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Higuchi S, Miyamoto T, Oka K, Kobara H, Shiozawa T. Successful pregnancy using immature oocytes retrieved from resected borderline ovarian tumor: a case report and literature review. Contracept Reprod Med 2024; 9:24. [PMID: 38755650 PMCID: PMC11097572 DOI: 10.1186/s40834-024-00285-9] [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: 01/29/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Despite the recent progress of fertility preservation technique, achievement of pregnancy in women with ovarian tumor is still challenging. Here, we report a case of OTO-IVM (ovarian tissue oocyte in-vitro maturation) resulting in a successful delivery. CASE PRESENTATION The patient, a 33-year-old woman with a history of left borderline ovarian tumor (BOT) who underwent left salpingo-oophorectomy three years ago, presented with an enlarged right ovary during infertility treatment, indicating the recurrence of BOT. Because the patient disagreed with curative surgery and normal part-preservation surgery, we eventually performed OTO-IVM. A right salpingo-oophorectomy was first performed. Eight immature oocytes were immediately aspirated not only from visible follicles, but also from entire cortex for invisible follicles, of the removed ovary. In addition, IVM procedure generated six mature oocytes, and were subjected to intracytoplasmic sperm injection (ICSI). Accordingly, three embryos were obtained and cryopreserved. Three months after surgery, hormone replacement therapy was initiated, and a frozen-thawed embryo was transferred, resulting in a successful pregnancy. Although a cesarean section was performed at 36 weeks due to maternal ileus, the baby was delivered without complications. CONCLUSIONS This report indicates this treatment to be an effective approach for fertility preservation in BOT patients, especially, the importance of collecting oocytes from the entire ovarian cortex was suggested.
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Affiliation(s)
- Shotaro Higuchi
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tsutomu Miyamoto
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Kenji Oka
- OKA Ladies Clinic, 1-14-1 Shimohigano, Nagano, Nagano, 381-2216, Japan
| | - Hisanori Kobara
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Tsui EL, McDowell HB, Laronda MM. Restoring Ovarian Fertility and Hormone Function: Recent Advancements, Ongoing Efforts and Future Applications. J Endocr Soc 2024; 8:bvae073. [PMID: 38698870 PMCID: PMC11065362 DOI: 10.1210/jendso/bvae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Indexed: 05/05/2024] Open
Abstract
The last 20 years have seen substantial improvements in fertility and hormone preservation and restoration technologies for a growing number of cancer survivors. However, further advancements are required to fill the gaps for those who cannot use current technologies or to improve the efficacy and longevity of current fertility and hormone restoration technologies. Ovarian tissue cryopreservation (OTC) followed by ovarian tissue transplantation (OTT) offers those unable to undergo ovarian stimulation for egg retrieval and cryopreservation an option that restores both fertility and hormone function. However, those with metastatic disease in their ovaries are unable to transplant this tissue. Therefore, new technologies to produce good-quality eggs and restore long-term cyclic ovarian function are being investigated and developed to expand options for a variety of patients. This mini-review describes current and near future technologies including in vitro maturation, in vitro follicle growth and maturation, bioprosthetic ovaries, and stem cell applications in fertility restoration research by their proximity to clinical application.
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Affiliation(s)
- Elizabeth L Tsui
- Department of Pediatrics, Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Hannah B McDowell
- Department of Pediatrics, Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Monica M Laronda
- Department of Pediatrics, Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Christodoulaki A, He H, Zhou M, De Roo C, Baetens M, De Pretre T, Fakhar-I-Adil M, Menten B, Van Soom A, Stoop D, Boel A, Heindryckx B. Pronuclear transfer rescues poor embryo development of in vitro-grown secondary mouse follicles. Hum Reprod Open 2024; 2024:hoae009. [PMID: 38425578 PMCID: PMC10904147 DOI: 10.1093/hropen/hoae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
STUDY QUESTION Is pronuclear transfer (PNT) capable of restoring embryo developmental arrest caused by cytoplasmic inferiority of in vitro-grown (IVG) mouse oocytes? SUMMARY ANSWER PNT to in vivo matured cytoplasm significantly improved embryo development of IVG mouse oocytes, leading to living, fertile offspring. WHAT IS KNOWN ALREADY In vitro follicle culture has been considered as a fertility preservation option for cancer patients. Studies describing the culture of human follicles remain scarce, owing to low availability of tissue. Mouse models have extensively been used to study and optimize follicle culture. Although important achievements have been accomplished, including the production of healthy offspring in mice, IVG oocytes are of inferior quality when compared to in vivo-grown oocytes, likely because of cytoplasmic incompetence. STUDY DESIGN SIZE DURATION The study was carried out from September 2020 to February 2022. In total, 120 15-day-old B6D2 mice were used to perform secondary follicle culture and assess the quality of IVG oocytes. In vivo-grown control oocytes were obtained from 85 8- to 12-week-old B6D2 mice, following ovarian stimulation. For sperm collection, four B6D2 males between 10 and 14 weeks old were used. For embryo transfer, 14 8- to 12-week-old CD1 females served as surrogate mothers and 10 CD1 vasectomized males 10-24 weeks old were used to generate pseudo-pregnant females. Finally, for mating, four B6D2 female mice aged 8-10 weeks and two B6D2 male mice aged 10 weeks old were used to confirm the fertility of nuclear transfer (NT)-derived pups. PARTICIPANTS/MATERIALS SETTING METHODS Secondary follicles from 15-day-old B6D2 mice were isolated from the ovaries and cultured for 9 days, before a maturation stimulus was given. Following 16-18 h of maturation, oocytes were collected and evaluated on maturation rate, oocyte diameter, activation rate, spindle morphology, calcium-releasing ability, and mitochondrial membrane potential. For every experiment, in vivo-grown oocytes were used as a control for comparison. When cytoplasmic immaturity and poor embryo development were confirmed in IVG oocytes, PNT was performed. For this, the pronuclei from IVG oocytes, created following parthenogenetic activation and IVF, were transferred to the cytoplasm of fertilized, in vivo-grown oocytes. Genetic analysis and embryo transfer of the generated embryos were implemented to confirm the safety of the technique. MAIN RESULTS AND THE ROLE OF CHANCE Following 9 days of follicle culture, 703 oocytes were collected, of which 76% showed maturation to the metaphase II stage. Oocyte diameters were significantly lower in IVG oocytes, measuring 67.4 μm versus 73.1 μm in controls (P < 0.001). Spindle morphology did not differ significantly between IVG and control oocytes, but calcium-releasing ability was compromised in the IVG group. An average calcium release of 1.62 arbitrary units was observed in IVG oocytes, significantly lower than 5.74 in control oocytes (P < 0.001). Finally, mitochondrial membrane potential was inferior in IVG compared to the control group, reaching an average value of 0.95 versus 2.27 (P < 0.001). Developmental potential of IVG oocytes was assessed following parthenogenetic activation with strontium chloride (SrCl2). Only 59.4% of IVG oocytes cleaved to two cells and 36.3% reached the blastocyst stage, significantly lower than 89.5% and 88.2% in control oocytes, respectively (P < 0.001 and 0.001). Both PNT and spindle transfer (ST) were explored in pilot experiments with parthenogenetically activated oocytes, as a means to overcome poor embryo development. After the added value of NT was confirmed, we continued with the generation of biparental embryos by PNT. For this purpose, IVG and control oocytes first underwent IVF. Only 15.5% of IVG oocytes were normally fertilized, in contrast to 45.5% in controls (P < 0.001), with resulting failure of blastocyst formation in the IVG group (0 versus 86.2%, P < 0.001). When the pronuclei of IVG zygotes were transferred to the cytoplasm of control zygotes, the blastocyst rate was restored to 86.9%, a similar level as the control. Genetic analysis of PNT embryos revealed a normal chromosomal profile, to a rate of 80%. Finally, the generation of living, fertile offspring from PNT was possible following embryo transfer to surrogate mothers. LARGE-SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION Genetic profiles of analysed embryos from PNT originate from groups that are too small to draw concrete conclusions, whilst ST, which would be the preferred NT approach, could not be used for the generation of biparental embryos owing to technical limitations. Even though promising, the use of PNT should be considered as experimental. Furthermore, results were acquired in a mouse model, so validation of the technique in human IVG oocytes needs to be performed to evaluate the clinical relevance of the technology. The genetic profiles from IVG oocytes, which would be the ultimate characterization for chromosomal abnormalities, were not analysed owing to limitations in the reliable analysis of single cells. WIDER IMPLICATIONS OF THE FINDINGS PNT has the ability to overcome the poor cytoplasmic quality of IVG mouse oocytes. Considering the low maturation efficiency of human IVG oocytes and potential detrimental effects following long-term in vitro culture, NT could be applied to rescue embryo development and could lead to an increased availability of good quality embryos for transfer. STUDY FUNDING/COMPETING INTERESTS A.C. is a holder of FWO (Fonds voor Wetenschappelijk Onderzoek) grants (1S80220N and 1S80222N). B.H. and A.V.S. have been awarded with a special BOF (Bijzonder Onderzoeksfonds), GOA (Geconcerteerde onderzoeksacties) 2018000504 (GOA030-18 BOF) funding. B.H. has been receiving unrestricted educational funding from Ferring Pharmaceuticals (Aalst, Belgium). The authors declare that they have no conflict of interest.
