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Erden M, Gayete-Lafuente S, Vural NA, Oktay KH. Utility and Outcomes of Ovarian Tissue Cryopreservation and Transplantation for Gynecologic Cancers: A Systematic Review and Meta-analysis. Obstet Gynecol 2024:00006250-990000000-01137. [PMID: 39173181 DOI: 10.1097/aog.0000000000005708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE To evaluate the utility, success, and safety of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for fertility preservation in patients with gynecologic cancers. DATA SOURCES A comprehensive search was performed of the MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases to identify relevant studies on the utility and outcomes of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for gynecologic cancers from inception until January 23, 2024. METHODS OF STUDY SELECTION Two reviewers independently performed the study selection, data extraction, and risk-of-bias assessment, and the results were then reviewed together. Twenty-three studies were included in the current systematic review. TABULATION, INTEGRATION, AND RESULTS The resultant data were meta-analyzed to produce a pooled-effect estimate of the utility of ovarian tissue cryopreservation and autologous transplantation in gynecologic cancers as a proportion of all indications. We found that 7.5% and 9.6% of women undergoing ovarian tissue cryopreservation and autologous transplantation, respectively, had gynecologic cancers. In comparison, hematologic malignancies and breast cancer accounted for approximately 66.0% of all indications for these procedures. The return rate for autologous cryopreserved ovarian tissue transplantation in gynecologic cancers (6.0%) was not statistically different from those for other indications. Among women with gynecologic cancer who underwent ovarian stimulation, 27.3% had at least one child, and the ovarian endocrine function was restored in 78.1% of the women after autologous transplantation. The median graft longevity was 32 months, and no graft-site recurrence was reported after autologous transplantation in women with gynecologic cancer. CONCLUSION Our results suggest that ovarian tissue cryopreservation and autologous transplantation are feasible options for preserving ovarian function in women with gynecologic cancers, although ovarian tissue cryopreservation is underutilized, and further studies are needed to determine the longer-term outcomes of autologous transplantation. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42024498522.
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Affiliation(s)
- Murat Erden
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; the Department of Gynecological Oncology, Yozgat State Hospital, Yozgat, Turkey; and the Innovation Institute for Fertility Preservation and IVF, New York, New York, and New Haven, Connecticut
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2
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Wnuk K, Świtalski J, Miazga W, Tatara T, Religioni U, Olszewski P, Augustynowicz A. The Usage of Cryopreserved Reproductive Material in Cancer Patients Undergoing Fertility Preservation Procedures. Cancers (Basel) 2023; 15:5348. [PMID: 38001608 PMCID: PMC10670543 DOI: 10.3390/cancers15225348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Many cancer treatment methods can affect fertility by damaging the reproductive organs and glands that control fertility. Changes can be temporary or permanent. In order to preserve the fertility of cancer patients and protect the genital organs against gonadotoxicity, methods of fertility preservation are increasingly used. Considering that some patients ultimately decide not to use cryopreserved reproductive material, this review analysed the percentage of post-cancer patients using cryopreserved reproductive material, collected before treatment as part of fertility preservation. METHODS A systematic search of studies was carried out in accordance with the Cochrane Collaboration guidelines, based on a previously prepared research protocol. The search was conducted in Medline (via PubMed), Embase (via OVID), and the Cochrane Library. In addition, a manual search was performed for recommendations/clinical practice guidelines regarding fertility preservation in cancer patients. RESULTS Twenty-six studies met the inclusion criteria. The studies included in the review discussed the results of cryopreservation of oocytes, embryos, ovarian tissue, and semen. In 10 studies, the usage rate of cryopreserved semen ranged from 2.6% to 21.5%. In the case of cryopreserved female reproductive material, the return/usage rate ranged from 3.1% to 8.7% for oocytes, approx. 9% to 22.4% for embryos, and 6.9% to 30.3% for ovarian tissue. In studies analysing patients' decisions about unused reproductive material, continuation of material storage was most often indicated. Recovering fertility or death of the patient were the main reasons for rejecting cryopreserved semen in the case of men. CONCLUSION Fertility preservation before gonadotoxic treatment is widely recommended and increasingly used in cancer patients. The usage rate is an important indicator for monitoring the efficacy of these methods. In all of the methods described in the literature, this indicator did not exceed 31%. It is necessary to create legal and organizational solutions regulating material collection and storage and to create clear paths for its usage in the future, including by other recipients.
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Affiliation(s)
- Katarzyna Wnuk
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032 Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826 Warsaw, Poland
| | - Jakub Świtalski
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01445 Warsaw, Poland;
| | - Wojciech Miazga
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032 Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826 Warsaw, Poland
| | - Tomasz Tatara
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032 Warsaw, Poland
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02091 Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826 Warsaw, Poland
| | | | - Anna Augustynowicz
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01445 Warsaw, Poland;
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Antunes MB, Cardeal SP, Magalhães M, Vale-Fernandes E, Barreiro M, Sá R, Sousa M. Preservation of fertility in female patients with hematologic diseases. Blood Rev 2023; 62:101115. [PMID: 37562987 DOI: 10.1016/j.blre.2023.101115] [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: 04/11/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
Recent developments of assisted reproduction techniques turned possible to avoid the infertility consequences of oncologic treatments, but fertility preservation (FP) has been somewhat neglected in women with hematologic diseases undergoing gonadotoxic treatments. For these specific cases, the current options for FP include the cryopreservation of embryos, mature oocytes and ovarian tissue, and oocyte in-vitro maturation. We intend to make patients and clinicians aware of this important and relevant issue, and provide hematologists, assisted reproduction physicians and patients, with updated tools to guide decisions for FP. The physicians of the units responsible for female FP should always be available to decide on the best-individualized FP option in strict collaboration with hematologists. With a wide range of options for FP tailored to each case, a greater level of training and information is needed among clinicians, so that patients proposed to gonadotoxic treatments can be previously advised for FP techniques in hematological conditions. ABBREVIATED ABSTRACT: Recent developments of assisted reproduction techniques turned possible to preserve the fertility of women with hematologic diseases undergoing gonadotoxic treatments. Current options for fertility preservation in women with hematologic diseases are presented. It is imperative to offer fertility preservation to all women before starting any gonadotoxic treatment and in some cases after treatment. Fertility preservation methods enable to later achieve the desired pregnancy.
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Affiliation(s)
- Marika Bini Antunes
- Department of Clinical Hematology, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, 4099-001 Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
| | - Sara Pinto Cardeal
- Laboratory of Cell Biology, Department of Microscopy, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Manuel Magalhães
- UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Department of Oncology, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Emídio Vale-Fernandes
- UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Centro de Procriação Medicamente Assistida, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo da Maternidade, 4050-371, Porto, Portugal
| | - Márcia Barreiro
- UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Centro de Procriação Medicamente Assistida, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo da Maternidade, 4050-371, Porto, Portugal.
| | - Rosália Sá
- UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Laboratory of Cell Biology, Department of Microscopy, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Mário Sousa
- UMIB-Unit for Multidisciplinary Research in Biomedicine/ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Laboratory of Cell Biology, Department of Microscopy, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
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Cermisoni GC, Pisaturo V, Vanni VS, Minetto S, Pagliardini L, Masciangelo R, Candiani M, Papaleo E, Alteri A. Fertility Preservation as an Option for Women with Genetic Disorders: Insights from a SWOT Analysis on Elective Oocyte Freezing and Preimplantation Genetic Testing. Life (Basel) 2023; 13:1483. [PMID: 37511857 PMCID: PMC10381289 DOI: 10.3390/life13071483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
This paper uses a SWOT (strengths, weaknesses, opportunities, and threats) analysis to overview the option of fertility preservation in women with genetic diseases, who would later use preimplantation genetic testing for monogenic disorders, in order to not transmit their condition. Strengths associated with elective oocyte freezing are ethical considerations, overall maternal and fetal safety, and effectiveness, if performed at <35 years of age. Weaknesses are related to costs and rare but present (<1-3%) risks of maternal complications. Counselling on fertility management aimed at preventing infertility offers a valuable opportunity, the same as it has been in oncological patients' care. The potentially high percentage of women with genetic conditions who would return to use their frozen oocytes also represents an opportunity together with the minimization of the need for egg donation, which has higher obstetrical risks compared to the use of autologous oocytes. Finally, a threat is represented by the potential psychological distress to young women who could never attempt to become pregnant through preimplantation genetic testing, or do it before any decline in their fertility. Potential unknown future long-term health risks for children conceived after egg vitrification/thawing are also a threat, but current knowledge is reassuring. Altogether, early counselling on the option of fertility preservation should thus be incorporated into standard care of all patients with any genetic condition.
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Affiliation(s)
- Greta Chiara Cermisoni
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Valeria Stella Vanni
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sabrina Minetto
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luca Pagliardini
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Rossella Masciangelo
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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5
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White R, Wilson A, Bechman N, Keay SD, McAvan L, Quenby S, Odendaal J. Fertility preservation, its effectiveness and its impact on disease status in pre-menopausal women with breast cancer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 287:8-19. [PMID: 37269752 DOI: 10.1016/j.ejogrb.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Preservation of reproductive function is a key concern for many premenopausal women with breast cancer, given the known gonadotoxic effects of treatments. The present systematic review aimed to investigate the effectiveness and safety of fertility preservation strategies in pre-menopausal women with breast cancer. METHODS Primary research assessing fertility preservation strategies of any type was identified. Markers of preservation of fertility including return of menstrual function, clinical pregnancy rates and live birth rates were selected as main outcome measures. An additional analysis of safety data was also performed. RESULTS Fertility preservation interventions were overall associated with higher fertility outcomes: with a pooled odds ratio 4.14 (95% CI 3.59-4.77) for any kind of fertility preservation intervention. This was seen both for return of menstruation and for clinical pregnancy rate, but not for live birth rates. Fertility preservation was associated with a reduced rate of disease recurrence (OR 0.63 (95% CI 0.49-0.81)), while there was no significant difference in disease free survival (OR 0.88 (95% CI 0.74-1.05)) or in overall survival (OR 0.9 (95% CI 0.74-1.10)) between the fertility preservation group and those who had not undergone fertility preservation. CONCLUSION Fertility preservation is both effective in preserving reproductive function, and safe with regard to disease recurrence, disease free survival and overall survival in premenopausal women with breast cancer.
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Affiliation(s)
- Rhiannon White
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom
| | - Anna Wilson
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom
| | - Natasha Bechman
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom
| | - Stephen D Keay
- University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom
| | - Lucy McAvan
- University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom
| | - Siobhan Quenby
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom; University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom
| | - Joshua Odendaal
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom; University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom.
