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McElhinney KL, Kennedy T, Rowell EE, Laronda MM. A dozen years of ovarian tissue cryopreservation at a pediatric hospital: tracking program and patient metrics while adapting to increasing needs. F S Rep 2024; 5:197-204. [PMID: 38983744 PMCID: PMC11228781 DOI: 10.1016/j.xfre.2024.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 07/11/2024] Open
Abstract
Objective To review the program and patient metrics for ovarian tissue cryopreservation (OTC) within a comprehensive pediatric fertility preservation program in its first 12 years of development. Design Retrospective review. Setting A tertiary children's hospital in a large urban center between March 2011 and February 2023. Patients Pediatric patients who underwent OTC. Interventions Unilateral oophorectomy for OTC. Main Outcome Measures Patient demographics and clinical course information were collected for analysis. Results A total of 184 patients underwent OTC in the first 12 years. One hundred fifteen patients were prepubertal at the time of OTC, and 69 were postpubertal. In total, 128 patients (69.6%) received part of their planned therapy before OTC. Starting in 2018, 104 participants (92.0%) donated tissue to research, 99 participants (87.6%) donated blood, and 102 (90.2%) donated media to research. There was a decrease in the median age of patients who underwent OTC from 16.4-6.6 years and an overall increase in the proportion of patients per year that were prepubertal. Forty-eight (26.0%) patients who underwent OTC were outside referrals and traveled from as far as Seattle, Washington. Conclusion During the first 12 years of this program, oncofertility research increased, annual tissue cryopreservation cases increased, and the median age of those who underwent OTC decreased. The program was adapted to build a stand-alone gonadal tissue processing suite and specialized in prepubertal ovarian tissue processing. The program will continue to adapt to patient needs in the upcoming decades because restoration technologies advance through research supported by this and collaborating programs.
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Affiliation(s)
- Kathryn L McElhinney
- Department of Surgery, Division of Pediatric Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Fertility & Hormone Preservation & Restoration Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Tara Kennedy
- Department of Surgery, Division of Pediatric Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Fertility & Hormone Preservation & Restoration Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin E Rowell
- Department of Surgery, Division of Pediatric Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Fertility & Hormone Preservation & Restoration Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Monica M Laronda
- Department of Surgery, Division of Pediatric Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Fertility & Hormone Preservation & Restoration Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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2
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Affdal AO, Salama M, Ravitsky V. Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review. J Assist Reprod Genet 2024; 41:999-1026. [PMID: 38430324 PMCID: PMC11052756 DOI: 10.1007/s10815-024-03059-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: 08/29/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. METHODS A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. RESULTS Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. CONCLUSION This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.
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Affiliation(s)
| | | | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- The Hastings Center, Garrison, USA
- Harvard Medical School, Boston, USA
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3
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Gonen LD. And When I Die: Theory of Planned Behavior as Applied to Sperm Cryopreservation. Healthcare (Basel) 2021; 9:554. [PMID: 34065091 PMCID: PMC8151572 DOI: 10.3390/healthcare9050554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
The present study investigates fertility intentions of men, aged 18-59, as expressed in willingness to cryopreserve sperm for future use in procreation. An economic stated-preference framework is combined with the Theory of Planned Behavior (TPB) to investigate which attributes are important in the decision to cryopreserve sperm, what is the Willingness to Pay (WTP) for cryopreservation, and which attributes influence it. A structured, two-part questionnaire was used, based on WTP and Conjoint analysis (CA) applied in tandem to elicit respondents' preferences in evaluating utility. Findings show which attributes are important in the decision to cryopreserve sperm among them Risk of Infertility, Personal monthly income, Chance of pregnancy from frozen semen, Age and what are significant predictor variables for the WTP which are Personal monthly income, Importance of the risk of infertility, Initial registration fee to sperm bank and cryopreservation, and Degree of religious observance. The findings further demonstrate that respondents value sperm cryopreservation and have a positive WTP for it as it seems to contribute to improving well-being. As a result of these findings, governments should consider state funding for cryopreservation as part of national health policy.