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Affiliation(s)
- Antonia Christodoulaki
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Haitang He
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhou
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Chloë De Roo
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Machteld Baetens
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium
| | - Tine De Pretre
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium
| | - Muhammad Fakhar-I-Adil
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Björn Menten
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium
| | - Ann Van Soom
- Faculty of Veterinary Medicine, Department of Reproduction, Obstetrics and Herd Health, University of Ghent, Merelbeke, Belgium
| | - Dominic Stoop
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Annekatrien Boel
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Björn Heindryckx
- Ghent-Fertility and Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
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Prades M, Marzouk F, Schubert B, Genestie C, Sitbon L, Fortin A, Boissel N, Poirot C. Factors associated with the collection of isolated immature oocytes during ovarian tissue cryopreservation. J Assist Reprod Genet 2023; 40:2799-2807. [PMID: 37782441 PMCID: PMC10656393 DOI: 10.1007/s10815-023-02948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To identify patient characteristics associated with successful isolated immature oocyte retrieval (IsO) during ovarian tissue cryopreservation (OTC) and to determine whether they are predictive of the collection of larger numbers of oocytes. METHODS We retrospectively analyzed all patients undergoing OTC with IsO for fertility preservation over three years of activity at a university hospital. Univariate and multivariate analyses were used to identify the patients with the highest and lowest chances of oocyte recovery, and those with the largest numbers of oocytes. We also analyzed the correlation of IsO with the number of ovarian fragments collected and histological parameters. RESULTS We analyzed 257 consecutive patients undergoing these procedures, at a median age of 17.1 years [0.3-38.3 years]. Isolated oocytes were obtained from 47.1% of patients, and IsO was more likely in patients with ovulatory cycles (63.0% vs. 38.6%; P≤ .001), without chemotherapy before OTC (61.4% vs. 33.1; P< .001) and with non-malignant diseases other than Turner syndrome (77.5%). Oocyte collection failure rates were highest in patients with Turner syndrome (OR 25.0, 95% CI 3.99-157.0; P< .001) or undergoing chemotherapy with alkylating agents before OTC (OR 37.6, 95% CI 8.36-168.8; P< .001). Prepubescent status (P= .043) and large numbers of ovarian fragments (P< .001) were associated with the retrieval of larger numbers of oocytes. Oocyte recovery was correlated with the presence of follicles in the medulla, but not with follicular density. CONCLUSION The chances of IsO differ between patients. Identifying patients with the highest chances of success facilitates appropriate resource allocation.
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Affiliation(s)
- Marie Prades
- Department of Reproductive Biology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France.
- Department of Reproductive Biology, Tenon Hospital AP-HP, 4 rue de la Chine, 75020, Paris, France.
| | - Flora Marzouk
- Department of Reproductive Biology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France
- Laboratoire d'Analyses Médicales Drouot, 21 rue Drouot, 75009, Paris, France
| | - Benoit Schubert
- Department of Reproductive Biology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France
- Eurofins-Biomnis Laboratory, Site du Val d'Ouest-Institut Rhônalpin-39, chemin de la Vernique, 69130, Ecully, France
| | - Catherine Genestie
- Department of Pathology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France
- Department of Pathology, Gustave Roussy Institute, 94800, Villejuif, France
| | - Leslie Sitbon
- Department of Reproductive Biology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France
- Department of Reproductive Biology, Bioclinic-Biomega, Centre Hospitalier Intercommunal, 40 avenue de Verdun, 94000, Créteil, France
| | - Anne Fortin
- Department of Obstetric Gynecology, University Hospital of Pitié-Salpêtrière-Charles Foix, 83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Nicolas Boissel
- Department of Hematology, AYA Unit, Saint Louis Hospital AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
- Université Paris Cité, UFR Médecine, Site Villemin, 10 avenue de Verdun, EA3518, 75010, Paris, France
| | - Catherine Poirot
- Department of Reproductive Biology, University Hospital of Pitié-salpêtrière-Charles Foix, 83 boulevard de l'Hopital, 75013, Paris, France
- Department of Hematology, AYA Unit, Saint Louis Hospital AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
- Médecine Sorbonne Université, Site Pitié Salpêtrière, 91 Boulevard de l'Hôpital, 75013, Paris, France
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Nogueira D, Fajau-Prevot C, Clouet M, Assouline P, Deslandres M, Montagut M. Outcomes of Different In Vitro Maturation Procedures for Oocyte Cryopreservation for Fertility Preservation and yet Another Live Birth in a Cancer Patient. Life (Basel) 2023; 13:1355. [PMID: 37374137 DOI: 10.3390/life13061355] [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: 04/11/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
To ensure patient care in an oncological fertility preservation (FP) programme, specialists must provide technology that best suits the patients' clinical conditions. In vitro oocyte maturation (IVM) and ovarian tissue cryopreservation (OTC) are possible fertility preservation treatments for women in need of urgent oncological treatment. IVM consists of the retrieval of immature oocytes from small antral follicles, with no or minimal ovarian stimulation by gonadotropins. Therefore, IVM has become a pertinent option for fertility preservation, especially for cases whereby ovarian stimulation is unfeasible or contra-indicated. Existing data on immature oocytes, retrieved transvaginally (OPU-IVM) or extracted from ovarian tissue 'ex vivo' (OTO-IVM), are still limited on technical consistency, efficacy, and safety. The present retrospective cohort study includes 89 women undergoing fertility preservation using IVM methodologies and 26 women undergoing ovarian stimulation (OS) in concomitant period. In total, 533 immature oocytes were collected from IVM patients, achieving a maturation rate of 57% and 70% in OTO-IVM and 73% and 82% in OPU-IVM at 24 h and 48 h in culture, respectively. The observed high maturation rates might be due to the use of patients' serum in its innate status, i.e., without heat-inactivation. This permitted 7.6 ± 5.7 and 4.6 ± 4.9 oocytes to be vitrified in OTO-IVM and OPU-IVM, respectively, compared to 6.8 ± 4.6 from OS patients. Regarding OS patients, two of them underwent embryo transfer following the insemination of warmed oocytes after complete remission, resulting in a single live birth from one patient. Upon follow-up of two OTO-IVM patients after the termination of their oncological treatment, a total of 11 warmed oocytes lead to a transfer of a single embryo, but pregnancy was not achieved. From OPU-IVM, six embryos were transferred in three patients 4.25 years after oocyte vitrification, leading to the live birth of a healthy boy. The present case of live birth is among the first cases reported so far and supports the notion that IVM might be a relevant and safe FP option for cancer patients when oocyte preservation is required but ovarian stimulation is contra-indicated.