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6
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Bolton VN, Hayden C, Robinson M, Abdo D, Pericleous-Smith A. Human oocyte cryopreservation: revised evidence for practice. HUM FERTIL 2023:1-15. [DOI: 10.1080/14647273.2023.2190987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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7
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Fraison E, Huberlant S, Labrune E, Cavalieri M, Montagut M, Brugnon F, Courbiere B. Live birth rate after female fertility preservation for cancer or haematopoietic stem cell transplantation: a systematic review and meta-analysis of the three main techniques; embryo, oocyte and ovarian tissue cryopreservation. Hum Reprod 2023; 38:489-502. [PMID: 36421038 PMCID: PMC9977128 DOI: 10.1093/humrep/deac249] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/21/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION What are the chances of achieving a live birth after embryo, oocyte and ovarian tissue cryopreservation (OTC) in female cancer survivors? SUMMARY ANSWER The live birth rates (LBRs) following embryo and oocyte cryopreservation are 41% and 32%, respectively, while for IVF and spontaneous LBR after tissue cryopreservation and transplantation, these rates are 21% and 33%, respectively. WHAT IS KNOWN ALREADY Currently, fertility preservation (FP) has become a major public health issue as diagnostic and therapeutic progress has made it possible to achieve an 80% survival rate in children, adolescents and young adults with cancer. In the latest ESHRE guidelines, only oocyte and embryo cryopreservation are considered as established options for FP. OTC is still considered to be an innovative method, while it is an acceptable FP technique in the American Society for Reproductive Medicine guidelines. However, given the lack of studies on long-term outcomes after FP, it is still unclear which technique offers the best chance to achieve a live birth. STUDY DESIGN, SIZE, DURATION We performed a systematic review and meta-analysis of published controlled studies. Searches were conducted from January 2004 to May 2021 in Medline, Embase and the Cochrane Library using the following search terms: cancer, stem cell transplantation, FP, embryo cryopreservation, oocyte vitrification, OTC and reproductive outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 126 full-text articles were preselected from 1436 references based on the title and abstract and assessed via the Newcastle-Ottawa Quality Assessment Scale. The studies were selected, and their data were extracted by two independent reviewers according to the Cochrane methods. A fixed-effect meta-analysis was performed for outcomes with high heterogeneity. MAIN RESULTS AND THE ROLE OF CHANCE Data from 34 studies were used for this meta-analysis. Regarding cryopreserved embryos, the LBR after IVF was 41% (95% CI: 34-48, I2: 0%, fixed effect). Concerning vitrified oocytes, the LBR was 32% (95% CI: 26-39, I2: 0%, fixed effect). Finally, the LBR after IVF and the spontaneous LBR after ovarian tissue transplantation were 21% (95% CI: 15-26, I2: 0%, fixed-effect) and 33% (95% CI: 25-42, I2: 46.1%, random-effect), respectively. For all outcomes, in the sensitivity analyses, the maximum variation in the estimated percentage was 1%. LIMITATIONS, REASONS FOR CAUTION The heterogeneity of the literature prevents us from comparing these three techniques. This meta-analysis provides limited data which may help clinicians when counselling patients. WIDER IMPLICATIONS OF THE FINDINGS This study highlights the need for long-term follow-up registries to assess return rates, as well as spontaneous pregnancy rates and birth rates after FP. STUDY FUNDING/COMPETING INTEREST(S) This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare. REGISTRATION NUMBER CRD42021264042.
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Affiliation(s)
- E Fraison
- Service de Médecine de la Reproduction, Hospices Civils de Lyon, Hôpital Mère Enfant, Bron, France.,Université Claude Bernard, Faculté de Médecine Laennec, Lyon, France.,INSERM Unité 1208, Bron, France
| | - S Huberlant
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU Carémeau, Nîmes, France.,Université de Montpellier-Nîmes, Nîmes Cedex 2, France
| | - E Labrune
- Service de Médecine de la Reproduction, Hospices Civils de Lyon, Hôpital Mère Enfant, Bron, France.,Université Claude Bernard, Faculté de Médecine Laennec, Lyon, France.,INSERM Unité 1208, Bron, France
| | - M Cavalieri
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU François Mitterrand, Dijon, France
| | - M Montagut
- Service de Médecine de la Reproduction, Clinique Croix du Sud, Quint-Fonsegrives, France
| | - F Brugnon
- Assistance Médicale à la Procréation, CECOS, CHU Clermont Ferrand, CHU Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, IMoST, INSERM 1240, Faculté de Médecine, Clermont-Ferrand, France
| | - B Courbiere
- Service d'Assistance Médicale à la Procréation, Plateforme Cancer & Fertilité OncoPACA-Corse, AP-HM, Hôpital La Conception, Marseille, France.,Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, Marseille, France
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Xu Z, Ibrahim S, Burdett S, Rydzewska L, Al Wattar BH, Davies MC. Long term pregnancy outcomes of women with cancer following fertility preservation: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 281:41-48. [PMID: 36535069 DOI: 10.1016/j.ejogrb.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE As cancer survivorship increases, there is higher uptake of fertility preservation treatments among affected women. However, there is limited evidence on the subsequent use of preserved material and pregnancy outcomes in women who underwent fertility preservation (FP) before cancer treatments. We aimed to systematically review the long-term reproductive and pregnancy outcomes in this cohort of women. PATIENTS Women who underwent any type of the following FP treatments: embryo cryopreservation (EC), oocyte cryopreservation (OC) and ovarian tissue cryopreservation (OTC)) before any planned cancer treatment. EVIDENCE REVIEW We searched electronic databases (MEDLINE, Embase, Cochrane CENTRAL, and HTA) from inception until May 2021 for all observational studies that met our inclusion criteria. We extracted data on reproductive and pregnancy outcomes in duplicate and assessed the risk of bias in included studies using the ROBINS-I tool. We pooled data using a random-effects model and reported using odds ratios (OR) with 95% confidence intervals (CI). MAIN OUTCOME MEASURES Our primary outcome was live birth rate and other important reproductive and pregnancy outcomes. RESULTS Of 5405 citations, we screened 103 and included 26 observational studies (n = 7061 women). Hematologic malignancy was the commonest cause for seeking FP treatments, followed by breast and gynecology cancers. Twelve studies reported on OTC (12/26, 46 %), eight included EC (8/26, 30 %), and twelve reported on OC (12/26, 46 %). The cumulative live birth rate following any FP treatment was 0.046 (95 %CI 0.029-0.066). Only 8 % of women returned to use their frozen reproductive material (558/7037, 8.0 %), resulting in 210 live births in total, including assisted conceptions following EC/OC/OTC and natural conceptions following OTC. The odds for live birth was OR 0.38 (95 %CI 0.29-0.48 I2 83.7 %). The odds for live birth was the highest among women who had EC (OR 0.45, 95 %CI 0.14-0.76, I2 95.1 %), followed by the OTC group (OR 0.37, 95 %CI 0.22-0.53, I2 88.7 %) and OC group (OR 0.31, 95 %CI 0.15-0.47, I2 78.2 %). CONCLUSIONS Fertility preservation treatments offered good long-term reproductive outcomes for women with cancer with a high chance to achieve a live birth. Further research is needed to evaluate the long-term pregnancy and offspring outcomes in this cohort.
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Affiliation(s)
- Zilin Xu
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Sameh Ibrahim
- UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Sarah Burdett
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Larysa Rydzewska
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Bassel H Al Wattar
- Beginings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, United Kingdom.
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
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Chen H, Zhang L, Meng L, Liang L, Zhang C. Advantages of vitrification preservation in assisted reproduction and potential influences on imprinted genes. Clin Epigenetics 2022; 14:141. [PMID: 36324168 PMCID: PMC9632035 DOI: 10.1186/s13148-022-01355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Cryopreservation has important application in assisted reproductive technology (ART). The vitrification technique has been widely used in the cryopreservation of oocytes and embryos, as a large number of clinical results and experimental studies have shown that vitrification can achieve a higher cell survival rate and preimplantation development rate and better pregnancy outcomes. Ovarian tissue vitrification is an alternative method to slow freezing that causes comparatively less damage to the original follicular DNA. At present, sperm preservation mainly adopts slow freezing or rapid freezing (LN2 vapor method), although the vitrification method can achieve higher sperm motility after warming. However, due to the use of high-concentration cryoprotectants and ultra-rapid cooling, vitrification may cause strong stress to gametes, embryos and tissue cells, resulting in potentially adverse effects. Imprinted genes are regulated by epigenetic modifications, including DNA methylation, and show single allele expression. Their accurate regulation and correct expression are very important for the placenta, fetal development and offspring health. Considering that genome imprinting is very sensitive to changes in the external environment, we comprehensively summarized the effect of cryopreservation—especially the vitrification method in ART—on imprinted genes. Animal studies have found that the vitrification of oocytes and embryos can have a significant impact on some imprinted genes and DNA methylation, but the few studies in humans have reported almost no influence, which need to be further explored. This review provides useful information for the safety assessment and further optimization of the current cryopreservation techniques in ART.
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Affiliation(s)
- Huanhuan Chen
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China.,Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Lei Zhang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China.,Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Li Meng
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China.,Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Linlin Liang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China. .,Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China.
| | - Cuilian Zhang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China. .,Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China.
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Zhang L, Chen H, Cui C, Liang L, Ge H, Meng L, Zhang C. Effects of oocyte vitrification on gene expression in the liver and kidney tissues of adult offspring. J Assist Reprod Genet 2022; 39:2635-2646. [PMID: 36223009 PMCID: PMC9723011 DOI: 10.1007/s10815-022-02611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
Oocyte vitrification is an important assisted reproductive technology (ART) that preserves the fertility of unmarried patients with malignant tumors, and promotes the development of the oocyte donation program. In recent years, the effects of ART, including the vitrification of oocytes and embryos on the health of offspring, have attracted much attention; however, it is difficult to conduct long-term follow-up and biochemical evaluation in humans. In this study, we detected the effect of oocyte vitrification on gene expression in the organs of adult mice offspring by RNA sequencing for the first time. Our results showed that only a small amount of gene expression was significantly affected. Seven genes (Tpm3, Hspe1-rs1, Ntrk2, Cyp4a31, Asic5, Cyp4a14, Retsat) were abnormally expressed in the liver, and ten genes (Lbp, Hspe1-rs1, Prxl2b, Pfn3, Gm9008, Bglap3, Col8a1, Hmgcr, Ero1lb, Ifi44l) were abnormal in the kidney. Several genes were related to metabolism and disease occurrence in the liver or kidney. Besides, we paid special attention to the expression of known imprinted genes and DNA methylation-related genes in adult organs, which are susceptible to oocyte cryopreservation in the preimplantation stage. As a result, some of these transcripts were detected in adult organs, but they were not affected by oocyte vitrification. In conclusion, we first report that oocyte vitrification did not significantly change the global gene expression in offspring organs; nonetheless, it can still influence the transcription of a few functional genes. The potential adverse effects caused by oocyte vitrification need attention and further study.