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Affiliation(s)
- Limor Dina Gonen
- Department of Economics and Business Administration, Ariel University, Ariel 40700, Israel
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4
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van Santen HM, van de Wetering MD, Bos AME, Vd Heuvel-Eibrink MM, van der Pal HJ, Wallace WH. Reproductive Complications in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67:1187-1202. [PMID: 33131541 DOI: 10.1016/j.pcl.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gonadal dysfunction and infertility after cancer treatment are major concerns for childhood cancer survivors and their parents. Uncertainty about fertility or being diagnosed with infertility has a negative impact on quality of survival. In this article, determinants of gonadal damage are reviewed and consequences for fertility and pregnancies are discussed. Recommendations for screening and treatment of gonadal function are provided. These should enable timely treatment of gonadal insufficiency aiming to improve linear growth, pubertal development, and sexual functioning. Options for fertility preservation are discussed.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, Utrecht 3505 AB, The Netherlands; Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands.
| | | | - Annelies M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, Postbus 85500, Utrecht 3508 GA, the Netherlands
| | | | - Helena J van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands
| | - William Hamish Wallace
- Department of Pediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
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5
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Nassau DE, Chu KY, Blachman-Braun R, Castellan M, Ramasamy R. The pediatric patient and future fertility: optimizing long-term male reproductive health outcomes. Fertil Steril 2020; 113:489-499. [DOI: 10.1016/j.fertnstert.2020.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
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6
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Zhao H, Jin L, Li Y, Zhang C, Wang R, Li Y, Huang W, Cui C, Zhang H, Wang H, Ma D, Liao S. Oncofertility: What can we do from bench to bedside? Cancer Lett 2019; 442:148-160. [DOI: 10.1016/j.canlet.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
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7
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van Santen HM, van den Heuvel-Eibrink MM, van de Wetering MD, Wallace WH. Hypogonadism in Children with a Previous History of Cancer: Endocrine Management and Follow-Up. Horm Res Paediatr 2019; 91:93-103. [PMID: 30703774 PMCID: PMC6615280 DOI: 10.1159/000495943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/29/2018] [Indexed: 01/15/2023] Open
Abstract
Hypogonadism after treatment for childhood cancer is a recognized complication and its cause may be subdivided into primary gonadal failure and central hypogonadism. Here, we provide an overview of the risk factors for the development of hypogonadism, assessment and potential interventions and give a summary of the current recommendations for management and follow-up of hypogonadism in childhood cancer survivors.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands,
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands,
| | | | | | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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8
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Arian SE, Flyckt RL, Herman R, Erfani H, Falcone T. Fertility preservation in pediatric female cancer patients. Fertil Steril 2018; 109:941. [PMID: 29778393 DOI: 10.1016/j.fertnstert.2018.02.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe and demonstrate ovarian tissue cryopreservation (OTC) as an emerging fertility preservation technique DESIGN: Video presentation. SETTING University hospital. PATIENT(S) A 6 year-old female patient diagnosed with aplastic anemia with plan for bone marrow transplantation underwent laparoscopic unilateral oophorectomy in conjunction with surgical procedure for port placement by the pediatric surgeon, followed by cryopreservation of ovarian tissue. INTERVENTION(S) Laparoscopic unilateral oophorectomy followed by ovarian decortication in the operating room, and ovarian tissue freezing prior to undergoing bone marrow transplantation. MAIN OUTCOME MEASURE(S) To present principle surgical techniques of ovarian tissue harvesting prior to OTC in pediatric patients, and different surgical techniques for ovarian auto-transplantation of cryobanked ovarian tissue after completion of gonadotoxic treatment and when the patient is ready to conceive. RESULT(S) This video demonstrates the detailed surgical technique for ovarian tissue harvesting. This harvesting can be performed laparoscopically or via mini-laparotomy and can involve a complete oophorectomy versus removing a portion of the ovary (a procedure also known as ovarian decortication). CONCLUSION(S) In the prepubertal child, due to the small size of the ovaries, we recommend oophorectomy rather than decortication owing to the small size of prepubertal gonadal tissue. Many young cancer patients can be offered the option of ovarian tissue freezing. This tissue contains immature primordial follicles that can be stored. OTC requires surgical ovarian harvesting followed by cryopreservation of strips of ovarian tissue. The increased number of eggs in prepubertal children underscores the fact that smaller ovarian size in this population does not preclude OTC. At this time, ovarian auto-transplantation is the only option to utilize this stored tissue for fertility preservation. OTC is a relatively new procedure within the area of ART. The overall data from OTC is reassuring and further suggests that cryopreservation of ovarian tissue has the potential to become an established fertility preservation method in the near future.