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Affiliation(s)
- Daniela Nogueira
- Fertility Institute La Croix du Sud-INOVIE Fertilité, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
- ART Fertility Clinics, Abu Dhabi P.O. Box 60202, United Arab Emirates
| | - Carole Fajau-Prevot
- Department of Gynecology, Clinique La Croix du Sud, 54 Chemin de Ribaute, 31130 Toulouse, France
| | - Muriel Clouet
- Department of Gynecology, Clinique La Croix du Sud, 54 Chemin de Ribaute, 31130 Toulouse, France
| | - Patrick Assouline
- Department of Obstetrics and Gynecology, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
| | - Marion Deslandres
- Department of Gynecology, Institut Universitaire du Cancer de Toulouse, 1 Av. Irène Joliot-Curie, 31100 Toulouse, France
| | - Marie Montagut
- Fertility Institute La Croix du Sud-INOVIE Fertilité, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
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Bourg M, Moreau J, Carles M, Cadoret F, Lesourd F, Tournier A, Léandri RD, Gatimel N. Is in vitro maturation of oocytes retrieved ex vivo from ovarian tissue an effective fertility preservation technique in the presence of organic ovarian cysts? Eur J Obstet Gynecol Reprod Biol 2023; 281:87-91. [PMID: 36586210 DOI: 10.1016/j.ejogrb.2022.12.025] [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: 03/29/2022] [Revised: 07/21/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE(S) In vitro maturation (IVM) of oocytes retrieved ex vivo from ovarian tissue (OTO-IVM) could be an additional source of mature oocytes with the potential to optimise medical fertility preservation (FP) after oophorectomy. It is often undertaken at the same time as the ovarian tissue cryopreservation (OTC). In the presence of an organic ovarian cyst, OTO-IVM could prove to be the only technique available to permit FP since ovarian stimulation, transvaginal ovarian needle puncture or future ovarian tissue graft are contraindicated. However, the presence of an organic cyst could alter follicular growth and the number of retrievd oocytes. Our study aims to assess the efficiency of OTO-IVM in such situations. STUDY DESIGN Retrospective, observational study involving 20 female patients with FP by OTO-IVM between May 2017 and November 2021 at the University Hospital of Toulouse. Oocytes retrieved "ex vivo" were transferred to an IVM medium with HP-hMG, LH and HSA and then vitrified after 24 to 48 h of IVM. Data analysis was performed on the total population and comparatively between patients who had or did not have an organic ovarian cyst. RESULTS The indications included 15 oncologic and 5 non-oncologic indications. Ten had an organic ovarian cyst on the retrieved ovary. The number of retrieved oocytes was 17.4+/-12.0 in the absence of cyst vs 4.1+/-6.3 in the presence (p = 0.003). The number of vitrified mature oocytes was 5.8+/-5.3 in the absence vs 1.1+/-2.2 (median = 0) in the presence of a cyst (p = 0.03). Ninety percent of the patients with an organic cyst had less than two vitrified mature oocytes. The mean maturation rate was 34%, not significantly different between the two groups. We found a correlation between serum AMH level and the number of mature oocytes: ρ:0.47 CI95 = [0.02; 0.76]; p = 0.04. CONCLUSION(S) OTO-IVM is an additional source of mature oocytes to optimise FP after oophorectomy. However, in the presence of an organic ovarian cyst on the retrieved ovary, the exocrine, paracrine and endocrine functions of the ovary are impaired. As such, the number of immature oocytes obtained is highly impacted and appears to be insufficient to be able to propose systematically this technique in such situations.
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Affiliation(s)
- Mona Bourg
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Jessika Moreau
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France; TOXALIM, EXPER group, Toulouse National Vetenary School, 23, chemin des Capelles, 31076 Toulouse cedex 3, France
| | - Manon Carles
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Florence Cadoret
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Florence Lesourd
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Anna Tournier
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Roger D Léandri
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France; TOXALIM, EXPER group, Toulouse National Vetenary School, 23, chemin des Capelles, 31076 Toulouse cedex 3, France
| | - Nicolas Gatimel
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, 31059 Toulouse, France; DEFE (Développement Embryonnaire, Fertilité et Environnement), UMR1203 Université Toulouse et Montpellier, INSERM, Toulouse Teaching Hospital Group, 330 avenue de Grande Bretagne, 31059 Toulouse, France.
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7
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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8
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Sirait B, Jusuf A, Wiweko B, Handayani N, Aubry D, Muharam R. Potential use of immature oocyte to improve fertility preservation outcome: A narrative review. J Hum Reprod Sci 2022; 15:3-11. [PMID: 35494192 PMCID: PMC9053342 DOI: 10.4103/jhrs.jhrs_112_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/04/2022] Open
Abstract
Fertility preservation through gamete vitrification has become one of the critical strategies to secure a childbearing potential in patients who are diagnosed with cancer or risks of infertility. Preserving the gametes would prevent the deleterious effects of cancer drugs or radiotherapy exposure on the quality of the gametes. Furthermore, in vitro fertilisation of vitrified mature human oocytes has lately demonstrated promising results that are reflected in the increased survival rate of thawed oocytes and the resultant clinical pregnancy rate. However, limitations in the cryopreservation of mature oocytes of cancer patients persist. Ovarian stimulation protocols which comprise administering gonadotrophin-releasing hormones could aggravate cancer or delay essential cancer therapy. Considering such circumstances, vitrification of immature oocytes would become a rational option. While the vitrification procedure of mature oocytes has been established, the vitrification of immature oocytes remains controversial due to a low post-thaw in vitro maturation and fertilisation rate. Apparent cryoinjuries to the immature oocytes post thawing or warming have been observed in both human and animal model oocytes. An alternative strategy was therefore proposed to improve the effectiveness of utilising immature oocytes for fertility preservation by conducting the in vitro oocyte maturation process first before vitrification. This method has prevailed, especially in oncofertility patients. Although the success rate of the clinical outcomes remains low, this approach, in conjugation with proper counselling, might provide oncofertility patients with an opportunity to preserve their reproductive potential.
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9
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Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives. J Clin Med 2021; 10:jcm10235690. [PMID: 34884393 PMCID: PMC8658080 DOI: 10.3390/jcm10235690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
Recent advances in early detection and oncological therapies have ameliorated the survival rate of young cancer patients. Yet, ovarian impairment induced by chemotherapy and radiotherapy is still a challenging issue. This review, based on clinical and lab-based studies, summarizes the evidence of gonadotoxicity of chemoradiotherapy, the recent approaches, ongoing controversies, and future perspectives of fertility preservation (FP) in female patients who have experienced chemo- or radio-therapy. Existing data indicate that chemotherapeutic agents induce DNA alterations and massive follicle activation via the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Meanwhile, the radiation causes ionizing damage, leading to germ cell loss. In addition to the well-established methods, numerous therapeutic approaches have been suggested, including minimizing the follicle loss in cryopreserved ovarian grafts after transplantation, in vitro activation or in vitro growing of follicles, artificial ovarian development, or fertoprotective adjuvant to prevent ovarian damage from chemotherapy. Some reports have revealed positive outcomes from these therapies, whereas others have demonstrated conflictions. Future perspectives are improving the live birth rate of FP, especially in patients with adverse ovarian reserve, eliminating the risk of malignancy reintroducing, and increasing society’s awareness of FP importance.