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Affiliation(s)
- Lei Zhang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Huanhuan Chen
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Chenchen Cui
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Linlin Liang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Hengtao Ge
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China
| | - Li Meng
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China.
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China.
| | - Cuilian Zhang
- Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China.
- Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou, Henan Province, China.
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11
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Hervas I, Gil Julia M, Rivera-Egea R, Navarro-Gomezlechon A, Mossetti L, Garrido N. Switching to testicular sperm after a previous ICSI failure with ejaculated sperm significantly improves blastocyst quality without increasing aneuploidy risk. J Assist Reprod Genet 2022; 39:2275-2285. [PMID: 35972585 PMCID: PMC9596654 DOI: 10.1007/s10815-022-02595-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The use of testicular sperm is confined to patients with azoospermia, but there is evidence to support its use in males with poor semen parameters and/or previous intracytoplasmic sperm injection (ICSI) failures with ejaculated spermatozoa. We compared the aneuploidy rate and quality between embryos derived from ICSI cycles with ejaculated sperm (EJ-ICSI) and those from ICSI cycles using testicular spermatozoa (TT-ICSI) within the same couple. METHODS Retrospective study of 27 couples who first underwent an EJ-ICSI cycle that did not result in a livebirth and afterwards a TT-ICSI cycle. Only the two closer cycles of each couple were included. Preimplantation genetic test for aneuploidies (PGT-A) was performed in both ICSI cycles and classic parameters of embryo quality were assessed until blastocyst-stage. RESULTS A total of 375 embryos from 54 ICSI cycles were evaluated. Aneuploidy rate was measured by two different parameters. Patients undergoing TT-ICSI presented a similar aneuploidy rate as EJ-ICSI group: 30.7% (23.4-38.0) vs 26.8% (18.1-35.5) per inseminated oocytes (P>0.05), and 76.2% (66.2-86.2) vs 72.1% (59.1-85.2) per the total number of biopsied embryos (P>0.05), respectively. Further, the good-quality blastocyst rate per correctly fertilized oocyte was significantly higher in TT-ICSI group (33.6% (30.4-36.9)) than EJ-ICSI group (24.2% (20.3-28.0)) (P<0.001). CONCLUSIONS Switching to testicular sperm for ICSI yielded better-quality blastocysts without affecting the chromosomal load of the embryos in non-azoospermic couples with a previous unsuccessful ICSI using ejaculated sperm. This strategy is a good option for couples seeking a livebirth who do not want to use donor sperm.
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Affiliation(s)
- Irene Hervas
- IVI Foundation, Health Research Institute, La Fe (IIS La Fe), Av. Fernando Abril Martorell, nº106, Torre A, Planta 1ª, 46026 Valencia, Spain
| | - Maria Gil Julia
- IVI Foundation, Health Research Institute, La Fe (IIS La Fe), Av. Fernando Abril Martorell, nº106, Torre A, Planta 1ª, 46026 Valencia, Spain
| | - Rocío Rivera-Egea
- Andrology Laboratory and Sperm Bank, IVIRMA Valencia, Plaza de la Policia Local 3, 46015 Valencia, Spain
| | - Ana Navarro-Gomezlechon
- IVI Foundation, Health Research Institute, La Fe (IIS La Fe), Av. Fernando Abril Martorell, nº106, Torre A, Planta 1ª, 46026 Valencia, Spain
| | - Laura Mossetti
- IVI Foundation, Health Research Institute, La Fe (IIS La Fe), Av. Fernando Abril Martorell, nº106, Torre A, Planta 1ª, 46026 Valencia, Spain
| | - Nicolás Garrido
- IVI Foundation, Health Research Institute, La Fe (IIS La Fe), Av. Fernando Abril Martorell, nº106, Torre A, Planta 1ª, 46026 Valencia, Spain
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12
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Ní Dhonnabháin B, Elfaki N, Fraser K, Petrie A, Jones BP, Saso S, Hardiman PJ, Getreu N. A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis. Fertil Steril 2022; 117:1266-1276. [PMID: 35459522 DOI: 10.1016/j.fertnstert.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare obstetric outcomes in patients cryopreserving reproductive cells or tissues before gonadotoxic therapy. DESIGN A literature search was conducted following PRISMA guidelines on Embase, Medline, and Web of Science. Studies reporting obstetric outcomes in cancer patients who completed cryopreservation of oocyte, embryo, or ovarian tissue were included. SETTING Not applicable. PATIENT(S) Cancer patients attempting pregnancy using cryopreserved cells or tissues frozen before cancer therapy. INTERVENTION(S) Oocyte, embryo, or ovarian tissue cryopreservation for fertility preservation in cancer. MAIN OUTCOME MEASURE(S) The total numbers of clinical pregnancies, live births, and miscarriages in women attempting pregnancy using cryopreserved reproductive cells or tissues were calculated. A meta-analysis determined the effect size of each intervention. RESULT(S) The search returned 4,038 unique entries. Thirty-eight eligible studies were analyzed. The clinical pregnancy rates were 34.9%, 49.0%, and 43.8% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. No significant differences were found among groups. The live birth rates were 25.8%, 35.3%, and 32.3% for oocyte, embryo, and ovarian tissue cryopreservation, respectively, with no significant differences among groups. The miscarriage rates were 9.2%, 16.9%, and 7.5% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. Significantly fewer miscarriages occurred with ovarian tissue cryopreservation than with embryo cryopreservation. CONCLUSION(S) This enquiry is required to counsel cancer patients wishing to preserve fertility. Although the limitations of this study include heterogeneity, lack of quality studies, and low utilization rates, it serves as a starting point for comparison of reproductive and obstetric outcomes in patients returning for family-planning after gonadotoxic therapy.
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Affiliation(s)
- Bríd Ní Dhonnabháin
- Institute for Women's Health, University College London, London, United Kingdom
| | - Nagla Elfaki
- Department of Obstetrics and Gynaecology, University College London Hospital, London, United Kingdom
| | - Kyra Fraser
- Department of Surgery, The Royal Free Hospital, London, United Kingdom
| | - Aviva Petrie
- Biostatistics Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Benjamin P Jones
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Srdjan Saso
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Paul J Hardiman
- Department of Gynaecology, The Royal Free Hospital, London, United Kingdom
| | - Natalie Getreu
- Institute for Women's Health, University College London, London, United Kingdom.
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Huang SM, Tseng LM, Yang MJ, Chang A, Lien PJ, Hsiung Y. Developing a web-based oncofertility tool for reproductive-age women with breast cancer based on social support framework. Support Care Cancer 2022; 30:6195-6204. [PMID: 35438338 DOI: 10.1007/s00520-022-07046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop electronic systems for oncofertility support, and to examine the comprehensibility, feasibility, usability, and effects on social support and preparation for decision-making. METHODS The study steps were guided, tested, and utilized to (a) identify the requirements of a patient, (b) guide the development of support interventions, and (c) evaluate the quality of web-based oncofertility support. Alpha testing and beta testing were used to ensure the quality of the web-based oncofertility support tool. The effectiveness was evaluated using the Preparation for Decision-Making Scale and Social Support Questionnaire. RESULTS At the alpha testing phase, the mean (± standard deviation) values of the comprehensibility and usability for reproductive-age women with breast cancer were 4.24 (± 0.47) and 4.42 (± 0.57); and the mean values of the acceptability and usability for healthcare providers were 4.04 (± 0.67) and 3.99 (± 0.66), respectively. At the beta testing phase, the mean values of the feasibility for patients and healthcare providers were 3.93 (± 0.67) and 4.17 (± 0.78), respectively. The corresponding mean Preparation for Decision-Making Scale scores were 3.78 ± 0.82 and 4.11 ± 0.93, respectively. The results of the Wilcoxon signed-rank test revealed that the informational and instrumental support scores improved significantly compared with the pre-test data (informational support: 8.94 ± 3.28 vs. 10.06 ± 1.91, p < 0.01; instrumental support: 7.44 ± 2.90 vs. 8.75 ± 2.57, p < 0.01). CONCLUSIONS The oncofertility support website demonstrated acceptable comprehensibility, feasibility, and usability, in addition to informational and instrumental support. TRIAL REGISTRATION Clinicaltrials.gov NCT05100498, https://clinicaltrials.gov/ct2/show/NCT05100498.
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Affiliation(s)
- Sheng-Miauh Huang
- Department of Nursing, Mackay Medical College, No. 46, Section 3, Zhongzheng Road, New Taipei City 252, Sanzhi District, Taiwan.
| | - Ling-Ming Tseng
- Department of Surgery, Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Ming-Jeng Yang
- Institute of Geriatric Welfare Technology & Science, Mackay Medical College, New Taipei City, Taiwan
| | - Aria Chang
- Institute of Geriatric Welfare Technology & Science, Mackay Medical College, New Taipei City, Taiwan
| | - Pei-Ju Lien
- Department of Surgery, Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yvonne Hsiung
- Department of Nursing, Mackay Medical College, No. 46, Section 3, Zhongzheng Road, New Taipei City 252, Sanzhi District, Taiwan
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Porcu E, Cipriani L, Dirodi M, De Iaco P, Perrone AM, Zinzani PL, Taffurelli M, Zamagni C, Ciotti PM, Notarangelo L, Calza N, Damiano G. Successful Pregnancies, Births, and Child Development Following Oocyte Cryostorage in Female Cancer Patients During 25 Years of Fertility Preservation. Cancers (Basel) 2022; 14:cancers14061429. [PMID: 35326578 PMCID: PMC8946047 DOI: 10.3390/cancers14061429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The study goal is to demonstrate that oocyte cryopreservation is a feasible and efficient option for fertility preservation in cancer patients through the comparison of in vitro fertilization treatments in nononcological patients. Abstract The preservation of fertility in cancer patients is a crucial aspect of modern reproductive medicine. Amenorrhea and infertility often occur after cancer therapy, worsening the quality of life. Cryopreservation of oocytes in young cancer patients is a therapeutic option for preserving fertility. A prospective study was conducted on 508 cancer patients who underwent oocyte cryopreservation to preserve fertility between 1996 and 2021 including the COVID-19 pandemic period. Patients underwent ovarian stimulation, followed by egg retrieval, and oocytes were cryopreserved by slow freezing or vitrification. Sixty-four thawing/warming cycles were performed. Survival, fertilization, pregnancy, and birth rate over the thawing/warming cycles were obtained. The data were compared with those from a group of 1042 nononcological patients who cryopreserved supernumerary oocytes. An average of 8.8 ± 6.9 oocytes were retrieved per cycle, and 6.1 ± 4.2 oocytes were cryopreserved. With their own stored oocytes, 44 patients returned to attempt pregnancy. From a total of 194 thawed/warmed oocytes, 157 survived (80%). In total, 100 embryos were transferred in 57 transfer/cycles, and 18 pregnancies were achieved. The pregnancy rate per transfer and pregnancy rate per patient were 31% and 41%, respectively. No statistically significant differences were observed between oncological patients and nononcological patients. A total of 15 babies were born from oncological patients. Children born showed normal growth and development. One minor malformation was detected.