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Affiliation(s)
- Sara E Arian
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; Obstetrics, Gynecology, and Reproductive Sciences, Baylor College of Medicine, Houston, Texas.
| | - Rebecca L Flyckt
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard Herman
- Department of Pediatric Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Hadi Erfani
- Obstetrics, Gynecology, and Reproductive Sciences, Baylor College of Medicine, Houston, Texas
| | - Tommaso Falcone
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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9
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Cable M, Kelly D. An analysis of the development of adolescent and young adult cancer care in the United Kingdom: A Foucauldian perspective. Nurs Inq 2018; 26:e12272. [DOI: 10.1111/nin.12272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Maria Cable
- School of Health; Coventry University; Coventry UK
| | - Daniel Kelly
- Royal College of Nursing Chair of Nursing Research; School of Healthcare Sciences; Cardiff University; Cardiff UK
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10
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Allingham C, Gillam L, McCarthy M, Zacharin M, Jayasuriya S, Heloury Y, Orme L, Sullivan M, Peate M, Jayasinghe Y. Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer. JMIR Pediatr Parent 2018; 1:e10463. [PMID: 31518288 PMCID: PMC6715396 DOI: 10.2196/10463] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/09/2018] [Accepted: 08/07/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Future infertility is a significant concern for survivors of childhood and adolescent cancer. Children and adolescents may have the opportunity to undergo fertility preservation (FP) procedures (which preserve gonadal tissue or gametes for future use) prior to the cancer treatment. However, the decision is very complex, as it is often made by parents as proxy decision makers at the time of cancer diagnosis, and is time-sensitive (needing to occur before the cancer treatment begins). Furthermore, FP procedures in children and adolescents are experimental and cannot guarantee future fertility. An uninformed decision may result in future decision regret. OBJECTIVE This study aimed to assess the acceptability, usability, and feasibility of a Web-based FP decision aid (DA) in parents of children and adolescents with cancer and clinicians. Fertility knowledge and decision regret were compared in families who reviewed the DA compared with those who did not. METHODS The Web-based DA was developed according to the International Patient Decision Aid Standards. A cross-sectional study of parents of patients with cancer, who discussed fertility, and clinicians at a tertiary children's hospital was undertaken. The acceptability, usability, and feasibility of the DA were assessed using a pre-post survey design. Measures included the validated Decision Regret Scale, a purpose-designed fertility-related knowledge scale, questions regarding satisfaction with the DA, and open-ended responses for additional feedback. Furthermore, clinicians involved in FP were also invited to review the DA. RESULTS We enrolled 34 parents and 11 clinicians in this study. Participants who reviewed the DA (15 parents and 11 clinicians) expressed satisfaction with its content and functionality. Parents reported an improved understanding of cancer treatments, infertility, and FP procedures and did not report greater decision regret after DA review. Most parents (13/15, 86%) would recommend the DA to other parents. All clinicians had a consensus that this was a valid and relevant information source for all involved in fertility care. CONCLUSIONS It is an international standard of care to discuss the impact of cancer treatment on fertility before cancer treatment. This is the first fertility DA for parents of children and adolescents with cancer and is found to be relevant and acceptable by parents and clinicians. This DA has the potential to help support parents to make informed fertility-related decisions for their children and adolescents. However, future research is needed to assess the impact of the DA on prospective decision making.