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10
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In Vitro Maturation of Oocytes Retrieved from Ovarian Tissue: Outcomes from Current Approaches and Future Perspectives. J Clin Med 2021; 10:jcm10204680. [PMID: 34682803 PMCID: PMC8540978 DOI: 10.3390/jcm10204680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/02/2023] Open
Abstract
In vitro maturation (IVM) of transvaginally aspirated immature oocytes is an effective and safe assisted reproductive treatment for predicted or high responder patients. Currently, immature oocytes are also being collected from the contralateral ovary during laparoscopy/laparotomy and even ex vivo from the excised ovary or the spent media during ovarian tissue preparation prior to ovarian cortex cryopreservation. The first live births from in vitro-matured ovarian tissue oocytes (OTO-IVM) were reported after monophasic OTO-IVM, showing the ability to achieve mature OTO-IVM oocytes. However, fertilisations rates and further embryological developmental capacity appeared impaired. The introduction of a biphasic IVM, also called capacitation (CAPA)-IVM, has been a significant improvement of the oocytes maturation protocol. However, evidence on OTO-IVM is still scarce and validation of the first results is of utmost importance to confirm reproducibility, including the follow-up of OTO-IVM children. Differences between IVM and OTO-IVM should be well understood to provide realistic expectations to patients.
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11
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Delattre S, Segers I, Van Moer E, Drakopoulos P, Mateizel I, Enghels L, Tournaye H, De Vos M. Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study. Hum Reprod 2021; 35:2524-2536. [PMID: 32951035 DOI: 10.1093/humrep/deaa193] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue 'ex vivo' (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Delattre
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - I Segers
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - E Van Moer
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - P Drakopoulos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - I Mateizel
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - L Enghels
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - M De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
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12
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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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Lierman S, Tolpe A, De Croo I, De Gheselle S, Defreyne J, Baetens M, Dheedene A, Colman R, Menten B, T'Sjoen G, De Sutter P, Tilleman K. Low feasibility of in vitro matured oocytes originating from cumulus complexes found during ovarian tissue preparation at the moment of gender confirmation surgery and during testosterone treatment for fertility preservation in transgender men. Fertil Steril 2021; 116:1068-1076. [PMID: 33832736 DOI: 10.1016/j.fertnstert.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the feasibility of in vitro maturation of ovarian tissue oocytes for fertility preservation in transgender men on testosterone treatment. DESIGN Cross-sectional study SETTING: University hospital PATIENT(S): Eighty-three transgender men enrolled from November 2015 to January 2019 INTERVENTION(S): In vitro maturation of cumulus-oocyte complexes (COCs) harvested at the time of gender confirmation surgery, and fertilization through intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) In vitro maturation, fertilization, and blastulation rates; comparison of morphokinetics with vitrified-warmed oocytes; and analysis of the genetic profiles of embryos. SECONDARY OUTCOMES association between serum hormone levels; COCs' morphologic characteristics, and vitrification rate. RESULT(S) All participants were on testosterone treatment for a median of 83 (64[Quartile 1]; 113.2[Quartile 2]) weeks. A total of 1,903 COCs (mean per participant, 23 ± 15.8) were collected. The in vitro maturation rate was 23.8%, vitrification rate was 21.5%, and survival rate after warming was 72.6% (n = 151). Intracytoplasmic sperm injection was performed in 139 oocytes. The rate of normal fertilized oocytes was 34.5%, and 25 (52.1%) embryos reached day 3. One blastocyst was achieved on day 5. Aberrant cleavage patterns and early embryo arrest were observed in 22 (45.8%) and 44 (91.7%) zygotes, respectively. Compared with vitrified-warmed donor oocytes, a delay was observed in pronuclei disappearance, t2 (time to reach 2 cell stage) timings, and CC1 (the duration of the 1st cell cycle) and SS3 (synchronization of cleavage pattern (calculated as t8-t5) time intervals. A normal genetic pattern was seen in 42% embryos. The proportion of vitrified oocytes was negatively associated with progesterone (odds ratio, 0.76) and positively associated with antimüllerian hormone serum levels (odds ratio, 1.23). The highest vitrification rate was achieved by the morphologic characteristic 344 at day 0 and by 433 at day 2. CONCLUSION(S) Ovarian tissue oocytes matured in vitro show low developmental capacity in transgender men, when collected under testosterone treatment.
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Affiliation(s)
- Sylvie Lierman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Annelies Tolpe
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ilse De Croo
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Justine Defreyne
- Department of Endocrinology - Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Machteld Baetens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Annelies Dheedene
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Biostatistics Unit, Ghent University Hospital, Ghent, Belgium
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology - Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Petra De Sutter
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.
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Bunyaeva E, Kirillova A, Khabas G, Asaturova A, Mishieva N, Nazarenko T, Abubakirov A, Sukhikh G. Feasibility of in vitro maturation of oocytes collected from patients with malignant ovarian tumors undergoing fertility preservation. Int J Gynecol Cancer 2021; 31:475-479. [PMID: 33649016 DOI: 10.1136/ijgc-2020-001754] [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: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In vitro maturation of oocytes collected from oophorectomy samples might be a promising approach in the field of oncofertility. In this study, we evaluate the feasibility of in vitro maturation of oocytes collected from oophorectomy samples in patients with ovarian tumors. METHODS This prospective observational study included 27 patients with malignant ovarian tumors. Patients underwent oophorectomy and ovarian tissue was examined for the presence of immature cumulus-oocyte complexes. These were matured in vitro for 48 hours. Mature oocytes were vitrified or used for fertilization. Serum anti-müllerian hormone (AMH) levels were analyzed in 11 patients and cancer antigen 125 (CA125) levels in 16 patients. RESULTS In this study, 99 cumulus-oocyte complexes were obtained from 17 patients (63%). The mean (SE) age of the patients was 33.47±1.86 years (range 16-44). A total of 14 patients had ovarian cancer (IA-IVB), one patient had ovarian cancer IC and endometrial cancer IA, one patient had endometrial cancer stage IA with metastasis into the ovary, and one patient had cervical cancer stage IIB with metastasis in the ovary. Oocytes were not obtained in 10 patients who had diminished ovarian reserve due to age (>38 years), chemotherapy, or previous surgical treatment. On average, 5.8 cumulus-oocyte complexes were obtained per patient. The maturation rate was 40.4% with an average of 2.8 metaphase II oocytes per patient. As a result of the study, 3 blastocysts in 3 patients and 22 oocytes in 9 patients were vitrified. CONCLUSIONS In vitro maturation of oocytes collected from oophorectomy samples in patients with malignant ovarian tumors may result in oocyte and blastocyst vitrification. However, it should be offered to patients before surgery and chemotherapy. This method might be most beneficial in patients younger than 38 years, with AMH serum levels >1 ng/mL and without a large tumor burden.
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Affiliation(s)
- Ekaterina Bunyaeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Anastasia Kirillova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Grigory Khabas
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexandra Asaturova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Nona Mishieva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Tatiana Nazarenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Aydar Abubakirov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Gennady Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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15
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Committee Of Diagnosis Treatment And Fertility Management Of Chinese Young Breast Cancer Patients. Expert consensus on diagnosis, treatment and fertility management of young breast cancer patients. JOURNAL OF THE NATIONAL CANCER CENTER 2021; 1:23-30. [PMID: 39036789 PMCID: PMC11256642 DOI: 10.1016/j.jncc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023] Open
Abstract
Breast cancer in young females is a relatively common disease in China. Young breast cancer has aggressive clinical and pathological features. During the treatment of young females with breast cancer, issues involving the choice of surgical methods, early amenorrhea, and fertility protection may have physical, psychological, and social impacts. Thus, a multidisciplinary model of diagnosis and treatment is indispensable. The breast cancer expert committee of the National Cancer Quality Control Center organized experts in related fields in China to compile this consensus as to provide scientific and feasible solutions for rational diagnosis, treatment, and fertility management for young females with breast cancer. This consensus is based on the literature data, the views of relevant international guidelines, and the clinical practice experience of experts in different fields.