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Affiliation(s)
- Eleonora Porcu
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-0512144364
| | - Linda Cipriani
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Maria Dirodi
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.D.I.); (A.M.P.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.D.I.); (A.M.P.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Haematology “Seragnoli”, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy;
| | - Mario Taffurelli
- Breast Unit, Department of Woman and Child, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy;
| | - Claudio Zamagni
- “Addari” Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40126 Bologna, Italy;
| | - Patrizia Maria Ciotti
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Leonardo Notarangelo
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Nilla Calza
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Giuseppe Damiano
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
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Johnston M, Fuscaldo G, Gwini SM, Catt S, Richings NM. Financing future fertility: Women's views on funding egg freezing. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:32-41. [PMID: 34693043 PMCID: PMC8517713 DOI: 10.1016/j.rbms.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23-37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Giuliana Fuscaldo
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Jiskra J, Horáček J, Špitálníková S, Paleček J, Límanová Z, Krátký J, Springer D, Žabková K, Vítková H. Thyroid nodules and thyroid cancer in women with positive thyroid screening in pregnancy: a double-centric, retrospective, cohort study. Eur Thyroid J 2022; 11:e210011. [PMID: 35108218 PMCID: PMC8963173 DOI: 10.1530/etj-21-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Thyroid nodules are a common finding in the general population. The primary aim of the study was to determine the prevalence of thyroid nodules and cancer found by ultrasound (US) in women who underwent screening for thyroid dysfunction during pregnancy. DESIGN A double-centric, retrospective, cohort study. PATIENTS AND METHODS We searched through medical records, including thyroid ultrasonography, of pregnant women who were positively screened for thyroid disorders (using thyroid-stimulating hormone and thyroid antibodies) from an unselected population ('universal screening group', n = 690) and of women who underwent the testing based on the presence of clinical risk factors defined by American Thyroid Association ('case-finding group', n = 249). RESULTS Prevalence of benign and malignant thyroid nodules was lower in the 'universal screening group' than in the 'case-finding group' (9.9% vs 17.7%, P= 0.002, and 0.9% vs 7.2%, P< 0.001, respectively). Consistently, the thyroid cancer rate was lower among the nodules in the 'universal screening group' than in the 'case-finding group' (8.1% vs 29.0%, P= 0.003). Ultrasound EU-TIRADS (European Thyroid Imaging and Reporting Data System) category ≥4 had a 95.8% sensitivity for thyroid cancer. In palpable nodules, the prevalence of cancer was significantly higher than in the non-palpable ones (44.0% vs 2.2%, P < 0.001). In a multivariate regression analysis, thyroid nodules were associated with a history of infertility and parity. CONCLUSIONS Compared to the data from cancer registries, universal screening allowed detecting thyroid cancer in pregnancy three to five times more frequently, but the cancer rate among nodules (8.1%) did not differ from the common population. US had very good sensitivity for thyroid cancer in pregnancy.
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Affiliation(s)
- Jan Jiskra
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Correspondence should be addressed to J Jiskra:
| | - Jiří Horáček
- 4th Department of Medicine, Faculty of Medicine, Charles University, University Hospital Hradec Králové, Czech Republic
| | - Sylvie Špitálníková
- Department of Nuclear Medicine, District Hospital, Havlíčkův Brod, Czech Republic
| | - Jan Paleček
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Zdeňka Límanová
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Jan Krátký
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Drahomíra Springer
- Department of Clinical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Kristýna Žabková
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Hana Vítková
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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Assessment of female fertility preservation in Auvergne 3 years after implementation of the PREFERA platform (PREservation FERtilité Auvergne). J Gynecol Obstet Hum Reprod 2022; 51:102342. [PMID: 35181543 DOI: 10.1016/j.jogoh.2022.102342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Fertility preservation (FP) in patients with cancer or pathology at risk of gonadotoxicity is now according to legislation, an integral part of the treatment protocol. for this reason, clinical-biological platforms have emerged with the aim of developing and improving this practice, such as the PREFERA platform (PREservation FERtilité Auvergne) MATERIAL ET METHOD: This is an observational cohort study to evaluate female fertility preservation activity in Auvergne at the AMP-CECOS center of the Clermont-Ferrand University Hospital from March 2013 to March 2019. This period covering 3 years before and after the creation of PREFERA in 2015. RESULTS 205 patients were referred for fertility preservation consultations, including 77 before the platform was set up and 128 after, corresponding to an increase of 66%. 190 patients (92.7%) referred were eligible for FP, of whom 169 (88.9%) received treatment. Thirty-nine patients underwent oocyte vitrification before the platform was set up and 74 after (+89.7%), twenty patients underwent ovarian cortex freezing before the platform was set up and 27 after (+35%). Only 54 patients (26.2%) were seen for follow-up with an increased number of consultations following the implementation of PREFERA. (8% vs 33%, p<0.001). CONCLUSION Creation of the PREFERA platform facilitated patient access and management of fertility preservation procedures. However, at the regional level, it is necessary to continue to raise awareness of fertility issues, particularly in the context of post-cancer follow-up, both among patients and health professionals.
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Sperm DNA fragmentation measured by TUNEL assay is not related to reduced cumulative live birth rates per consumed oocyte after IVF/ICSI from unselected males. Reprod Biomed Online 2022; 44:1079-1089. [DOI: 10.1016/j.rbmo.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/24/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022]
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Park JK, Lee JH, Park EA, Lim HJ, Lyu SW, Lee WS, Kim J, Song H. Development of Optimized Vitrification Procedures Using Closed Carrier System to Improve the Survival and Developmental Competence of Vitrified Mouse Oocytes. Cells 2021; 10:cells10071670. [PMID: 34359838 PMCID: PMC8304188 DOI: 10.3390/cells10071670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
The open carrier system (OC) is used for vitrification due to its high efficiency in preserving female fertility, but concerns remain that it bears possible risks of cross-contamination. Closed carrier systems (CC) could be an alternative to the OC to increase safety. However, the viability and developmental competence of vitrified/warmed (VW) oocytes using the CC were significantly lower than with OC. We aimed to improve the efficiency of the CC. Metaphase II oocytes were collected from mice after superovulation and subjected to in vitro fertilization after vitrification/warming. Increasing the cooling/warming rate and exposure time to cryoprotectants as key parameters for the CC effectively improved the survival rate and developmental competence of VW oocytes. When all the conditions that improved the outcomes were applied to the conventional CC, hereafter named the modified vitrification/warming procedure using CC (mVW-CC), the viability and developmental competence of VW oocytes were significantly improved as compared to those of VW oocytes in the CC. Furthermore, mVW-CC increased the spindle normality of VW oocytes, as well as the cell number of blastocysts developed from VW oocytes. Collectively, our mVW-CC optimized for mouse oocytes can be utilized for humans without concerns regarding possible cross-contamination during vitrification in the future.
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Affiliation(s)
- Jae Kyun Park
- Department of Biomedical Sciences, CHA University, Seongnam 13488, Korea; (J.K.P.); (J.H.L.)
- CHA Fertility Center Gangnam, CHA University, Seoul 06125, Korea; (S.W.L.); (W.S.L.)
| | - Ju Hee Lee
- Department of Biomedical Sciences, CHA University, Seongnam 13488, Korea; (J.K.P.); (J.H.L.)
| | - Eun A Park
- CHA Fertility Center Seoul Station, CHA University, Seoul 04637, Korea;
| | - Hyunjung J. Lim
- Department of Veterinary Medicine, School of Veterinary Medicine, Konkuk University, Seoul 05029, Korea;
| | - Sang Woo Lyu
- CHA Fertility Center Gangnam, CHA University, Seoul 06125, Korea; (S.W.L.); (W.S.L.)
| | - Woo Sik Lee
- CHA Fertility Center Gangnam, CHA University, Seoul 06125, Korea; (S.W.L.); (W.S.L.)
| | - Jayeon Kim
- CHA Fertility Center Seoul Station, CHA University, Seoul 04637, Korea;
- Correspondence: (J.K.); (H.S.)
| | - Haengseok Song
- Department of Biomedical Sciences, CHA University, Seongnam 13488, Korea; (J.K.P.); (J.H.L.)
- Correspondence: (J.K.); (H.S.)
