1
|
Eijkenboom L, Saedt E, Zietse C, Braat D, Beerendonk C, Peek R. Strategies to safely use cryopreserved ovarian tissue to restore fertility after cancer: A systematic review. Reprod Biomed Online 2022; 45:763-778. [DOI: 10.1016/j.rbmo.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
|
2
|
Diaz AA, Kubo H, Handa N, Hanna M, Laronda MM. A Systematic Review of Ovarian Tissue Transplantation Outcomes by Ovarian Tissue Processing Size for Cryopreservation. Front Endocrinol (Lausanne) 2022; 13:918899. [PMID: 35774145 PMCID: PMC9239173 DOI: 10.3389/fendo.2022.918899] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED Ovarian tissue cryopreservation (OTC) is the only pre-treatment option currently available to preserve fertility for prepubescent girls and patients who cannot undergo ovarian stimulation. Currently, there is no standardized method of processing ovarian tissue for cryopreservation, despite evidence that fragmentation of ovaries may trigger primordial follicle activation. Because fragmentation may influence ovarian transplant function, the purpose of this systematic review was (1) to identify the processing sizes and dimensions of ovarian tissue within sites around the world, and (2) to examine the reported outcomes of ovarian tissue transplantation including, reported duration of hormone restoration, pregnancy, and live birth. A total of 2,252 abstracts were screened against the inclusion criteria. In this systematic review, 103 studies were included for analysis of tissue processing size and 21 studies were included for analysis of ovarian transplantation outcomes. Only studies where ovarian tissue was cryopreserved (via slow freezing or vitrification) and transplanted orthotopically were included in the review. The size of cryopreserved ovarian tissue was categorized based on dimensions into strips, squares, and fragments. Of the 103 studies, 58 fertility preservation sites were identified that processed ovarian tissue into strips (62%), squares (25.8%), or fragments (31%). Ovarian tissue transplantation was performed in 92 participants that had ovarian tissue cryopreserved into strips (n = 51), squares (n = 37), and fragments (n = 4). All participants had ovarian tissue cryopreserved by slow freezing. The pregnancy rate was 81.3%, 45.5%, 66.7% in the strips, squares, fragment groups, respectively. The live birth rate was 56.3%, 18.2%, 66.7% in the strips, squares, fragment groups, respectively. The mean time from ovarian tissue transplantation to ovarian hormone restoration was 3.88 months, 3.56 months, and 3 months in the strips, squares, and fragments groups, respectively. There was no significant difference between the time of ovarian function' restoration and the size of ovarian tissue. Transplantation of ovarian tissue, regardless of its processing dimensions, restores ovarian hormone activity in the participants that were reported in the literature. More detailed information about the tissue processing size and outcomes post-transplant are required to identify a preferred or more successful processing method. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk], identifier [CRD42020189120].
Collapse
Affiliation(s)
- Ashley A. Diaz
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hana Kubo
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Nicole Handa
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maria Hanna
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Monica M. Laronda
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Monica M. Laronda,
| |
Collapse
|
3
|
Hornshøj VG, Dueholm M, Mamsen LS, Ernst E, Andersen CY. Hormonal response in patients transplanted with cryopreserved ovarian tissue is independent of whether freezing was performed in childhood or adulthood. J Assist Reprod Genet 2021; 38:3039-3045. [PMID: 34617199 DOI: 10.1007/s10815-021-02320-z] [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: 05/04/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study evaluated the concentrations of hormones resulting from the transplantation of ovarian tissue (OTT) in relation to whether the tissue was frozen at a time close to puberty or above the age of 19 years. METHODS Six girls and adolescents (aged 9-14 years) who underwent ovarian tissue cryopreservation (OTC) were followed after transplantation in adulthood. After OTT, the women were followed via regular blood samples to evaluate the concentrations of FSH, LH, oestradiol and AMH. Twenty-three women undergoing OTT (aged 19-36 years at the time of OTC) were included as a reference group. All of the women had postmenopausal levels of gonadotropins at the time of transplantation. RESULTS The return of FSH and LH to normal premenopausal concentrations in adult women transplanted with ovarian tissue that was frozen at a time close to puberty was similar to the profiles in women from the reference group. Serum AMH levels were below the detection limit (via the Roche Elecsys assay) in many samples, but four out of six young girls showed measurable concentrations. Oestradiol similarly increased in the first 12 weeks following transplantation, after which it tended to be higher in women having frozen tissue in adulthood. CONCLUSIONS Ovarian tissue that was excised from girls at a time close to puberty, after which it was frozen and transplanted in adulthood, interacts with pituitary tissue in a similar manner to ovarian tissue that is frozen from adult women. Follicles located in the ovarian tissue from young girls are equally sensitive to gonadotropin stimulation as follicles from adult women when exposed to postmenopausal levels of gonadotropins. This result indicates that it is not the ovaries that require maturation to sustain full reproductive potential but rather proper FSH and LH stimulation. Moreover, these results support the continued use of OTC in young women.