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Affiliation(s)
- Catherine Allingham
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Department of Paediatric & Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.,Children's Bioethics Centre, The Royal Children's Hospital, Parkville, Australia
| | - Maria McCarthy
- Department of Psychology, The Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Margaret Zacharin
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Endocrinology, The Royal Children's Hospital, Parkville, Australia
| | - Sadunee Jayasuriya
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Monash University, Clayton, Australia
| | - Yves Heloury
- Department of Urology, The Royal Children's Hospital, Parkville, Australia
| | - Lisa Orme
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Michael Sullivan
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Department of Paediatric & Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Australia
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11
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de Lambert G, Chargari C, Minard-Colin V, Haie-Meder C, Guérin F, Martelli H. Testicular transposition in children undergoing brachytherapy for bladder and/or prostate rhabdomyosarcoma. J Pediatr Surg 2018; 53:1428-1431. [PMID: 29753523 DOI: 10.1016/j.jpedsurg.2018.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Fertility preservation is a major goal in treatment of children with cancer. We describe a new technique of testicular transposition (TT) in patients treated with pulse-dose-rate (PDR) brachytherapy as part of the multimodal conservative treatment of bladder neck and/or prostate rhabdomyosarcoma (BP RMS). METHODS Medical records of consecutive patients treated between September 2016 and August 2017 were studied. These patients underwent a TT performed during BP RMS surgery by the same suprapubic incision. The external oblique aponeurosis was not incised. The spermatic cord was mobilized up to the external inguinal ring, and the gubernaculum attachments were severed from the scrotum. The testis was then flipped over with care taken to avoid injury of the vessels or the vas, wrapped in a silicone material and sutured under the abdominal skin with a transfixing stitch facing the anterior superior iliac spine. At the end of brachytherapy, the testis was relocated in the scrotum and during the same general anesthesia, plastic tubes and stents were removed. Surgical outcome and dosimetric parameters were examined. RESULTS Eight patients were identified. Median age was 24 months (range 11-80 months). All had embryonal BP RMS and received chemotherapy according to RMS 2005 protocol prior to local treatment. All patients underwent conservative surgery followed by brachytherapy (60 Gy) and had testicular transposition of one testis. None had surgical complications. After converting doses to biologically equivalent doses in 2-Gy fractions (EQD2), the dose delivered to 75% of the transposed testis was 1.5 GyEQD2 (1-3 GyEQD2), versus 5.4 GyEQD2 (3.9-9.4 Gy EQD2) for the untransposed testis (p < 0.001). CONCLUSION Testicular transposition is feasible in order to potentially preserve fertility and future quality of life in children undergoing brachytherapy for BP RMS. TYPE OF STUDY Level IV Treatment Study: Case Study with no Comparison Group.
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Affiliation(s)
- Guenolee de Lambert
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France.
| | - Cyrus Chargari
- Gustave Roussy, Department of Radiotherapy, Villejuif, 94800, France; French Military Health Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | | | | | - Florent Guérin
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France
| | - Hélène Martelli
- AP - HP, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Department of Pediatric Surgery, Le Kremlin-Bicêtre, 94275, France
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12
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Fertility preservation for adolescent and young adult cancer patients in Japan. Obstet Gynecol Sci 2018; 61:443-452. [PMID: 30018898 PMCID: PMC6046357 DOI: 10.5468/ogs.2018.61.4.443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/24/2017] [Accepted: 12/12/2017] [Indexed: 12/27/2022] Open
Abstract
Adolescent and young adult (AYA) patients are generally defined as being from 15 to 39 years old. For preservation of fertility in AYA cancer patients, the best-known guideline in this field was released by the American Society of Clinical Oncology (ASCO) in 2006. However, the ASCO guideline is not necessarily applicable to Japanese cancer patients. The Japan Society for Fertility Preservation (JSFP) was formed in 2012, and a system and guideline for fertility preservation in Japanese AYA cancer patients plus children was released in July 2017. According to this guideline, patients should receive psychological and social support from health care providers such as doctors, nurses, psychologists, pharmacists, and social workers. In 2013, the American Society for Reproductive Medicine stated that freezing oocytes is a method that has passed beyond the research stage. However, freezing ovarian tissue is still a research procedure. While slow freezing of ovarian tissue is generally performed, rapid freezing (vitrification) is more popular in Japan. We have developed a new closed technique for ovarian tissue cryopreservation. It has been suggested that optical coherence tomography might be applied clinically to measure the true ovarian reserve and localize follicles in patients undergoing ovarian tissue transplantation. Combining gonadotropin-releasing hormone agonist therapy with anticancer agents might be useful for ovarian protection and it is expected that discussion of such combined treatment will continue in the future. This article outlines practical methods of fertility preservation using assisted reproductive techniques for AYA cancer patients in Japan.
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13
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Bizic MR, Jeftovic M, Pusica S, Stojanovic B, Duisin D, Vujovic S, Rakic V, Djordjevic ML. Gender Dysphoria: Bioethical Aspects of Medical Treatment. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9652305. [PMID: 30009180 PMCID: PMC6020665 DOI: 10.1155/2018/9652305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/26/2018] [Indexed: 12/02/2022]
Abstract
Gender affirmation surgery remains one of the greatest challenges in transgender medicine. In recent years, there have been continuous discussions on bioethical aspects in the treatment of persons with gender dysphoria. Gender reassignment is a difficult process, including not only hormonal treatment with possible surgery but also social discrimination and stigma. There is a great variety between countries in specified tasks involved in gender reassignment, and a complex combination of medical treatment and legal paperwork is required in most cases. The most frequent bioethical questions in transgender medicine pertain to the optimal treatment of adolescents, sterilization as a requirement for legal recognition, role of fertility and parenthood, and regret after gender reassignment. We review the recent literature with respect to any new information on bioethical aspects related to medical treatment of people with gender dysphoria.