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Cobo A, García-Velasco JA, Remohí J, Pellicer A. Oocyte vitrification for fertility preservation for both medical and nonmedical reasons. Fertil Steril 2021; 115:1091-1101. [DOI: 10.1016/j.fertnstert.2021.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
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21
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Segers I, Bardhi E, Mateizel I, Van Moer E, Schots R, Verheyen G, Tournaye H, De Vos M. Live births following fertility preservation using in-vitro maturation of ovarian tissue oocytes. Hum Reprod 2021; 35:2026-2036. [PMID: 32829388 DOI: 10.1093/humrep/deaa175] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Can oocytes extracted from excised ovarian tissue and matured in vitro be a useful adjunct for urgent fertility preservation (FP)? SUMMARY ANSWER Ovarian tissue oocyte in-vitro maturation (OTO-IVM) in combination with ovarian tissue cryopreservation (OTC) is a valuable adjunct technique for FP. WHAT IS KNOWN ALREADY Despite the impressive progress in the field, options for FP for cancer patients are still limited and, depending on the technique, clinical outcome data are still scarce. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study conducted at a university hospital-affiliated fertility clinic between January 2012 and May 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included 77 patients who underwent unilateral oophorectomy for OTC. Cumulus-oocyte complexes (COCs) obtained during ovarian tissue processing were matured in vitro for 28-42 h. Oocytes reaching metaphase II stage were vitrified or inseminated for embryo vitrification. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 1220 COCs were collected. The mean oocyte maturation rate was 39% ± 23% (SD). There were 64 patients who had vitrification of oocytes (6.7 ± 6.3 oocytes per patient). There were 13 patients who had ICSI of mature oocytes after IVM, with 2.0 ± 2.0 embryos vitrified per patient. Twelve patients have returned to the clinic with a desire for pregnancy. For seven of these, OTO-IVM material was thawed. Two patients had OTO-IVM oocytes warmed, with survival rates of 86% and 60%. After ICSI, six oocytes were fertilised in total, generating three good quality embryos for transfer, leading to a healthy live birth for one patient. In five patients, for whom a mean of 2.0 ± 0.8 (SD) embryos had been vitrified, seven embryos were warmed in total: one embryo did not survive the warming process; two tested genetically unsuitable for transfer; and four were transferred in separate cycles to three different patients, resulting in two healthy babies. In this small series, the live birth rate per patient after OTO-IVM, ICSI and embryo transfer was 43%. LIMITATIONS, REASONS FOR CAUTION The retrospective study design and the limited sample size should be considered when interpreting results. WIDER IMPLICATIONS OF THE FINDINGS The results of the study illustrate the added value of OTO-IVM in combination with OTC. We report the first live birth following the use of this appended technique combined with oocyte vitrification. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. M.D.V. reports honoraria for lectures in the last 2 years from MSD and Ferring, outside the submitted work, as well as grant support from MSD. The other authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ingrid Segers
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Erlisa Bardhi
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium.,Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Roma, Italy
| | - Ileana Mateizel
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Ellen Van Moer
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Rik Schots
- Department of Hematology, University Hospital Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine (CRG), University Hospital Brussel - Vrije Universiteit Brussel, 1090 Brussels, Belgium.,Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels 1090, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
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22
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Mayeur A, Puy V, Windal V, Hesters L, Gallot V, Benoit A, Grynberg M, Sonigo C, Frydman N. Live birth rate after use of cryopreserved oocytes or embryos at the time of cancer diagnosis in female survivors: a retrospective study of ten years of experience. J Assist Reprod Genet 2021; 38:1767-1775. [PMID: 33797007 DOI: 10.1007/s10815-021-02168-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the outcomes of frozen oocytes or embryos cryopreserved after controlled ovarian stimulation (COS) or in vitro maturation (IVM) for female cancer patients who underwent a fertility preservation (FP) prior to gonadotoxic therapy. METHODS A retrospective cohort study from 2009 to December 2017 was conducted. Among the 667 female cancer patients who underwent oocytes or embryos cryopreservation for FP, 40 (6%) have returned to the fertility clinic between 2011 and 2019 to use their frozen material after being cured. We compared these thaw cycles outcomes according to the techniques used at the time of cryopreservation. RESULTS Among the 40 women cancer survivors who used their cryopreserved material, thirty patients have benefited from at least one embryo transfer. Ten patients did not have an embryo transfer since the oocytes did not survive after the thawing process or because no embryo was obtained after fertilization. We related three live births following FP using IVM (two from frozen oocytes and one after embryo cryopreservation). Five live births were obtained when COS was performed at the time of FP (one from frozen oocytes and four after embryo cryopreservation). CONCLUSIONS Our preliminary results, although they are obtained in a small sample, are encouraging and show that different FP techniques can be used in female cancer patients and lead to live births. IVM is one of the options available that does not delay the start of chemotherapy or if ovarian stimulation using gonadotropins is contraindicated.
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Affiliation(s)
- Anne Mayeur
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.
| | - Vincent Puy
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
| | - Victoria Windal
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Laetitia Hesters
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Vanessa Gallot
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Nelly Frydman
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
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Tseng LM, Lien PJ, Huang CY, Tsai YF, Chao TC, Huang SM. Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach. J Med Internet Res 2021; 23:e24926. [PMID: 33729164 PMCID: PMC8074988 DOI: 10.2196/24926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. Objective The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. Methods We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect—collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan—apply the initial results to create a paper design and modify the content; (3) plan and act—brainstorm about the web pages and modify the content; (4) act and observe—evaluate the effectiveness and refine the website’s shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. Results Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients’ and health providers’ needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. Conclusions We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. Trial Registration Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910
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Affiliation(s)
- Ling-Ming Tseng
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Ju Lien
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Yu Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Fang Tsai
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chung Chao
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Miauh Huang
- MacKay Medical College, Department of Nursing, New Taipei City, Taiwan
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Yasmin E, Mitchell R, Lane S. Preservation of fertility in teenagers and young adults treated for haematological malignancies. LANCET HAEMATOLOGY 2021; 8:e149-e160. [PMID: 33513374 DOI: 10.1016/s2352-3026(20)30324-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 01/03/2023]
Abstract
As survival rates in teenagers and young adults diagnosed with haematological malignancies now exceed 70%, it is important that long-term quality of life, including measures to protect future fertility, are considered and discussed with patients and their families. Although discussion on the effect of planned cancer treatment on fertility is standard of care, knowledge of potential fertility treatment options and when they should be offered in haematological malignancies is not always so clear. In each case, the advice on the appropriate preservation of fertility depends upon a complex interplay of factors, weighing out the risk of future infertility against the risk of fertility preservation treatment, and recommendations must be made on a case-by-case basis. The aim of this Review is to evaluate the gonadotoxicity of treatments of prevalent haematological malignancies in teenagers and young adults, and provide an evidence-based framework to help with fertility discussion and management at the time of diagnosis, relapse or resistant disease, and in long-term follow-up settings.
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Affiliation(s)
- Ephia Yasmin
- University College London Hospitals NHS Foundation Trust, University College London, London, UK.
| | - Rod Mitchell
- MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh, UK
| | - Sheila Lane
- Oxford University Hospitals NHS Foundation Trust, Oxford University, Oxford, UK
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25
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Kato K, Ochi M, Nakamura Y, Kamiya H, Utsunomiya T, Yano K, Michikura Y, Hara T, Kyono K, Takeuchi K, Nakayama T, Iwamasa J, Mio Y, Kuramoto T, Nagata Y, Jo T, Asada Y, Ohishi H, Osada H, Yoshida H. A multi-centre, retrospective case series of oocyte cryopreservation in unmarried women diagnosed with haematological malignancies. Hum Reprod Open 2021; 2021:hoaa064. [PMID: 33501384 PMCID: PMC7810816 DOI: 10.1093/hropen/hoaa064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is oocyte cryopreservation an applicable option for fertility preservation in unmarried patients with haematological malignancies? SUMMARY ANSWER Oocyte cryopreservation via the vitrification method is accessible and may be considered an option for fertility preservation in unmarried patients with haematological malignancies. WHAT IS KNOWN ALREADY Haematological malignancies are most commonly observed amongst adolescent and young adult women. Although the survival rate and life expectancy of those with haematological malignancies have improved, chemotherapy and radiotherapy may impair their reproductive potential. Oocyte cryopreservation is thus an ideal option to preserve their fertility. STUDY DESIGN SIZE DURATION This study retrospectively evaluated 193 unmarried patients (age: 26.2 ± 0.4 years) with haematological malignancies, who consulted for oocyte cryopreservation across 20 different fertility centres in Japan between February 2007 and January 2015. The primary outcome measures were the oocyte retrievals and oocyte cryopreservation outcomes. The secondary outcome measures were the outcomes following oocyte warming for IVF. PARTICIPANTS/MATERIALS SETTING METHODS The patients had commenced ovarian stimulation cycles via antagonist, agonist, natural and minimal methods for oocyte retrievals, defined according to the treatment strategy of each respective fertility centre. A vitrification method using the Cryotop safety kit was used for oocyte cryopreservation. ICSIs were used for insemination of warmed oocytes. The endometrial preparation method for embryo transfer was hormonal replacement therapy, except in the case of a patient who underwent a spontaneous ovulatory cycle. MAIN RESULTS AND THE ROLE OF CHANCE Among 193 patients, acute myeloid leukaemia (n = 45, 23.3%) was most common, followed by acute lymphoid leukaemia (n = 38, 19.7%) and Hodgkin's lymphoma (n = 30, 15.5%). In total, 162 patients (83.9%) underwent oocyte retrieval, and oocytes were successfully cryopreserved for 155 patients (80.3%). The mean number of oocyte retrieval cycles and cryopreserved oocytes were 1.7 ± 0.2 and 6.3 ± 0.4, respectively. As of December 2019, 14 patients (9.2%) had requested oocyte warming for IVF. The survival rate of oocytes after vitrification-warming was 85.2% (75/88). The rates of fertilisation and embryo development were 80.0% (60/75) and 46.7% (28/60), respectively. Ten patients (71.4%) had successful embryo transfers, and seven live births (50.0%) were achieved. LIMITATIONS REASONS FOR CAUTION This study was limited by its retrospective nature. Additionally, there remains an insufficient number of cases regarding the warming of vitrified oocytes to reliably conclude whether oocyte cryopreservation is effective for patients with haematological malignancies. Further long-term follow-up study is required. WIDER IMPLICATIONS OF THE FINDINGS Oocyte retrieval and oocyte cryopreservation were accessible for patients with haematological malignancies; however, the number of oocyte retrievals may have been limited due to the initiation of cancer treatments. Acceptable embryonic and pregnancy outcomes could be achieved following oocyte warming; therefore, our results suggest that oocyte cryopreservation can be considered an option for fertility preservation in patients with haematological malignancies. STUDY FUNDING/COMPETING INTERESTS This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- K Kato
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
| | - M Ochi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Ochi Yume Clinic Nagoya, Nagoya, Aichi 460-0002, Japan
| | - Y Nakamura
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Nakamura Ladies Clinic, Suita, Osaka 564-0051, Japan
| | - H Kamiya
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kamiya Ladies Clinic, Sapporo, Hokkaido 060-0003, Japan
| | - T Utsunomiya
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- St. Luke Clinic, Oita, 870-0823 Japan
| | - K Yano
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Yano Maternity Clinic, Matsuyama, Ehime 790-0872, Japan
| | - Y Michikura
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kanazawa Tamago Clinic, Kanazawa, Ishikawa 920-0016, Japan
| | - T Hara
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - K Kyono
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kyono ART Clinic Sendai, Sendai, Miyagi 980-0014, Japan
| | - K Takeuchi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Takeuchi Ladies Clinic, Aira, Kagoshima 899-5421, Japan
| | - T Nakayama
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Adachi Hospital, Chuo-ku, Kyoto 604-0837, Japan
| | - J Iwamasa
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Sofia Ladies Clinic Suidocho, Chuo-ku, Kumamoto 860-0844, Japan
| | - Y Mio
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Mio Fertility Clinic, Yonago, Totttori 683-0008, Japan
| | - T Kuramoto
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Kuramoto Women’s Clinic, Hakata-ku, Fukuoka 812-0013, Japan
| | - Y Nagata
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- IVF Nagata Clinic, Chuo-ku, Fukuoka 810-0001, Japan
| | - T Jo
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Jo Clinic, Nishinomiya, Hyogo 860-0844, Japan
| | - Y Asada
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Asada Ladies Clinic, Nagoya, Aichi 450-0002, Japan
| | - H Ohishi
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Hamanomachi Hospital, Fukuoka 810-0072, Japan
| | - H Osada
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
- Natural ART Clinic Nihombashi, Chuo-ku, Tokyo 103-6008, Japan
| | - H Yoshida
- Kato Ladies Clinic, Tokyo 160-0023, Japan
- Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories (Japan A-PART), Tokyo 160-0023, Japan
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Haddad M, Stewart J, Xie P, Cheung S, Trout A, Keating D, Parrella A, Lawrence S, Rosenwaks Z, Palermo GD. Thoughts on the popularity of ICSI. J Assist Reprod Genet 2020; 38:101-123. [PMID: 33155089 PMCID: PMC7823003 DOI: 10.1007/s10815-020-01987-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Intracytoplasmic sperm injection (ICSI) is the most widely utilized assisted reproductive technique (ART) worldwide. In this feature, we review the early assisted fertilization attempts that eventually led to the development of ICSI, and discuss its current utilization in cases of male and non-male factor infertility. Methods We researched the literature related to the development, indications, and current use of ICSI, such as sperm structural abnormalities, male genetic indications, surgically retrieved sperm, high sperm chromatin fragmentation, oocyte dysmorphism, and preimplantation genetic testing (PGT). We also describe the potential future applications of ICSI. Results This review summarizes the early micromanipulation techniques that led to the inception of ICSI. We also explore its current indications, including non-male factor infertility, where its use is more controversial. Finally, we consider the benefits of future advancements in reproductive biology that may incorporate ICSI, such as in vitro spermatogenesis, neogametogenesis, and heritable genome editing. Conclusion The versatility, consistency, and reliability of ICSI have made it the most prevalently utilized ART procedure worldwide.
