.1155/2010/160386] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/02/2010] [Indexed: 02/04/2023] Open
Abstract
Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation.
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Chevalier N, Dewailly D, Fenichel P. [Oncofertility: a new focus in women health-care...]. ANNALES D'ENDOCRINOLOGIE 2010; 70 Suppl 1:S33-41. [PMID: 19878767 DOI: 10.1016/s0003-4266(09)72474-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although treatment and survival are the primary focus of health-care patients, with cancer survivors living longer it is now appropriate to consider their quality of life after treatment, including the possibility of becoming parents. There are several options for fertility preservation in cancer patients. Even though most of them are still experimental and their efficacy and reliability have not been determined, especially in women. The most successful alternative for female survivors is embryo cryopreservation, an approach not suitable for many single or virgin women or even possible for prepubertal girls. Reports of live birth after transplantation of human ovarian tissue have reinforced the clinical potential of ovarian tissue banking for fertility preservation. Many exciting studies are underway to improve the efficacy and solve the problems with current fertility preservation strategies, especially for in vitro culture of cryopreserved tissue or follicles. Continuous efforts to improve current strategies and to develop new strategies will benefit many women and children who are facing premature ovarian failure and sterility.
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Affiliation(s)
- N Chevalier
- Service d'Endocrinologie et Médecine de la Reproduction, CECOS, Hôpital de l'Archet 1, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 NICE cedex 3.
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Sánchez-Serrano M, Novella-Maestre E, Roselló-Sastre E, Camarasa N, Teruel J, Pellicer A. Malignant cells are not found in ovarian cortex from breast cancer patients undergoing ovarian cortex cryopreservation. Hum Reprod 2009; 24:2238-43. [PMID: 19491203 DOI: 10.1093/humrep/dep196] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is a frequent indication for ovarian cortex cryopreservation due to its high incidence. The main concern of this procedure is the possibility of reintroducing metastatic cells within the implant, an issue that has not been addressed systematically. Thus, a study was designed to analyse the presence of ovarian metastases in breast cancer patients undergoing ovarian tissue cryopreservation. METHODS Morphological and immunohistochemical studies following the concept of the sentinel lymph node (SLN) were performed on 100 cortical ovarian biopsies obtained from 63 patients and on six frozen-thawed entire cortex from patients with the diagnosis of infiltrating ductal breast carcinoma undergoing ovarian cortex extraction and cryopreservation. The antibody panel included Cytokeratin CAM 5.2, Gross Cystic Disease Fluid Protein-15 (GCDFP15), Wilms' tumour antigen-1 (WT1) and Mammaglobin 1. RESULTS Employing only morphologic criteria, suspicious neoplastic cells were detected in five biopsies, but in none of the six entire cortex analysed. These five cases were reclassified as hyperplasic surface epithelium-inclusion cysts (CAM 5.2+, WT1+) or apoptotic granulosa cells (CAM 5.2-, GCDFP15+, WT1-). CONCLUSIONS Using the methodology of the SLN our data suggest the absence of tumour cells in biopsies obtained from patients undergoing ovarian cortex cryopreservation to preserve their fertility potential, although future methods of cancer screening may change our perception of this procedure.
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Affiliation(s)
- María Sánchez-Serrano
- Department of Obstetrics and Gynaecology, Hospital Universitario Dr Peset, Av Gaspar Aguilar 90, 46017 Valencia, Spain
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Affiliation(s)
- Jacqueline S Jeruss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Weidong Gong, Hong Cheng, Qingguo Yan, Gaosheng Huang, Pifu Luo, Zhe Wang. Serous Papillary Cystadenocarcinoma Arising From Autografted Ovary of the Abdominal Wall. Int J Surg Pathol 2009; 18:398-400. [PMID: 19147508 DOI: 10.1177/1066896908325875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 58-year-old-woman developed a serous papillary cystadenocarcinoma between the fascia and peritoneum of the left abdominal wall. The patient had undergone bilateral oophorectomy for serous cystadenoma 17 years earlier and her residual normal ovarian parenchyma had also been transplanted to the abdominal wall. Grossly and microscopically, the current tumor arises from the autografted ovarian parenchyma. Literature review indicates that carcinoma arising from autografted ovarian tissue is extremely rare.