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Affiliation(s)
- Marta R. Bizic
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- University Children's Hospital, Belgrade, Serbia
| | - Milos Jeftovic
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Slavica Pusica
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Borko Stojanovic
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- University Children's Hospital, Belgrade, Serbia
| | - Dragana Duisin
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Svetlana Vujovic
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Vojin Rakic
- Center for the Study of Bioethics, University of Belgrade, Serbia
| | - Miroslav L. Djordjevic
- Belgrade Center for Genital Reconstructive Surgery, Serbia
- School of Medicine, University of Belgrade, Serbia
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14
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Kenney LB, Antal Z, Ginsberg JP, Hoppe BS, Bober SL, Yu RN, Constine LS, van Santen HM, Skinner R, Green DM. Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research. J Clin Oncol 2018; 36:2160-2168. [PMID: 29874140 DOI: 10.1200/jco.2017.76.3839] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.
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Affiliation(s)
- Lisa B Kenney
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Zoltan Antal
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Jill P Ginsberg
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Bradford S Hoppe
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Sharon L Bober
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Richard N Yu
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Louis S Constine
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Hanneke M van Santen
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Roderick Skinner
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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15
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Utility of pediatric female fertility preservation discussions following pelvic radiation. Pediatr Surg Int 2018; 34:647-651. [PMID: 29619566 DOI: 10.1007/s00383-018-4257-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While many childhood cancers are curable with therapy, adverse consequences in fertility exist. We sought to assess the number of female patients with pelvic tumors receiving radiation therapy, and the proportion that undergo measures for fertility preservation (FP). METHODS A total of 53 female patients treated with pelvic tumors from 2000 to 2016 were retrospectively identified. RESULTS 19 (34%) of these patients underwent pelvic radiation therapy (pXRT). Three of the patients received pXRT for palliative treatment. Of the 19 female patients receiving pXRT, six (31%) were prepubertal and 13 (68%) were postpubertal. Three patients (16%) had documentation of a discussion of FP measures prior to pXRT. One was prepubertal and the others were post-pubertal. Six patients (32%) were evaluated by endocrinology after radiation therapy, diagnosed with ovarian failure, and placed on hormone therapy. Current guidelines recommend discussion of FP in pre-and postpubertal patients with cancer. This 16-year retrospective review of female patients that underwent pXRT for pelvic tumors demonstrated < 17% of patients have documentation of a discussion of FP measures. CONCLUSION Female pediatric patients who underwent chemotherapy and pXRT suffer a high rate of premature ovarian failure, high morbidity and mortality as well as low rates of documented FP discussions. Based on these findings we have established a multi-disciplinary fertility preservation team available for consultation and a protocol for discussing and documenting the impact of pXRT, along with other treatments, on fertility. LEVEL OF EVIDENCE III.
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16
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McCracken K, Nahata L. Fertility preservation in children and adolescents: current options and considerations. Curr Opin Obstet Gynecol 2018; 29:283-288. [PMID: 28787283 DOI: 10.1097/gco.0000000000000395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline current pediatric fertility preservation options, and discuss ethical and financial considerations impacting this rapidly expanding field. RECENT FINDINGS With the improvement in treatment of pediatric malignancies and medical conditions that threaten fertility, survival rates are increasing. Therefore, minimizing long-term morbidities such as gonadal damage and infertility is of utmost importance. Impaired fertility not only has a significant negative impact on patient's quality of life; in women, gonadal damage puts patients at risk for premature menopause, and increased risk of cardiac, skeletal, and cognitive issues. Fortunately, fertility preservation options exist for both female and male prepubertal and pubertal patients, and discussion of such options with patients and their families prior to the initiation of therapy and/or before further deterioration of gonadal function is crucial. A multidisciplinary approach to fertility counseling, with attention to the patient's goals and cultural beliefs, is ideal. SUMMARY Although several national organizations support integrating a fertility consultation into routine care, fertility preservation is still underutilized. Continued research is needed to understand barriers for patients/families and reduce the number of missed opportunities for fertility preservation.