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Affiliation(s)
- Mounia Haddad
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joshua Stewart
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Philip Xie
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Stephanie Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aysha Trout
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Derek Keating
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alessandra Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sherina Lawrence
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianpiero D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA.
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27
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Crown A, Muhsen S, Zabor EC, Sevilimedu V, Kelvin J, Goldfarb SB, Gemignani ML. Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer? Ann Surg Oncol 2020; 27:4740-4749. [PMID: 32767225 PMCID: PMC7554118 DOI: 10.1245/s10434-020-08883-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). We evaluated premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. METHODS This retrospective review included all premenopausal women diagnosed at our institution with stage 0-III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. RESULTS A total of 334 women were identified. Median age was 35 years (interquartile range 32-38). The majority of women were single (n = 198, 59.3%) and nulliparous (n = 239, 71.6%). REI referrals were common (n = 237, 71.0%). The Breast Surgery service was the most frequent referring service (n = 194, 58.1%), with significantly more REI referrals compared to Breast Medicine and Genetics services (p = 0.002). Nulliparity was associated with REI referral (p < 0.0001). Adjuvant chemotherapy (p = 0.003) was associated with pursuing REI referral, whereas NAC (p < 0.001) was associated with declining REI referral. CONCLUSIONS Most women elected to consult with an REI specialist, confirming strong interest in fertility preservation among premenopausal women with breast cancer. However, women receiving NAC more frequently declined referral to REI, suggesting that the need to start NAC may influence decisions regarding fertility preservation. With increasing utilization of NAC, our study supports the need for further counseling and education regarding fertility preservation for women undergoing NAC.
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Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Muhsen
- Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Kelvin
- Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari B Goldfarb
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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28
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Bonardi B, Massarotti C, Bruzzone M, Goldrat O, Mangili G, Anserini P, Spinaci S, Arecco L, Del Mastro L, Ceppi M, Demeestere I, Lambertini M. Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:574669. [PMID: 33117711 PMCID: PMC7575927 DOI: 10.3389/fonc.2020.574669] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background: The co-administration of letrozole during controlled ovarian stimulation (COS) with gonadotropins is used to limit the potentially harmful effects of a supra-physiological rise in estrogen levels on hormone-sensitive cancers. However, the efficacy and safety of adding letrozole to COS remain debated. Methods: This is a systematic review and meta-analysis of published studies that compared the efficacy and safety of COS with co-administration of letrozole vs. COS without letrozole in all patient populations. A secondary analysis was done including only the studies in breast cancer patients. The primary efficacy endpoint was the number of retrieved mature Metaphase II (MII) oocytes. Secondary efficacy and safety endpoints were total number of oocytes, maturation rate, fertilization rate, number of cryopreserved embryos, peak estradiol levels, progesterone levels, and total gonadotropin dose. Data for each endpoint were reported and analyzed thorough mean ratio (MR) with 95% confidence interval (CI). Results: A total of 11 records were selected including 2,121 patients (990 patients underwent COS with letrozole and 1,131 COS without letrozole). The addition of letrozole to COS did not have any negative effect on the number of mature oocytes collected (MR = 1.00, 95% CI = 0.87–1.16; P = 0.967) and the other efficacy endpoints. COS with letrozole was associated with significantly decreased peak estradiol levels (MR = 0.28, 95% CI = 0.24–0.32; P < 0.001). Similar results were observed in the secondary analysis including only breast cancer patients. Conclusions: These findings are reassuring on the efficacy and safety of COS with gonadotropins and letrozole and are particularly important for fertility preservation in women with hormone-sensitive cancers.
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Affiliation(s)
- Benedetta Bonardi
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi, Genova, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Fertility Clinic, CUB-Hôpital Erasme, Brussels, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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29
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Massarotti C, Scaruffi P, Lambertini M, Sozzi F, Remorgida V, Anserini P. Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients. Hum Reprod 2020; 34:1462-1469. [PMID: 31339999 DOI: 10.1093/humrep/dez108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/26/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit? SUMMARY ANSWER Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy. WHAT IS KNOWN ALREADY Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material. STUDY DESIGN, SIZE, DURATION We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18-40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any. PARTICIPANTS/MATERIALS, SETTING, METHODS Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit. LIMITATIONS, REASONS FOR CAUTION These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard. WIDER IMPLICATION OF THE FINDINGS The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N.A.
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Affiliation(s)
- Claudia Massarotti
- Academic Unit of Obstetrics and Gynecology, DINOGMI Department, University of Genova, 16132, Genova, Italy
| | - Paola Scaruffi
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132, Genova, Italy
| | - Fausta Sozzi
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genova, Italy
| | - Valentino Remorgida
- Academic Unit of Obstetrics and Gynecology, DINOGMI Department, University of Genova, 16132, Genova, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genova, Italy
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30
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Barberet J, Barry F, Choux C, Guilleman M, Karoui S, Simonot R, Bruno C, Fauque P. What impact does oocyte vitrification have on epigenetics and gene expression? Clin Epigenetics 2020; 12:121. [PMID: 32778156 PMCID: PMC7418205 DOI: 10.1186/s13148-020-00911-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Children conceived by assisted reproductive technologies (ART) have a moderate risk for a number of adverse events and conditions. The question whether this additional risk is associated with specific procedures used in ART or whether it is related to the intrinsic biological factors associated with infertility remains unresolved. One of the main hypotheses is that laboratory procedures could have an effect on the epigenome of gametes and embryos. This suspicion is linked to the fact that ART procedures occur precisely during the period when there are major changes in the organization of the epigenome. Oocyte freezing protocols are generally considered safe; however, some evidence suggests that vitrification may be associated with modifications of the epigenetic marks. In this manuscript, after describing the main changes that occur during epigenetic reprogramming, we will provide current information regarding the impact of oocyte vitrification on epigenetic regulation and the consequences on gene expression, both in animals and humans. Overall, the literature suggests that epigenetic and transcriptomic profiles are sensitive to the stress induced by oocyte vitrification, and it also underlines the need to improve our knowledge in this field.
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Affiliation(s)
- Julie Barberet
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Fatima Barry
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Cécile Choux
- Gynécologie-Obstétrique, CHU Dijon Bourgogne, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Magali Guilleman
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Sara Karoui
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Raymond Simonot
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Céline Bruno
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Patricia Fauque
- CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction, CECOS, 14 rue Gaffarel, 21079 Dijon Cedex, France
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31
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Ashizawa M, Kanda Y. Preservation of fertility in patients with hematological malignancies. Jpn J Clin Oncol 2020; 50:729-742. [PMID: 32419028 DOI: 10.1093/jjco/hyaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Oncofertility is the medical field that bridges oncology and reproduction that seeks to give healthcare providers and patients the opportunity to optimize residual fertility. The treatment for hematological malignancies carries gonadal toxicity, so that the preservation of fertility should be considered in all patients in childhood, adolescence and young adulthood. Most patients who receive only chemotherapy remain fertile, whereas those who receive regimens consisting of high-dose alkylating agents or total body irradiation can develop permanent infertility. In postpubertal patients, there are established methods for preserving fertility, such as the cryopreservation of sperm, oocytes and embryos. Although ideally performed before the initiation of gonadotoxic treatment, these procedures for fertility preservation can be performed any time prior to the loss of gonadal function. In contrast, a standard option is not available in prepubertal patients, and the preservation of fertility must be sought through experimental methods. Future advances in reproductive medicine may overcome this limitation. Gonadal tissue cryopreservation might be performed in the hope that sperm or mature oocytes could later be extracted from cryopreserved tissue. Healthcare providers, including hematologists, reproductive endocrinologists, nurses, clinical psychotherapists and embryologists, need to optimize the patient's fertility through shared decision-making while always remaining aware of the rapidly progressing developments in reproductive medicine.
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Affiliation(s)
- Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan, and
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan, and.,Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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32
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Added Benefit of Immature Oocyte Maturation for Fertility Preservation in Women with Malignancy. Reprod Sci 2020; 27:2257-2264. [PMID: 32617879 DOI: 10.1007/s43032-020-00245-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
To assess the added value of maturing immature oocytes collected during fertility preservation treatments in women with malignancy. A retrospective case-control study analyzing the results of 327 cancer patients undergoing fertility preservation treatments. Oocyte maturation rates and cycle parameters were compared between 3 types of fertility preservation treatments: (1) stimulated IVF cycle (n = 143), (2) non-stimulated IVM cycle (n = 158), (3) follicle aspiration and oocyte collection from ovarian tissue prepared for ovarian tissue cryopreservation followed by in vitro maturation of the immature oocytes (n = 48). The primary outcome measure was the maturation rate and the number of mature oocytes. The secondary outcomes were oocyte fertilization and embryo development rates. The mean maturation rate in IVF cycles was 38% and in the non-stimulated IVM cycles was 55%. In women who chose to cryopreserve their embryos, similar fertilization and embryo cleavage rates were found in oocytes that matured after stimulated IVF cycles compared to non-stimulated IVM cycles. Gonadotropin-releasing hormone agonist triggering, treatment with aromatase inhibitor, or oral contraceptives use before the cycle did not affect the maturation rate. Ovarian stimulation yields the highest number of oocytes or embryos for cryopreservation. Although the maturation rate of immature oocytes collected in stimulated IVF cycles is low, it is still a viable source of oocytes that can be used to improve the efficacy of fertility preservation treatments by increasing the number of mature oocytes available for freezing or fertilization.