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16
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Kirillova A, Bunyaeva E, Van Ranst H, Khabas G, Farmakovskaya M, Kamaletdinov N, Nazarenko T, Abubakirov A, Sukhikh G, Smitz JEJ. Improved maturation competence of ovarian tissue oocytes using a biphasic in vitro maturation system for patients with gynecological malignancy: a study on sibling oocytes. J Assist Reprod Genet 2021; 38:1331-1340. [PMID: 33619680 DOI: 10.1007/s10815-021-02118-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the developmental competence of ovarian tissue oocytes from patients with gynecological tumors using a biphasic in vitro maturation system with capacitation (CAPA-IVM) in comparison with standard IVM. METHODS This sibling pilot study included 210 oocytes in 10 patients with gynecological malignancies. After ovariectomies, ovaries were cut into even halves and immature cumulus-oocyte complexes (COCs) were retrieved from the ovarian tissue. COCs were separately cultured in either a biphasic CAPA-IVM system for 53 h or in standard IVM for 48 h. After IVM, all COCs were denuded and mature oocytes were either vitrified (N=5) or used for ICSI (N=5). Embryos were cultured for 5-6 days and obtained blastocysts were vitrified. RESULTS Use of the CAPA-IVM system led to a higher meiotic maturation rate in ovarian tissue oocytes (OTO) compared to standard IVM (56 vs 35%, p=0.0045) and had a tendency to result in lower degeneration after IVM. Only the CAPA-IVM method supported blastocyst formation. CONCLUSIONS The biphasic in vitro maturation system improved the competence of OTO in comparison to the standard IVM method. The study suggests that fertility preservation programs could become more efficient using IVM after capacitation culture.
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Affiliation(s)
- Anastasia Kirillova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia.
| | - Ekaterina Bunyaeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Heidi Van Ranst
- Follicle Biology Laboratory (FOBI), Vrije Universiteit Brussel, Brussels, Belgium
| | - Grigory Khabas
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Maria Farmakovskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Nail Kamaletdinov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Tatiana Nazarenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Aydar Abubakirov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Gennady Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Johan E J Smitz
- Follicle Biology Laboratory (FOBI), Vrije Universiteit Brussel, Brussels, Belgium.
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Dietrich JE, Jauckus J, Hoffmann S, Liebenthron J, Capp E, Strowitzki T, Germeyer A. In vitro maturation of immature oocytes from ovarian tissue prior to shipment to a cryobank. Arch Gynecol Obstet 2020; 302:1019-1024. [PMID: 32556511 DOI: 10.1007/s00404-020-05643-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Female fertility preservation prior to gonadotoxic therapies can be achieved by the cryopreservation of ovarian cortical tissue. Immature oocytes may be recovered during the preparation, matured in vitro and lead to live births, thereby providing an additional option for fertility preservation. The purpose of this study was to test the feasibility of this approach in a setting with unilateral biopsy of a small piece of ovarian tissue and minimal tissue preparation prior to shipment to an external cryobank. METHODS A prospective observational clinical study in an academic center was performed from January 2018 through December 2019. Ovarian tissue was obtained laparoscopically. Immature oocytes were recovered by minimal preparation of the tissue before shipment to an external cryobank for cryopreservation. In vitro maturation was performed on recovered immature oocytes. RESULTS Twelve patients were enrolled. Immature oocytes could be recovered for all. The maturation rate was 38.9% (n = 14/36). Metaphase II (MII) were either directly used for intracytoplasmic sperm injection (ICSI) with a fertilization rate of 66.6% (n = 4/6) or vitrified (n = 8). PNs were cryopreserved (n = 4). Vitrified MII were warmed with a post-warming vitality rate of 75.0% (n = 3/4) and used for ICSI with a fertilization rate of 33.3% (n = 1/3). CONCLUSIONS Immature oocytes can be successfully retrieved from ovarian tissue through minimal tissue preparation prior to shipment to a cryobank, matured in vitro, fertilized and cryopreserved for potential future fertility treatments. The total number of oocytes available for fertility preservation can be increased even without controlled ovarian stimulation in a situation where only ovarian biopsy for cryopreservation is performed. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00013170. Registered 11 December 2017, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013170 .
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Affiliation(s)
- Jens Erik Dietrich
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Julia Jauckus
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sabrina Hoffmann
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Jana Liebenthron
- UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD, University Women's Hospital Düsseldorf, Düsseldorf, Germany
| | - Edison Capp
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Department of Obstetrics and Gynecology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thomas Strowitzki
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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18
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Human Ovarian Cortex biobanking: A Fascinating Resource for Fertility Preservation in Cancer. Int J Mol Sci 2020; 21:ijms21093245. [PMID: 32375324 PMCID: PMC7246700 DOI: 10.3390/ijms21093245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/21/2022] Open
Abstract
Novel anti-cancer treatments have improved the survival rates of female young patients, reopening pregnancy issues for female cancer survivors affected by the tumor treatment-related infertility. This condition occurs in approximately one third of women of fertile age and is mainly dependent on gonadotoxic protocols, including radiation treatments. Besides routine procedures such as the hormonal induction of follicular growth and subsequent cryopreservation of oocytes or embryos, the ovarian protection by gonadotropin-releasing hormone (GnRH) agonists during chemotherapy as well as even gonadal shielding during radiotherapy, other innovative techniques are available today and need to be optimized to support their introduction into the clinical practice. These novel methods are hormone stimulation-free and include the ovarian cortex cryopreservation before anti-cancer treatments and its subsequent autologous reimplantation and a regenerative medicine approach using oocytes derived in vitro from ovarian stem cells (OSCs). For both procedures, the major benefit is related to the prompt recruitment and processing of the ovarian cortex fragments before gonadotoxic treatments. However, while the functional competence of oocytes within the cryopreserved cortex is not assessable, the in vitro maturation of OSCs to oocytes, allows to select the most competent eggs to be cryopreserved for fertility restoration.
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19
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Kirillova A, Kovalskaya E, Brovkina O, Ekimov A, Bunyaeva E, Gordiev M, Mishieva N, Nazarenko T, Abubakirov A, Sukikh G. Cryopreservation of euploid blastocysts obtained after fertilization of in vitro matured ovarian tissue oocytes: a case report. J Assist Reprod Genet 2020; 37:905-911. [PMID: 32206960 PMCID: PMC7183014 DOI: 10.1007/s10815-020-01729-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
With the increased rate of stable remission after gonadotoxic cancer treatment, new methods of fertility preservation are required in order to provide the best possible care for oncological patients. Here, we report an original case of euploid blastocyst cryopreservation after in vitro maturation of ovarian tissue oocytes (OTO IVM). Thirty-three oocytes were obtained from the ovarian tissue after ovariectomy in the breast cancer patient. Six out of 12 matured oocytes fertilized successfully and 3 blastocysts were formed. Genetic investigation for mutations associated with this type of malignancy found that the patient is not a carrier. Preimplantation genetic testing was performed only for aneuploidies and found all 3 blastocysts to be euploid and suitable for embryo transfer. Our study showed that the ovarian tissue oocytes matured in vitro have the potential for euploid blastocyst formation after ICSI which could be screened for aneuploidies and inherited mutations and then be vitrified in order to provide the best fertility preservation strategy for women with cancer.
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Affiliation(s)
- Anastasia Kirillova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia.
| | - Evgeniya Kovalskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Olga Brovkina
- Federal Research and Clinical Center, FMBA of Russia, Moscow, Russia
| | - Aleksey Ekimov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Ekaterina Bunyaeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | | | - Nona Mishieva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Tatiana Nazarenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Aydar Abubakirov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Gennady Sukikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov, of the Ministry of Healthcare of Russian Federation, Moscow, Russia
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20
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Sella T, Partridge AH. Fertility Counseling and Preservation in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Hampe ME, Rhoton-Vlasak AS. Fertility preservation in breast cancer with case-based examples for guidance. J Assist Reprod Genet 2020; 37:717-729. [PMID: 32008180 PMCID: PMC7125269 DOI: 10.1007/s10815-019-01665-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
With more young breast cancer survivors, a trend toward having children later in life, and improvements in assisted reproductive technology (ART), fertility preserving techniques are of growing importance prior to initiation of gonadotoxic treatments. The American Society for Clinical Oncology (ASCO) updated their Fertility Preservation in Patients with Cancer guidelines in April of 2018. ASCO continues to recognize oocyte and embryo cryopreservation as standard practice for women interested in preserving fertility and sperm cryopreservation as standard practice for men. ASCO has clarified their statement on ovarian suppression during chemotherapy as an option when standard methods are unavailable but should not be used as the sole method of fertility preservation (FP) due to conflicting evidence. ASCO also updated their statement on ovarian tissue cryopreservation, which is still labeled experimental but ASCO acknowledges that it can restore global ovarian function and could be of use in specific patients. The NCCN's Version 1.2018 Clinical Practice Guidelines® for treatment of breast cancer include fertility counseling as part of their work-up in all types of breast cancer for premenopausal women.The purpose of this review is to explain the indications and evidence for the different methods of FP for young breast cancer patients in accordance with ASCO and NCCN guidelines. The guidance will then be applied to three theoretical clinical cases in order to highlight actual use in clinical practice.