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Affiliation(s)
- Weidong Gong
- Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Hong Cheng
- Department of Pathology, State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Qingguo Yan
- Department of Pathology, State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Gaosheng Huang
- Department of Pathology, State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Pifu Luo
- Department of Pathology & Laboratory Medicine, Arnot Ogden Medical Center, Elmira, New York (PL)
| | - Zhe Wang
- Department of Pathology, State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
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Schubert B, Canis M, Darcha C, Artonne C, Smitz J, Grizard G. Follicular growth and estradiol follow-up after subcutaneous xenografting of fresh and cryopreserved human ovarian tissue. Fertil Steril 2008; 89:1787-94. [PMID: 17707378 DOI: 10.1016/j.fertnstert.2007.03.101] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 03/30/2007] [Accepted: 03/30/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess ovarian cortex surrounding benign ovarian cysts after cryopreservation and grafting to severe combined immunodeficient (SCID) mice. DESIGN Animal study. SETTING Academic research laboratories. PATIENT(S) Ovarian tissue obtained from 15 patients. INTERVENTION(S) Grafting of fresh and frozen/thawed ovarian tissue into the subcutaneous space of 22 SCID mice for 80 days. MAIN OUTCOME MEASURE(S) Histologic analysis before and after grafting. Serum E(2) measured before (after 37 days of grafting) and after FSH/LH supplementation (end of the study). RESULT(S) After grafting, follicular density had decreased for frozen/thawed tissue in all cases. The follicular distribution was modified in fresh tissue: Primordial follicles proportion was reduced (79% vs. 17%), whereas the primary and secondary ones were increased (21% vs. 57% and 0% vs. 23%, respectively). The same tendency was observed in frozen/thawed tissue. Significant E(2) secretion was obtained before and after FSH/LH supplementation in castrated mice, grafted with either fresh or frozen/thawed tissue. CONCLUSION(S) Fresh and cryopreserved ovarian cortex surrounding benign ovarian cysts grafted into the subcutaneous space of SCID mice is able to sustain ovarian tissue function, although follicular growth appears lower with frozen/thawed tissue.
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Affiliation(s)
- Benoit Schubert
- Department of Biology of Development and Reproduction-CECOS, CHU Clermont-Ferrand, Clermont-Ferrand, France.
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Impact of Oncostatic Treatments for Childhood Malignancies (Radiotherapy and Chemotherapy) on Uterine Competence to Pregnancy. Obstet Gynecol Surv 2007; 62:803-11. [DOI: 10.1097/01.ogx.0000290348.29697.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Langmár Z, Mátrai M, Bánhidy F, Csömör S. [Procedures for fertility preservation in female cancer patients]. Orv Hetil 2007; 148:2219-24. [PMID: 18003580 DOI: 10.1556/oh.2007.28163] [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
Improving survival rates and quality of life following modern combined cancer treatments have resulted a growing number of patients requesting maintenance of reproductive functions. Several methods are currently available to maintain fertility during oncotherapy. Even though most of them are still experimental and their efficacy and safety have not been determined, the future for fertility preservation in women with cancer is promising. In vitro fertilization with embryo cryopreservation offers an established method, but time to delay cancer treatment could be risky regarding the progression of several cancer types. Moreover, exposure to a high oestrogen milieu during ovarian stimulation is undesirable when patients have estrogen-sensitive malignant tumours. Cryopreservation of mature oocytes following in vitro fertilization and intracytoplasmatic sperm injection offers advantages, but it is still limited due to its low success rate. Emerging techniques of ovarian tissue cryopreservation followed by autotransplantation have been clinically explored. Novel technologies of tissue freezing and thawing promise improving results. However, only one live birth following autotransplanted frozen-thawed ovarian tissue has been established. This procedure can be offered in the future for prepubertal girls before cancer treatment to maintain future fertility. Gonadal tissue cryopreservation and transplantation should be considered experimental in humans for the present time until greater evidence regarding efficacy and safety is accrued.
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Affiliation(s)
- Zoltán Langmár
- Semmelweis Egyetem, Altalános Orvostudományi Kar II. Szülészeti és Nogyógyászati Klinika Budapest Ulloi út 78/a 1082.
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Abstract
Ovarian tissue preservation and transplantation are intended for women undergoing aggressive regimens of chemical and/or radiological therapy, bone marrow transplantation or stem cell transplantation. Main indications for the procedure are neoplastic diseases and autoimmune disorders. The first live human birth after ovarian tissue autotransplantation was successfully done in 2002. Cryopreserved ovarian tissue can be autografted either orthotopically or heterotopically. Neovascularization of the implanted tissue is essential for the procedure. Vascular transplantation seems to be the best approach for avoiding follicular loss and extending the lifespan of the ovarian grafts. The procedure, regardless of whether ortho- or heterotopic, is connected with a risk of reimplantation of neoplastic cells. This can be minimized by multiple ovary biopsies, thorough histological examination and molecular genetic techniques. Introducing ovarian tissue transplantation into clinical practice requires many problems to be solved. Standardization of the freeze-thaw protocol is one of the most important issues. Solving the problem of transient graft ischemia is also essential. Eventually, the future safety of the method requires the development of efficient tests to detect the presence of neoplastic cells in the transplanted tissue.