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33
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Sciorio R. Cryopreservation of human embryos and oocytes for fertility preservation in cancer and non cancer patients: a mini review. Gynecol Endocrinol 2020; 36:381-388. [PMID: 32003268 DOI: 10.1080/09513590.2020.1719402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The term 'cryopreservation' illustrates the process of freezing cells and storing at very low temperature in liquid nitrogen (-196 °C). Cooling is not a physiological condition for human cells especially due to the high concentration of water in the living matter, whose conversion to ice crystals may be associated with cell death. Human oocytes are particularly sensitive to the freezing process, primarily because of their large size and the presence of the meiotic spindle, which at low temperature can degenerate. In the last decade, the cryopreservation technology has become highly important as an option for fertility preservation (FP) in women with cancer. Anticancer therapy might promote premature ovarian failure and negatively affects the reproductive outcome. Over the years, scientists have proposed different cryopreservation strategies in the effort to maintain the physiological functions of oocytes and embryo. However, despite the first success obtained in the 1980s with frozen oocytes, it was not until recently that a new approach has been proposed: the 'Vitrification' which allowed a breakthrough in this procedure. FP is a major determinant for cancer survivor women in the reproductive age. This article describes the FP options currently available, focusing mainly on oocyte and embryo cryopreservation.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
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34
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Hussein RS, Khan Z, Zhao Y. Fertility Preservation in Women: Indications and Options for Therapy. Mayo Clin Proc 2020; 95:770-783. [PMID: 32247351 DOI: 10.1016/j.mayocp.2019.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 01/21/2023]
Abstract
Fertility preservation (FP) is a vital issue for individuals in either reproductive or prepubescent stage of life when future fertility may be compromised. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure maintaining or preserving reproductive health. Fertility potential can be affected by cancer therapy and numerous other factors, including advancing age, metabolic conditions, autoimmune diseases, specific surgical interventions, and sex affirmation procedures. A paradigm shift focusing on quality-of-life issues and long-term survivorship has emerged, especially because of advances in cancer diagnostics and treatment. Several FP techniques have been widely distributed, while others are still in the research stage. In addition, specific procedures and some potentially fertoprotective agents are being developed, aiming to minimize the hazards of gonadal damage caused by cancer therapy and decrease the need for more costly, invasive, and time-consuming FP methods. This review highlights the advances, indications, and options for FP, both experimental and well-established, in females of various age groups. An electronic search in PubMed, Embase, and Google Scholar databases was conducted, including retrospective studies, prospective clinical trials, meta-analyses, original reviews, and online abstracts published up to June 30, 2019. The search terms used included fertility preservation, oncofertility, embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. The meeting proceedings of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology were also hand searched.
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Affiliation(s)
- Reda S Hussein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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35
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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] [Accepted: 01/16/2018] [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
| | - 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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36
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Ferreiro E, de Uralde BL, Abreu R, García-Velasco JA, Muñoz E. Aromatase Inhibitors for Ovarian Stimulation in Patients with Breast Cancer. Curr Drug Targets 2020; 21:910-921. [PMID: 32077823 DOI: 10.2174/1389450121666200220124607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy diagnosed in women, and its treatment has a high probability of loss of fertility. Oocyte vitrification is the most commonly used technique to preserve fertility before starting oncological treatment. Aromatase inhibitors induce hypoestrogenemia while promoting the release of gonadotropins and constitute an alternative drug for ovarian stimulation in patients with breast cancer. OBJECTIVE In this mini-review, we update and describe the current status of aromatase inhibitor use in controlled ovarian stimulation for oocyte vitrification in patients with breast cancer. RESULTS Aromatase inhibitors are commonly used in combination with gonadotropins for ovarian stimulation in patients with breast cancer who preserve their fertility through oocyte vitrification. They achieve similar ovarian responses as conventional ovarian stimulation protocols in regards to the number of oocytes, and no additional complications after their use have been reported. Furthermore, aromatase inhibitors seem to be safe not only for offspring, as no more congenital defects occur in newborns from pregnancies achieved after their use, but also for the patients, as no more malignancy recurrence or increased mortality was found in cohort studies. CONCLUSION Aromatase inhibitors are elective drugs for ovarian stimulation in patients with breast cancer who decide to preserve their fertility through oocyte vitrification.
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Affiliation(s)
- Esteban Ferreiro
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Rita Abreu
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Elkin Muñoz
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
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37
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Ter Welle-Butalid MEE, Vriens IJHI, Derhaag JGJ, Leter EME, de Die-Smulders CEC, Smidt MM, van Golde RJTR, Tjan-Heijnen VCGV. Counseling young women with early breast cancer on fertility preservation. J Assist Reprod Genet 2019; 36:2593-2604. [PMID: 31760547 PMCID: PMC6910894 DOI: 10.1007/s10815-019-01615-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. METHODS A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. RESULTS Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. CONCLUSIONS Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.
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Affiliation(s)
- M E Elena Ter Welle-Butalid
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - I J H Ingeborg Vriens
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J G Josien Derhaag
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - E M Edward Leter
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - C E Christine de Die-Smulders
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - M Marjolein Smidt
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - R J T Ron van Golde
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - V C G Vivianne Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Internal Medicine, division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Alvarez RM, Ramanathan P. Fertility preservation in female oncology patients: the influence of the type of cancer on ovarian stimulation response. Hum Reprod 2019; 33:2051-2059. [PMID: 27370358 DOI: 10.1093/humrep/dew158] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Does the type of cancer influence on the ovarian response to stimulation for fertility preservation (FP) in female oncology patients? SUMMARY ANSWER Patients with gynaecological cancer have less number of retrieved mature oocytes compared with haematological and breast cancer patients. WHAT IS KNOWN ALREADY Concerns about the impact of cancer therapy on future fertility have been raised and FP has become an important component in cancer management. Previous studies analysing FP results in cancer patients have shown conflicting findings. STUDY DESIGN, SIZE, DURATION This was a retrospective analytical study performed in the Centre for Reproductive Medicine, at St Bartholomew's Hospital, between January 2000 and December 2014. The aim of this study was to analyse the response to ovarian stimulation in cancer patients before undergoing cancer treatment and to determine whether any difference can be attributed to underlying cancer diagnosis. We also report the pregnancy outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 531 female patients recently diagnosed with cancer were referred for counselling on FP. A total of 306 patients underwent ovarian stimulation for oocyte or embryo cryopreservation. We compared the baseline characteristics and ovarian response in five main subgroups: breast cancer, haematological cancer, gynaecological cancer, gastrointestinal cancer and others. The primary outcome was the total number of mature oocytes retrieved and pregnancy outcomes. MAIN RESULTS AND THE ROLE OF CHANCE The main cancer diagnosis was breast cancer with 145 patients (47.4%); 79 patients (25.8%) had haematological malignancies; 42 (13.7%) had gynaecological malignancies; 20 (6.5%) had gastrointestinal cancer and 20 (6.5%) had other types of cancer. Patients with breast cancer were older (P < 0.001). Patients with haematological malignancies had higher number of mature oocytes retrieved (P = 0.003). The number of mature oocytes retrieved was lower in patients with gynaecological malignancy compared with haematological and breast cancer patients (P = 0.005 and P = 0.045, respectively). The fertilization rate and the number of cycles cancelled were comparable between all the groups. Thirty-two embryo transfer cycles have been done in 22 patients who have returned to attempt pregnancy. Pregnancy rate per transfer cycle was 43.75%, and cumulative pregnancy rate per patient was 54.5%. Live birth rate per patient was 22.72%. LIMITATIONS, REASONS FOR CAUTION Apart from the retrospective nature of the study, patients were included over the period of 15 years, and over that time technology has changed and protocols have evolved. The results obtained from subcategory analyses should be interpreted with caution, as in each subgroup there are different types of malignancies with different number of patients in different age groups. Different ovarian stimulation protocols were applied. Only a few patients have come back to attempt pregnancy after being cured from their disease. We do not have follow-up data on these patients; as a result, we are not able to report the survival rate and the reason for non-return for embryo transfer. In addition, we cannot report information on spontaneous conceptions and births. Slow freezing used for embryo cryopreservation, high miscarriage rate and low live birth rate per transfer are other limitations of this study. WIDER IMPLICATIONS OF THE FINDINGS The current study is the largest series analysing each group of cancer separately and showing pregnancy outcomes in oncology patients undergoing FP. These results provide valuable information about the success of this technique in oncology patients. STUDY FUNDING/COMPETING INTEREST(S) The authors have not received any funding to support this study. There are no conflicts of interest to declare.
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Affiliation(s)
- R M Alvarez
- The Centre for Reproductive Medicine, St Bartholomew's Hospital, West Smithfield, London, UK.,Department of Gynaecological Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - P Ramanathan
- The Centre for Reproductive Medicine, St Bartholomew's Hospital, West Smithfield, London, UK
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Liu D, Yan J, Qiao J. Effects of malignancies on fertility preservation outcomes and relevant cryobiological advances. SCIENCE CHINA-LIFE SCIENCES 2019; 63:217-227. [DOI: 10.1007/s11427-019-9526-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/03/2019] [Indexed: 01/04/2023]
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Specchia C, Baggiani A, Immediata V, Ronchetti C, Cesana A, Smeraldi A, Scaravelli G, Levi-Setti PE. Oocyte Cryopreservation in Oncological Patients: Eighteen Years Experience of a Tertiary Care Referral Center. Front Endocrinol (Lausanne) 2019; 10:600. [PMID: 31551931 PMCID: PMC6733913 DOI: 10.3389/fendo.2019.00600] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/15/2019] [Indexed: 01/16/2023] Open
Abstract
Objective: The aim of the present study is to report our experience on elective women fertility preservation before cancer treatment. Study Design: This is a single-center retrospective observational study, including all patients who underwent elective fertility preservation before oncological treatment between January 2001 and March 2019 at our Institute. Results: Of a total of 568 women who received fertility counseling, 244 (42.9%) underwent 252 oocyte retrieval cycles after controlled ovarian stimulation for cryopreservation. The majority of patients were diagnosed with breast cancer (59.9%), followed by women affected by Hodgkin's and non-Hodgkin's lymphoma (27.4%). A minority comprised patients diagnosed with other malignancies that affected soft tissues (2.8%), ovary borderline type (2.4%), digestive system (1.6%), leukemia (1.6%), uterine cervix (1.2%). The remaining 3.1% were affected by other cancer types. The mean age of the cohort was 31.3 ± 6.4 years and the mean oocyte retrieval was 13.5± 8.4. Of 11 women who returned to attempt a pregnancy, three performed two thawed cycles. We obtained four pregnancies from 24 embryo transfers (Pregnancy Rate 36.4% for couple): two miscarriages and two live births. Overall, 95.7% of oocytes are still in storage. Conclusions: A close collaboration between Cancer and Fertility Center in a tertiary care hospital is essential to provide a good health service in oncological patients. Offering fertility preservation is no longer considered optional and must be included in every therapeutic program for women who receive an oncological diagnosis in their reproductive age. Oocyte cryopreservation appears to be a good opportunity for fertility preservation. Our results, although they are obtained in a small sample, are encouraging, even if only 4.5% of patients returned to use their gametes.