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Affiliation(s)
- Mary E Hampe
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alice S Rhoton-Vlasak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA.
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22
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Corkum KS, Rhee DS, Wafford QE, Demeestere I, Dasgupta R, Baertschiger R, Malek MM, Aldrink JH, Heaton TE, Weil BR, Madonna MB, Lautz TB. Fertility and hormone preservation and restoration for female children and adolescents receiving gonadotoxic cancer treatments: A systematic review. J Pediatr Surg 2019; 54:2200-2209. [PMID: 30773394 DOI: 10.1016/j.jpedsurg.2018.12.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this systematic review by the American Pediatric Surgical Cancer Committee was to summarize evidence from the current medical literature regarding fertility restoration and hormone replacement for female children and adolescents treated with gonadotoxic treatments. METHODS Using PRISMA guidelines, questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Eligible studies included those that addressed ovarian tissue cryopreservation (OTC), oocyte harvest, ovarian transposition, and ovarian tissue auto-transplantation for females under the age of 20. Four reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Study outcomes were summarized in a narrative synthesis. RESULTS Two thousand two hundred seventy-six studies were identified by database search and manual review and 2185 were eliminated based on defined exclusion criteria. Ninety-one studies served as the basis for the systematic review. There were 1019 patients who underwent OTC with ages ranging from 0.4 to 20.4 years old, with 298 under the age of 13. Twenty patients aged 13-20 years old underwent successful oocyte harvest. Thirty-seven children underwent ovarian transposition as a means of fertility preservation. Eighteen patients underwent auto-transplantation of thawed ovarian cortical tissue that was harvested before the age of 21 years resulting in 10 live births. CONCLUSIONS Clinically accepted and experimental fertility preservation options such as OTC, oocyte cryopreservation, and ovarian transposition are available to females aged 20 years and younger who are at risk for premature ovarian insufficiency and infertility due to gonadotoxic treatments. There is a large cohort of pediatric-aged patients, with a wide variety of diagnoses and treatments, who have undergone fertility preservation. Currently, fertility and hormone restoration experience for patients who were 20- years of age or younger at the time of fertility preservation remains limited. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kristine S Corkum
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isabelle Demeestere
- Research Laboratory in Human Reproduction, Université Libre de Bruxelles, (ULB), Brussels, Belgium
| | | | - Reto Baertschiger
- Division of Pediatric Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Todd E Heaton
- Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | | | - Timothy B Lautz
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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23
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González-Fernández L, Sánchez-Calabuig MJ, Alves MG, Oliveira PF, Macedo S, Gutiérrez-Adán A, Rocha A, Macías-García B. Expanded equine cumulus-oocyte complexes exhibit higher meiotic competence and lower glucose consumption than compact cumulus-oocyte complexes. Reprod Fertil Dev 2018; 30:297-306. [PMID: 28679463 DOI: 10.1071/rd16441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/06/2017] [Indexed: 12/29/2022] Open
Abstract
Equine cumulus-oocyte complexes (COCs) are classified as compact (cCOC) or expanded (eCOC) and vary in their meiotic competence. This difference could be related to divergent glucose metabolism. To test this hypothesis in the present study, eCOCs, cCOCs and expanded or compact mural granulosa cells (EC and CC respectively) were matured in vitro for 30h, at which time maturation rate, glucose metabolism and the expression of genes involved in glucose transport, glycolysis, apoptosis and meiotic competence were determined. There were significant differences between eCOCs and cCOCs in maturation rate (50% vs 21.7% (n=192 and 46) respectively; P<0.001), as well as mean (±s.e.m.) glucose consumption (1.8±0.5 vs 27.9±5.9 nmol per COC respectively) and pyruvate (0.09±0.01 vs 2.4±0.8 nmol per COC respectively) and lactate (4.7±1.3 vs 64.1±20.6 nmol per COC respectively; P<0.05 for all) production. Glucose consumption in EC and CC did not differ significantly. Expression of hyaluronan-binding protein (tumour necrosis factor alpha induced protein 6; TNFAIP6) was increased in eCOCs and EC, and solute carrier family 2 member 1 (SLC2A1) expression was increased in eCOCs, but there were no differences in the expression of glycolysis-related enzymes and solute carrier family 2 member 3 (SLC2A3) between the COC or mural granulosa cell types. The findings of the present study demonstrate that metabolic and genomic differences exist between eCOCs and cCOCs and mural granulosa cells in the horse.
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Affiliation(s)
- L González-Fernández
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, Portugal
| | - M J Sánchez-Calabuig
- Department of Animal Reproduction, Instituto nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Ctra. De la Coruña,Km. 5.9, Madrid 28040, Spain
| | - M G Alves
- Department of Microscopy, Cell Biology Laboratory, Abel Salazar Institute of Biomedical Sciences and Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - P F Oliveira
- Department of Microscopy, Cell Biology Laboratory, Abel Salazar Institute of Biomedical Sciences and Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - S Macedo
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, Portugal
| | - A Gutiérrez-Adán
- Department of Animal Reproduction, Instituto nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Ctra. De la Coruña,Km. 5.9, Madrid 28040, Spain
| | - A Rocha
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, Portugal
| | - B Macías-García
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, Portugal
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24
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Fisch B, Abir R. Female fertility preservation: past, present and future. Reproduction 2018; 156:F11-F27. [DOI: 10.1530/rep-17-0483] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/23/2018] [Indexed: 12/19/2022]
Abstract
Anti-cancer therapy, particularly chemotherapy, damages ovarian follicles and promotes ovarian failure. The only pharmacological means for protecting the ovaries from chemotherapy-induced injury is gonadotrophin-releasing hormone agonist, but its efficiency remains controversial; ovarian transposition is used to shield the ovary from radiation when indicated. Until the late 1990s, the only option for fertility preservation and restoration in women with cancer was embryo cryopreservation. The development of other assisted reproductive technologies such as mature oocyte cryopreservation andin vitromaturation of oocytes has contributed to fertility preservation. Treatment regimens to obtain mature oocytes/embryos have been modified to overcome various limitations of conventional ovarian stimulation protocols. In the last decades, several centres have begun cryopreserving ovarian samples containing primordial follicles from young patients before anti-cancer therapy. The first live birth following implantation of cryopreserved-thawed ovarian tissue was reported in 2004; since then, the number has risen to more than 130. Nowadays, ovarian tissue cryopreservation can be combined within vitromaturation and vitrification of oocytes. The use of cryopreserved oocytes eliminates the risk posed by ovarian implantation of reseeding the cancer. Novel methods for enhancing follicular survival after implantation are presently being studied. In addition, researchers are currently investigating agents for ovarian protection. It is expected that the risk of reimplantation of malignant cells with ovarian grafts will be overcome with the putative development of an artificial ovary and an efficient follicle class- and species-dependentin vitrosystem for culturing primordial follicles.