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Affiliation(s)
- Artur J Jakimiuk
- Department of Obstetrics and Gynecology, Central Clinical Hospital of Ministry of Interior and Administration, Woloska Str. 137, 02-507 Warsaw, Poland.
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Abstract
OBJECTIVES To discuss long-term physical effects of treatment for breast cancer including effects on reproductive, bone, sexual health, and related women's issues. DATA SOURCES Research articles, abstracts, literature reviews. CONCLUSION Long-term effects of treatment have become increasingly prevalent in breast cancer survivors. The most common are effects on reproductive, bone, and sexual health. IMPLICATIONS FOR NURSING PRACTICE Long-term effects of treatment can have a significant negative impact on the long-term health and QOL of women with breast cancer. Oncology nurses are well-positioned to anticipate and address the reproductive and endocrine consequences of breast cancer treatment.
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Abstract
PURPOSE OF REVIEW To summarize current knowledge about premature ovarian failure (POF) with an emphasis on recent developments regarding its management. RECENT FINDINGS The incidence of POF is increasing largely due to improved survival rates of cancer patients treated with radiation and chemotherapy. Delayed diagnosis and management of POF leads to suboptimal outcomes. Anticipation and early detection of this condition in high-risk women by means of ovarian function testing, followed by early institution of appropriate management could improve outcomes. Choice of strategies should vary depending on the age of onset, associated symptoms and fertility aspirations of the individual, and should change with the patient's advancing age. SUMMARY Early assessment of the individual's risk of developing POF, development of a strategic management plan, and timely commencement of infertility and hormone deficiency treatment, together with counselling in an integrated management plan should improve both the short and long-term health of those with POF.
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Affiliation(s)
- Apollo Meskhi
- Academic Unit of Obs & Gynae, University of Manchester, St Mary's Hospital, Manchester, UK
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Liou WS, Yap OWS, Chan JK, Westphal LM. Innovations in fertility preservation for patients with gynecologic cancers. Fertil Steril 2005; 84:1561-73. [PMID: 16359944 DOI: 10.1016/j.fertnstert.2005.03.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 02/09/2005] [Accepted: 04/07/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review options for fertility preservation in women with gynecologic cancers. DESIGN Literature review. RESULT(S) We discuss the data regarding cancer treatment and fertility outcomes and current controversies for women with gynecologic cancers. CONCLUSION(S) Gynecologic cancers represent 12%-15% of cancers affecting women, and 21% of these are diagnosed in women of reproductive age. Current advances in our understanding of these diseases, along with improved multimodality treatment, allow for consideration of fertility options. For some women with gynecologic cancers, fertility-sparing treatment might be appropriate.
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Affiliation(s)
- Wen-Shiung Liou
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Stanford University School of Medicine, Palo Alto, California, USA
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Kiran G, Kiran H, Coban YK, Guven AM. Ovarian cortical transplantation may be an alternative to hormone therapy in patients with early climacterium. Fertil Steril 2005; 84:1509. [PMID: 16275256 DOI: 10.1016/j.fertnstert.2005.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 05/18/2005] [Accepted: 05/18/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To discuss the 18-month follow-up results of fresh ovarian cortical tissue transplant. DESIGN Case study. SETTING Academic medical center. PATIENT(S) A 46-year-old patient who was operated on for uterine fibroids, and who then received an ovarian tissue transplant in July 2003. INTERVENTION(S) Serum hormone levels were measured at 3-month intervals. MAIN OUTCOME MEASURE(S) Follicular development evident by ultrasound examination; serum hormone levels (FSH, LH, E2). RESULT(S) Preoperative and 3rd-, 6th-, 9th-, 12th-, 15th-, and 18th-month hormone levels were, respectively, as follows: FSH: 9.06, 79.5, 13.7, 16.66, 51.91, 44.37, and 24.17 mIU/mL; LH: 5.91, 33.92, 8.78, 21.83, 38.31, 40.85, and 22.4 mIU/mL; E2: 166, 46, 48, 117, 31, 14.4, and 137.7 pg/mL. Folliculogenesis was confirmed by ultrasonography at the 6th, 9th, and 18th months during the follow-up period. CONCLUSION(S) Fresh ovarian autotransplantation may be a logical alternative for hormonal support for a specific patient group.
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Affiliation(s)
- Gurkan Kiran
- Department of Obstetrics and Gynecology, School of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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