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Affiliation(s)
- Cristina Specchia
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Annamaria Baggiani
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Valentina Immediata
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Camilla Ronchetti
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Amalia Cesana
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Antonella Smeraldi
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
| | - Giulia Scaravelli
- ART Italian National Register, National Centre for Epidemiology, Surveillance and Health Promotion, National Health Institute, Rome, Italy
| | - Paolo Emanuele Levi-Setti
- Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Fertility Center, Humanitas Clinical and Research Institute, Milan, Italy
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, CT, United States
- *Correspondence: Paolo Emanuele Levi-Setti
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Awareness of fertility and reproductive aging in women seeking oocyte cryopreservation, reproductive aged controls, and female health care professionals: A comparative study. Eur J Obstet Gynecol Reprod Biol 2018; 233:146-150. [PMID: 30597339 DOI: 10.1016/j.ejogrb.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the awareness of fertility and reproductive aging in women seeking oocyte cryopreservation (OC) with age matched controls. STUDY DESIGN In this cross-sectional comparative study, women who were candidates for OC due to impending oocyte depletion (n = 81) were compared to age matched reproductive aged women (RAW) (n = 91) and female healthcare professionals (FHP) (n = 82) in terms of awareness about fertility and reproductive aging and knowledge about OC. A study specific 18-item questionnaire was constructed on the basis of previous research on OC and fertility. RESULTS Awareness of fertility and reproductive aging was similar among groups. The majority of study population was quite realistic of women's most fertile age period whereas they were fairly optimistic about the age that a woman may lose her ability to conceive, monthly fecundity rate, and estimated in vitro fertilization treatment success. OC candidates and FHP were more realistic compared to RAW regarding the age after which the chances of conception is severely diminished (p = 0.005). When the knowledge on OC and willingness to preserve fertility in the future were asked to FHP and RAW, 90% stated that they were aware of the option (93% in FHP versus 88% in RAW, p = 0.006). However, they lacked detailed information about OC and they were unlikely to consider it in the future. CONCLUSIONS Women seeking OC did not appear to have a better awareness of reproductive ageing compared to the general female population. The results of this study highlight the need for additional awareness campaigns and education on both personal and professional levels.
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Cavagna F, Pontes A, Cavagna M, Dzik A, Donadio NF, Portela R, Nagai MT, Gebrim LH. Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients. ACTA ACUST UNITED AC 2018; 25:e527-e532. [PMID: 30607119 DOI: 10.3747/co.25.3889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Fertility preservation is an important concern in breast cancer patients. In the present investigation, we set out to create a specific protocol of controlled ovarian stimulation (cos) for oocyte cryopreservation in breast cancer patients. Methods From November 2014 to December 2016, 109 patients were studied. The patients were assigned to a specific random-start ovarian stimulation protocol for oocyte cryopreservation. The endpoints were the numbers of oocytes retrieved and of mature oocytes cryopreserved, the total number of days of ovarian stimulation, the total dose of gonadotropin administered, and the estradiol level on the day of the trigger. Results Mean age in this cohort was 31.27 ± 4.23 years. The average duration of cos was 10.0 ± 1.39 days. The mean number of oocytes collected was 11.62 ± 7.96 and the mean number of vitrified oocytes was 9.60 ± 6.87. The mean estradiol concentration on triggering day was 706.30 ± 450.48 pg/mL, and the mean dose of gonadotropins administered was 2610.00 ± 716.51 IU. When comparing outcomes by phase of the cycle in which cos was commenced, we observed no significant differences in the numbers of oocytes collected and vitrified, the length of ovarian stimulation, and the estradiol level on trigger day. The total dose of follicle-stimulating hormone and human menopausal gonadotropin administered was statistically greater in the group starting cos in the luteal phase than in the group starting in the late follicular phase. Conclusions Our results suggest that using a specific protocol with random-start ovarian stimulation for oocyte cryopreservation in breast cancer patients is effective and could be offered to young women undergoing oncologic treatment.
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Affiliation(s)
- F Cavagna
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - A Pontes
- Department of Gynecology and Obstetrics, Botucatu Medical School, University of the State of Sao Paulo, Botucatu, Brazil
| | - M Cavagna
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - A Dzik
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - N F Donadio
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - R Portela
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - M T Nagai
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - L H Gebrim
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
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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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Reproductive outcomes after oocyte banking for fertility preservation. Reprod Biomed Online 2018; 37:425-433. [DOI: 10.1016/j.rbmo.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022]
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Parmar V. Rising Incidence of Breast Cancer in the Young Fertile Indian Population-a Reality Check. Indian J Surg Oncol 2018; 9:296-299. [PMID: 30287986 PMCID: PMC6154358 DOI: 10.1007/s13193-018-0800-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
Abstract
Breast cancer in India appears to be diagnosed more in the young women, but whether this is an actual higher incidence, and hence a matter of concern, needs more clarity, and the extent to which correctable measures can be taken to reduce or overcome this additional disease burden, if any, has to be better understood. The article analyzes these and more in a systematic manner and highlights the important issues in the very young women which makes the clinical management of breast cancer more complex.
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Affiliation(s)
- Vani Parmar
- Breast Unit, Surgical Oncology, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, India
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Martinez F. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Hum Reprod 2018; 32:1802-1811. [PMID: 29117320 PMCID: PMC5850800 DOI: 10.1093/humrep/dex218] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION What progress has been made in fertility preservation (FP) over the last decade? SUMMARY ANSWER FP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended. WHAT IS KNOWN ALREADY FP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility. STUDY DESIGN, SIZE, DURATION An international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Twenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included. MAIN RESULTS AND THE ROLE OF CHANCE Several oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in post-pubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended. LIMITATIONS, REASONS FOR CAUTION Given the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was three or below. WIDER IMPLICATIONS OF THE FINDINGS Further high quality studies are needed to study the long-term outcomes of FP techniques. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Francisca Martinez
- Hospital Universitario Dexeus, Gran Via Carlos III, 71-75, 08208 Barcelona, Spain
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Fertility Drugs Associated with Thyroid Cancer Risk: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7191704. [PMID: 29862285 PMCID: PMC5971354 DOI: 10.1155/2018/7191704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/04/2023]
Abstract
Associations have been demonstrated between fertility drugs and a variety of hormone-sensitive carcinomas. The purpose of this study was to determine the relationship between fertility drugs used in the treatment of female infertility and the risk of thyroid cancer. To investigate the clinical significance of fertility drugs used for the treatment of female infertility and the risk associated with thyroid cancer, we performed a literature search using PubMed, MEDLINE, the Cochrane Library, the Web of Science, and EBSCOHOST for comparative studies published any time prior to July 21, 2017. The studies included women who were treated for infertility with fertility drugs, such as clomiphene citrate, gonadotropins, or other unspecified fertility agents, which reported the incidence of thyroid cancer as the main outcome. Eight studies were included in the meta-analyses. Among women with infertility, there was a significant positive association between thyroid cancer risk and the use of fertility drugs (relative risk [RR] = 1.35; 95% confidence interval [CI] 1.12–1.64; P = 0.002). Additionally, among women with infertility, the use of clomiphene citrate was associated with an increased risk of thyroid cancer compared to women who did not use fertility drugs (RR = 1.45; 95% CI 1.12–1.88; P = 0.005). After pooling results, we found that the parity status of infertile women using fertility drugs was not associated with thyroid cancer risk (RR = 0.99; 95% CI 0.61–1.58, P = 0.95). In summary, clomiphene citrate (the most commonly used fertility drug) and other fertility drugs are associated with an increased risk of thyroid cancer.
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Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? J Glob Oncol 2018; 4:JGO.17.00213. [PMID: 32259161 PMCID: PMC7853872 DOI: 10.1200/jgo.17.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [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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Creux H, Monnier P, Son WY, Buckett W. Thirteen years' experience in fertility preservation for cancer patients after in vitro fertilization and in vitro maturation treatments. J Assist Reprod Genet 2018; 35:583-592. [PMID: 29502188 DOI: 10.1007/s10815-018-1138-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/08/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aims to describe the experience and outcomes of in vitro maturation without ovarian stimulation (IVM-FP) and conventional in vitro fertilization after ovarian stimulation (IVF-FP) in a fertility preservation (FP) program for women with cancer. METHODS Retrospective cohort study from 2003 to 2015 was conducted. The study population consisted of 353 women with cancer who underwent 394 FP cycles (187 IVF-FP cycles and 207 IVM-FP) for oocytes and/or embryos cryopreservation. RESULT(S) Comparatively with IVM-FP, IVF-FP had a higher median [25th-75th percentile] number of oocytes collected-12 [8-18] vs 7 [5-13]; oocytes cryopreserved-10 [6-15] vs 5 [2-8]; and, where applicable, embryos cryopreserved-5 [3-7] vs 3 [2-5] (p < 0.000001). Following FP treatment, 32 patients (9.0%) died, 18 patients (5.6%) conceived spontaneously, and 23 patients (6.5%) returned to attempt pregnancy with a median lapse of returning of 4.6 [3.1-6.1] years. Of these, cryopreserved oocytes or embryos were used in 33 cycles (19 after IVF-FP and 14 after IVM-FP). Overall, the cumulative pregnancy rate (CPR) was 47.6% (10/21) and the live birth rate (LBR) was 38.1% (8/21). Per cycle, CPR and LBR were 37 and 31% following IVF-FP and 14 and 7% following IVM-FP, although these differences did not reach statistical significance. We report the fourth live birth after IVM-FP in cancer, and the first one after IVM embryo warming resulting from in vivo oocyte retrieval and IVM procedure. CONCLUSION(S) Both IVF-FP and IVM-FP are possible options for FP women with cancer. Due to minimal data regarding ultimate outcomes, further follow-up is needed.
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Affiliation(s)
- Helene Creux
- Department of Obstetrics and Gynecology, McGill University Health Centre (MUHC), MUHC Reproductive centre, 888, Blvd de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada. .,Reproductive Centre, Department of Obstetrics and Gynecology, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076, Bordeaux, France.
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University Health Centre (MUHC), MUHC Reproductive centre, 888, Blvd de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada.,Research Institute of McGill University Health Center, 2155 Guy Street, Montreal, QC, H3H2R9, Canada
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, McGill University Health Centre (MUHC), MUHC Reproductive centre, 888, Blvd de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Health Centre (MUHC), MUHC Reproductive centre, 888, Blvd de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
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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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