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Hatırnaz Ş, Ata B, Hatırnaz ES, Dahan MH, Tannus S, Tan J, Tan SL. Oocyte in vitro maturation: A sytematic review. Turk J Obstet Gynecol 2018; 15:112-125. [PMID: 29971189 PMCID: PMC6022428 DOI: 10.4274/tjod.23911] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023] Open
Abstract
In vitro maturation (IVM) is one of the most controversial aspects of assisted reproductive technology. Although it has been studied extensively, it is still not a conventional treatment option and is accepted as an alternative treatment. However, studies have shown that IVM can be used in almost all areas where in vitro fertilization (IVF) is used and it has a strong place in fertility protection and Ovarian Hyperstimulation syndrome management. The aim of this systematic review was to address all aspects of the current knowledge of IVM treatment together with the evolution of IVM and IVF.
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Affiliation(s)
- Şafak Hatırnaz
- Medicana International Hospital, In Vitro Fertilization Center, Samsun, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, In Vitro Fertilization Center, İstanbul, Turkey
| | | | - Michael Haim Dahan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Samer Tannus
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Justin Tan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Seang Lin Tan
- Originelle Women and Reproductive Medicine Center, Clinic of Obstetrics and Gynecology, Montreal, Quebec, Canada
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26
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Prospective assessment of follicular growth and the oocyte cohort after ovarian stimulation for fertility preservation in 90 cancer patients versus 180 matched controls. Reprod Biomed Online 2018; 36:543-551. [DOI: 10.1016/j.rbmo.2018.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/19/2022]
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Virant-Klun I, Vogler A. In vitro maturation of oocytes from excised ovarian tissue in a patient with autoimmune ovarian insufficiency possibly associated with Epstein-Barr virus infection. Reprod Biol Endocrinol 2018; 16:33. [PMID: 29618356 PMCID: PMC5885381 DOI: 10.1186/s12958-018-0350-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/25/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some reports show that it is possible to isolate immature oocytes from human ovarian tissue retrieved by a cortex biopsy or ovariectomy of non-stimulated ovaries and mature them in vitro. The mature oocytes can be vitrified and stored for in vitro fertilization, which, along with ovarian tissue cryopreservation, is mostly practiced in young cancer patients to preserve their fertility. There is much less data on this new approach in women with a natural ovarian insufficiency, which can be caused by different factors, including viral infection. In this case report this advanced methodology was used in a young patient suffering from ovarian insufficiency which was possibly associated with Epstein-Barr virus and infectious mononucleosis (glandular fever). METHODS This case report included a 27-year-old patient who attended our infertility clinic because of ovarian failure as a part of autoimmune polyendocrinopathy that occurred after Epstein-Barr virus infection, which has rarely been reported until now. Although antral follicles were observed in her ovaries by ultrasound monitoring, she was amenorrhoeic with menopausal concentrations of follicle-stimulating hormone (FSH) and without mature follicles. Therefore, a small biopsy of ovarian cortex tissue was performed using laparoscopy to retrieve immature oocytes. The retrieved oocytes were matured in vitro, cryopreserved, and stored for in vitro fertilization and potential pregnancy. RESULTS Four immature, germinal vesicle (GV) oocytes were found and removed from tissue, denuded mechanically by a pipette, and matured in vitro in a maturation medium with added FSH and hCG as well as in co-culture with cumulus cells, which were retrieved by their denudation. Three oocytes matured in vitro to the metaphase II (MII) stage and were vitrified for in vitro fertilization along with ovarian tissue cryopreservation. CONCLUSION Our results show that Epstein-Barr infection is possibly associated with autoimmune ovarian failure. The devastating impact on fertility in such disorder can be successfully avoided by in vitro maturation of oocytes from excised ovarian tissue.
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Affiliation(s)
- Irma Virant-Klun
- 0000 0004 0571 7705grid.29524.38Reproductive Unit, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Zaloska cesta 002, 1000 Ljubljana, SI Slovenia
| | - Andrej Vogler
- 0000 0004 0571 7705grid.29524.38Reproductive Unit, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Zaloska cesta 002, 1000 Ljubljana, SI Slovenia
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Outcome of immature oocytes collection of 119 cancer patients during ovarian tissue harvesting for fertility preservation. J Assist Reprod Genet 2018; 35:851-856. [PMID: 29574609 DOI: 10.1007/s10815-018-1153-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/28/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Few clinical options for fertility preservation are available to females with cancer, and data about clinical outcomes is limited. Potential supplementary approaches to fertility preservation include retrieval of immature oocytes followed by in vitro maturation (IVM) and storage. The aim of this study was to evaluate post-thawing outcomes of immature oocytes collected both by transvaginal aspiration and from excised ovarian tissue. METHODS We conducted a retrospective cohort study of patients treated in a single tertiary center. We reviewed the records of 119 cancer patients who underwent ovarian tissue cryopreservation and immature oocyte harvesting for fertility preservation. All embryos and oocytes that were frozen and thawed were included in the study. Post-thawing outcomes were evaluated. RESULTS Thirty-five stored embryos from eight patients were thawed. Twenty-nine embryos survived (82% survival rate) and were transferred. Six oocytes were thawed, two oocytes survived, and no oocytes were fertilized. Only one PCOS patient became pregnant, resulting in the normal delivery of a healthy baby. CONCLUSIONS Although a relatively high number of mature oocytes and embryos can be stored with the combined procedure, the limited rate of pregnancies represents a poor reproductive outcome. Therefore, this approach should be reserved for special groups with limited options.
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Yasmin E, Balachandren N, Davies MC, Jones GL, Lane S, Mathur R, Webber L, Anderson RA. Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline. HUM FERTIL 2018; 21:3-26. [DOI: 10.1080/14647273.2017.1422297] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ephia Yasmin
- Department of Women’s Health, University College London Hospitals, London, UK
| | | | - Melanie C. Davies
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Georgina L. Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, Children’s Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Raj Mathur
- Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Lisa Webber
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Khrouf M, Braham M, Bouyahia M, Kacem-Berejeb K, Elloumi-Chaabane H, Zhioua A, Zhioua F. Perurethral transvesical route for oocytes retrieval: an old technique for a new indication in oncofertility. Future Oncol 2017; 13:2547-2553. [PMID: 29186987 DOI: 10.2217/fon-2017-0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We aimed to evaluate the safety and efficiency of the peruretheral transvesical oocyte retrieval in oncofertility. We conducted a retrospective comparative study in our assisted reproductive technologies center. STUDY GROUP 28 pubertal young women affected by malignancies, referred for fertility preservation and refusing transvaginal (TV) procedure. CONTROL GROUP 28 infertile patients, aged less than 25 years, who have undergone in vitro fertilization with TV oocyte retrieval. The ovarian stimulation was significantly longer on the study group. There was no difference between the two groups regarding mean number of collected metaphase II oocytes. One patient of the study group had a transient dysuria. These preliminary data suggest that, in oncofertility, peruretheral transvesical oocyte retrieval is an alternative when the TV route is refused or not feasible.