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Affiliation(s)
- Kate McCracken
- aSection of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital bDivision of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine cCenter for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital dDivision of Endocrinology, The Ohio State University/Nationwide Children's Hospital, Columbus, Ohio, USA
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17
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Gertosio C, Magistrali M, Musso P, Meazza C, Bozzola M. Fertility Preservation in Pediatric Oncology Patients: New Perspectives. J Adolesc Young Adult Oncol 2018; 7:263-269. [PMID: 29346023 DOI: 10.1089/jayao.2017.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, advances in antineoplastic treatment led to a significant increase in the survival of patients with childhood cancer. In Europe and the United States, 82% of children, adolescents, and young adults survive 5 years from the cancer diagnosis and the majority achieves long-term survival into adulthood. The impact of cancer therapy on fertility is related to the age of the patient and to the duration, dose/intensity, and type of treatment. Exposure to chemotherapy or to radiation to gonads or pituitary brings long-term complications of cancer-directed therapies that include effects on reproductive capacity. Different methods to preserve fertility can be offered. In prepubertal women, ovarian tissue freezing, in vitro maturation, and surgical movement of ovaries outside the field of irradiation are still experimental. In pubertal and postpubertal women, oocyte-embryo freezing is an established option. In men, the options are sperm cryopreservation, gonadal transposition, and testicular tissue or spermatogonial cryopreservation and reimplantation. Fertility risks and provision of strategies to minimize cancer treatment impact fertility include discussion of the tail of the option before cancer treatment. Having to make a decision in a limited time, while still coming to terms with a potentially life-threatening diagnosis, can cause patients to feel overwhelmed. To date, there are no uniform guidelines on how to approach this problem, so it is important to be aware of it for proper clinical practice.
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Affiliation(s)
- Chiara Gertosio
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mariasole Magistrali
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Musso
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Cristina Meazza
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mauro Bozzola
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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18
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Uijldert M, Meißner A, de Melker AA, van Pelt AMM, van de Wetering MD, van Rijn RR, van Wely M, van der Veen F, Repping S. Development of the testis in pre-pubertal boys with cancer after biopsy for fertility preservation. Hum Reprod 2017; 32:2366-2372. [DOI: 10.1093/humrep/dex306] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/18/2017] [Indexed: 11/14/2022] Open
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19
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Stachs A, Hartmann S, Gerber B. Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies. Geburtshilfe Frauenheilkd 2017; 77:861-869. [PMID: 28845050 DOI: 10.1055/s-0043-116222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 12/17/2022] Open
Abstract
Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.
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Affiliation(s)
| | | | - Bernd Gerber
- Universitätsfrauenklinik Rostock, Rostock, Germany
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20
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Garavaglia E, Sala C, Taccagni G, Traglia M, Barbieri C, Ferrari S, Candiani M, Panina-Bordignon P, Toniolo D. Fertility Preservation in Endometriosis Patients: Anti-Müllerian Hormone Is a Reliable Marker of the Ovarian Follicle Density. Front Surg 2017; 4:40. [PMID: 28791295 PMCID: PMC5524724 DOI: 10.3389/fsurg.2017.00040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the ovarian reserve via measurement of follicular density and anti-Müllerian hormone (AMH) in endometriosis patients participating to a clinical program of cortical ovarian cryopreservation. DESIGN Retrospective analysis of serum AMH levels and prospective investigation of ovarian follicle number. SETTING University Hospital. PATIENTS Two hundred and two women with endometriosis and 400 controls. INTERVENTIONS Blood samples and ovarian biopsies. MAIN OUTCOME MEASURES Correlation of serum AMH levels and the number of non-growing follicles in the biopsied cortical tissues in endometriosis and control subjects, including age, type of AMH kit, and the laboratory performing the analysis as covariates. RESULTS AMH levels were shown to decrease with age in untreated endometriosis patients (P < 1.0 × 10-5) but they were significantly lower in endometriosis compared to controls only in patients over 36 years old (P = 2.7 × 10-4). The AMH decrease was faster in endometriosis compared to controls (beta = 0.27, P = 4.0 × 10-4). Primordial follicle number decreased with the reduction of AMH levels in both cases and controls (beta = 0.3; P = 0.04). CONCLUSION AMH is a reliable marker of ovarian reserve in endometriosis patients, and it can predict follicular density in women undergoing ovarian tissue cryopreservation.
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Affiliation(s)
| | - Cinzia Sala
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Michela Traglia
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Barbieri
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Ferrari
- Obstetrics and Gynaecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Panina-Bordignon
- Reproductive Sciences, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Toniolo
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
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21
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Kotzur T, Benavides-Garcia R, Mecklenburg J, Sanchez JR, Reilly M, Hermann BP. Granulocyte colony-stimulating factor (G-CSF) promotes spermatogenic regeneration from surviving spermatogonia after high-dose alkylating chemotherapy. Reprod Biol Endocrinol 2017; 15:7. [PMID: 28077131 PMCID: PMC5225630 DOI: 10.1186/s12958-016-0226-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The lifesaving chemotherapy and radiation treatments that allow patients to survive cancer can also result in a lifetime of side-effects, including male infertility. Infertility in male cancer survivors is thought to primarily result from killing of the spermatogonial stem cells (SSCs) responsible for producing spermatozoa since SSCs turn over slowly and are thereby sensitive to antineoplastic therapies. We previously demonstrated that the cytokine granulocyte colony-stimulating factor (G-CSF) can preserve spermatogenesis after alkylating chemotherapy (busulfan). METHODS Male mice were treated with G-CSF or controls before and/or after sterilizing busulfan treatment and evaluated immediately or 10-19 weeks later for effects on spermatogenesis. RESULTS We demonstrated that the protective effect of G-CSF on spermatogenesis was stable for at least 19 weeks after chemotherapy, nearly twice as long as previously shown. Further, G-CSF treatment enhanced spermatogenic measures 10 weeks after treatment in the absence of a cytotoxic insult, suggesting G-CSF acts as a mitogen in steady-state spermatogenesis. In agreement with this conclusion, G-CSF treatment for 3 days before busulfan treatment exacerbated the loss of spermatogenesis observed with G-CSF alone. Reciprocally, spermatogenic recovery was modestly enhanced in mice treated with G-CSF for 4 days after busulfan. These results suggested that G-CSF promoted spermatogonial proliferation, leading to enhanced spermatogenic regeneration from surviving SSCs. Similarly, there was a significant increase in proportion of PLZF+ undifferentiated spermatogonia that were Ki67+ (proliferating) 1 day after G-CSF treatment. CONCLUSIONS Together, these results clarify that G-CSF protects spermatogenesis after alkylating chemotherapy by stimulating proliferation of surviving spermatogonia, and indicate it may be useful as a retrospective fertility-restoring treatment.
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Affiliation(s)
- Travis Kotzur
- Department of Biology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 USA
| | - Roberto Benavides-Garcia
- Department of Biology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 USA
| | - Jennifer Mecklenburg
- Department of Biology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 USA
| | - Jamila R. Sanchez
- Department of Biology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 USA
| | - Matthew Reilly
- Departments of Biomedical Engineering and Ophthalmology, The Ohio State University, 1080 Carmack Road, Columbus, OH 43210 USA
| | - Brian P. Hermann
- Department of Biology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 USA
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22
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Lorenzo AJ. Editorial Comment. J Urol 2016; 197:943. [PMID: 27840019 DOI: 10.1016/j.juro.2016.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Armando J Lorenzo
- Fertility Preservation Program, Hospital for Sick Children, University of Toronto, Ontario, Canada
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23
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Köhn FM, Schuppe HC. [Fertility of oncological patients - andrological aspects]. MMW Fortschr Med 2016; 158:50-53. [PMID: 27797036 DOI: 10.1007/s15006-016-8896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Hans-Christian Schuppe
- Funktionsbereich Andrologie, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH - Standort Gießen, Standort Gießen, Deutschland
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24
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Smith RP, Lipshultz LI, Kovac JR. Stem cells, gene therapy, and advanced medical management hold promise in the treatment of male infertility. Asian J Androl 2016; 18:364. [PMID: 27056350 PMCID: PMC4854081 DOI: 10.4103/1008-682x.179249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
| | | | - Jason R Kovac
- Men's Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260, USA
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25
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Current and Future Issues in Pediatric and Adolescent Urologic Oncology. Urology 2016; 91:174. [PMID: 27107195 DOI: 10.1016/j.urology.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022]
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