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Affiliation(s)
- Mohamed Khrouf
- ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Marouen Braham
- ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Maha Bouyahia
- ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Khadija Kacem-Berejeb
- ART Departement of Reproductive Biology & Cytogenetics, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Hanène Elloumi-Chaabane
- ART Departement of Reproductive Biology & Cytogenetics, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Amel Zhioua
- ART Departement of Reproductive Biology & Cytogenetics, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
| | - Fethi Zhioua
- ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1008, Tunis, Tunisia
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Validation of an automated technique for ovarian cortex dissociation: isolation of viable ovarian cells and their qualification by multicolor flow cytometry. J Ovarian Res 2017. [PMID: 28645304 PMCID: PMC5481923 DOI: 10.1186/s13048-017-0337-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Ovarian tissue cryopreservation is a technique for fertility preservation addressed to prepubertal girls or to patients for whom no ovarian stimulation is possible before initiation of gonadotoxic treatments. Autotransplantation of frozen-thawed ovarian tissue is the only available option for reuse but presents some limitations: ischemic tissue damages post-transplant and reintroduction of malignant cells in cases of cancer. It is therefore essential to qualify ovarian tissue before autograft on a functional and oncological point of view. Here, we aimed to isolate viable cells from human ovarian cortex in order to obtain an ovarian cell suspension analyzable by multicolor flow cytometry. Methods Ovarian tissue (fresh or frozen-thawed), from patients with polycystic ovarian syndrome (reference tissue) and from patients who underwent ovarian tissue cryopreservation, was used for dissociation with an automated device. Ovarian tissue-dissociated cells were analyzed by multicolor flow cytometry; the cell dissociation yield and viability were assessed. Two automated dissociation protocols (named laboratory and commercial protocols) were compared. Results The effectiveness of the dissociation was not significantly different between reference ovarian tissue (1.58 × 106 ± 0.94 × 106 viable ovarian cells per 100 mg of ovarian cortex, n = 60) and tissue from ovarian tissue cryopreservation (1.70 × 106 ± 1.35 × 106 viable ovarian cells, n = 18). However, the viability was slightly different for fresh ovarian cortex compared to frozen-thawed ovarian cortex whether we used reference tissue (p = 0.022) or tissue from ovarian cryopreservation (p = 0.018). Comparing laboratory and commercial protocols, it appeared that cell yield was similar but cell viability was significantly improved when using the commercial protocol (81.3% ± 12.3% vs 23.9% ± 12.5%). Conclusion Both dissociation protocols allow us to isolate more than one million viable cells per 100 mg of ovarian cortex, but the viability is higher when using the commercial dissociation kit. Ovarian cortex dissociation is a promising tool for human ovarian cell qualification and for ovarian residual disease detection by multicolor flow cytometry.
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A review of reported surgical techniques in fertility preservation for prepubertal and adolescent females facing a fertility threatening diagnosis or treatment. Am J Surg 2017; 214:695-700. [PMID: 28683892 DOI: 10.1016/j.amjsurg.2017.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ovarian tissue cryopreservation is increasing as a preferred option for fertility preservation for prepubertal and young adolescent females facing a fertility threatening diagnosis or treatment. DATA SOURCES Ovid MEDLINE and PubMed searches for terms related to ovarian tissue removal for fertility preservation revealed there is no current consensus on operative technique for surgical ovarian cortical tissue removal in adult females. Additionally, there are limited published reports of surgical approach and outcomes in the pediatric population. In total, 22 publications were reviewed for their operative approach, ovarian tissue harvesting techniques, complications and outcomes. CONCLUSIONS Reported operative approaches and techniques for ovarian tissue cryopreservation for pediatric and adolescent patients are variable. Further investigations into operative technique and tissue harvesting that maintains healthy ovarian follicles for transplant will help establish standard technical principles for surgery in pediatric and adolescent females undergoing fertility preservation.
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Shirasawa H, Terada Y. In vitro maturation of human immature oocytes for fertility preservation and research material. Reprod Med Biol 2017; 16:258-267. [PMID: 29259476 PMCID: PMC5715881 DOI: 10.1002/rmb2.12042] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Aim In recent years, the importance of fertility preservation (FP) has increased. In vitro maturation (IVM), an important technique in FP, has started to be used in the clinic, but controversies persist regarding this technique. Here, a survey of IVM for FP is provided. Methods Based on a literature review, the applications of FP, methods of FP, IVM of oocytes that had been collected in vivo and ex vivo, maturation of oocytes after IVM for FP, cryopreservation of oocytes for FP, explanation of the procedures to patients, and recent research on FP using IVM were investigated. Results Although IVM for FP remains controversial, the application of FP is expected to expand. Depending on the age and disease status of the patient, various methods of oocyte collection and ovarian stimulation, as well as various needle types and aspiration pressures, have been reported. The maturation rate of IVM in FP ranges widely and requires optimization in the future. In regard to cryopreservation for matured oocytes, the vitrification method is currently recommended. Conclusion Regarding FP for patients with cancer, the treatment of cancer is prioritized; thus, the time and use of medicines are often constrained. As several key points regarding IVM remain unclear, well‐designed and specific counseling for patients is necessary.
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Affiliation(s)
- Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology Akita University Graduate School of Medicine Akita Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology Akita University Graduate School of Medicine Akita Japan
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Ladanyi C, Mor A, Christianson MS, Dhillon N, Segars JH. Recent advances in the field of ovarian tissue cryopreservation and opportunities for research. J Assist Reprod Genet 2017; 34:709-722. [PMID: 28365839 PMCID: PMC5445043 DOI: 10.1007/s10815-017-0899-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 03/01/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this study was to summarize the latest advances and successes in the field of ovarian tissue cryopreservation while identifying gaps in current knowledge that suggest opportunities for future research. METHODS A systematic review was performed according to PRISMA guidelines for all relevant full-text articles in PubMed published in English that reviewed or studied historical or current advancements in ovarian tissue cryopreservation and auto-transplantation techniques. RESULTS Ovarian tissue auto-transplantation in post-pubertal women is capable of restoring fertility with over 80 live births currently reported with a corresponding pregnancy rate of 23 to 37%. The recently reported successes of live births from transplants, both in orthotopic and heterotopic locations, as well as the emerging methods of in vitro maturation (IVM), in vitro culture of primordial follicles, and possibility of in vitro activation (IVA) suggest new fertility options for many women and girls. Vitrification, as an ovarian tissue cryopreservation technique, has also demonstrated successful live births and may be a more cost-effective method to freezing with less tissue injury. Further, transplantation via the artificial ovary with an extracellular tissue matrix (ECTM) scaffolding as well as the effects of sphingosine-1-phosphate (SIP) and fibrin modified with heparin-binding peptide (HBP), heparin, and a vascular endothelial growth factor (VEGF) have demonstrated important advancements in fertility preservation. As a fertility preservation method, ovarian tissue cryopreservation and auto-transplantation are currently considered experimental, but future research may pave the way for these modalities to become a standard of care for women facing the prospect of sterility from ovarian damage.
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Affiliation(s)
- Camille Ladanyi
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME 04102 USA
| | - Amir Mor
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219 USA
| | - Mindy S. Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Namisha Dhillon
- University of Toledo College of Medicine, Toledo, OH 43614 USA
| | - James H. Segars
- Howard W. and Georgeanna Seegar Jones Division of Reproductive Sciences and Women’s Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Building (Room 624), Baltimore, MD 21205 USA
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Hudson JN, Stanley NB, Nahata L, Bowman-Curci M, Quinn GP. New Promising Strategies in Oncofertility. EXPERT REVIEW OF QUALITY OF LIFE IN CANCER CARE 2017; 2:67-78. [PMID: 28959743 PMCID: PMC5612405 DOI: 10.1080/23809000.2017.1308808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments. AREAS COVERED Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies. EXPERT COMMENTARY There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.
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Affiliation(s)
- Janella N. Hudson
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Nathanael B. Stanley
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Global Health, College of Public Health, University of South Florida
| | - Leena Nahata
- Division of Endocrinology and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Meghan Bowman-Curci
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Gwendolyn P. Quinn
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, FL
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36
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Combelles CM. In VitroMaturation of Human Oocytes: Current Practices and Future Promises. Hum Reprod 2016. [DOI: 10.1002/9781118849613.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wang X, Gook DA, Walters KA, Anazodo A, Ledger WL, Gilchrist RB. Improving fertility preservation for girls and women by coupling oocyte in vitro maturation with existing strategies. ACTA ACUST UNITED AC 2016; 12:275-8. [PMID: 27188229 DOI: 10.2217/whe-2016-0019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Xiaoqian Wang
- Department of Obstetrics & Gynaecology, St George Public Hospital, Sydney, NSW 2217, Australia
| | - Debra A Gook
- Reproductive Services & Melbourne IVF, Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics & Gynaecology, University of Melbourne, Parkville, Australia
| | - Kirsty A Walters
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Antoinette Anazodo
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia.,Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW 2031, Australia.,Nulune Comprehensive Cancer Center, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - William L Ledger
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Robert B Gilchrist
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
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Liang T, Motan T. Mature Oocyte Cryopreservation for Fertility Preservation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 951:155-161. [DOI: 10.1007/978-3-319-45457-3_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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