Collapse
Affiliation(s)
- V Greve Hornshøj
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - L S Mamsen
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Faculty of Health and Medicine, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen N, Denmark
| | - E Ernst
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - C Y Andersen
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Faculty of Health and Medicine, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen N, Denmark.
| |
Collapse
|
4
|
Wall MA, Padmanabhan V, Shikanov A. Hormonal Stimulation of Human Ovarian Xenografts in Mice: Studying Folliculogenesis, Activation, and Oocyte Maturation. Endocrinology 2020; 161:5939202. [PMID: 33099627 PMCID: PMC7671278 DOI: 10.1210/endocr/bqaa194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 12/25/2022]
Abstract
Ovarian tissue cryopreservation and banking provides a fertility preservation option for patients who cannot undergo oocyte retrieval; it is quickly becoming a critical component of assisted reproductive technology programs across the world. While the transplantation of cryopreserved ovarian tissue has resulted in over 130 live births, the field has ample room for technological improvements. Specifically, the functional timeline of grafted tissue and each patient's probability of achieving pregnancy is largely unpredictable due to patient-to-patient variability in ovarian reserve, lack of a reliable method for quantifying follicle numbers within tissue fragments, potential risk of reintroduction of cancer cells harbored in ovarian tissues, and an inability to control follicle activation rates. This review focuses on one of the most common physiological techniques used to study human ovarian tissue transplantation, xenotransplantation of human ovarian tissue to mice and endeavors to inform future studies by discussing the elements of the xenotransplantation model, challenges unique to the use of human ovarian tissue, and novel tissue engineering techniques currently under investigation.
Collapse
Affiliation(s)
- Monica Anne Wall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Vasantha Padmanabhan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Cellular and Molecular Biology, University of Michigan, Ann Arbor, Michigan, USA
- Macromolecular Science and Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Correspondence: Ariella Shikanov, PhD, 2126 LBME, Ann and Robert H. Lurie Biomedical Engineering Building, Ann Arbor, MI 48109, USA. E-mail:
| |
Collapse
|
5
|
Lotz L, Barbosa PR, Knorr C, Hofbeck L, Hoffmann I, Beckmann MW, Antoniadis S, Dittrich R. The safety and satisfaction of ovarian tissue cryopreservation in prepubertal and adolescent girls. Reprod Biomed Online 2020; 40:547-554. [PMID: 32199797 DOI: 10.1016/j.rbmo.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 01/18/2023]
Abstract
RESEARCH QUESTION Is ovarian tissue cryopreservation (OTC) for fertility preservation in prepubertal and adolescent girls safe, and who would benefit most from the procedure? DESIGN Survey and retrospective study including patients who had OTC under the age of 18 years in a single centre for fertility preservation. Serum anti-Müllerian hormone levels were measured as a marker for detection of diminished ovarian reserve. RESULTS Fifty-three from 102 women participated in the survey (12 deceased, 19 declined, 17 unreachable, 1 palliative). The average age at OTC was 14.8 ± 2.3 (range: 6-17) years and at survey 21.9 ± 4.3 (range: 16-33) years. Ovarian tissue retrieval (laparoscopy: n = 45, laparotomy: n = 8) was without complications in 52 cases. In 23 (53.5%) of the 43 women who were post-menarchal at OTC, transient amenorrhoea occurred. At survey, 15 women reported a regular menstrual cycle, 25 used oral contraceptives, 9 women reported hormone replacement therapy due to primary ovary insufficiency and 4 had amenorrhoea. Two patients reported the birth of a healthy child after IVF, while 51 patients are still childless, mostly due to their young age (mean: 21.2 years). To date, one patient has had transplantation of the ovarian tissue (17 years at cryopreservation). Forty-nine of the interviewees would again decide on OTC, while three argued against it on the basis of the previous financial cost; one woman was unsure. CONCLUSIONS Children with cancer may be at risk for gonadal insufficiency. OTC is practically the only technique that can be offered to young girls. The procedure is safe and well accepted.
Collapse
Affiliation(s)
- Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
| | - Patricia Reis Barbosa
- Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St Hedwig, Hospital Barmherzige Brüder Regensburg, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Christian Knorr
- Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St Hedwig, Hospital Barmherzige Brüder Regensburg, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Louisa Hofbeck
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Sophia Antoniadis
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| |
Collapse
|
6
|
Lautz TB, Harris CJ, Laronda MM, Erickson LL, Rowell EE. A fertility preservation toolkit for pediatric surgeons caring for children with cancer. Semin Pediatr Surg 2019; 28:150861. [PMID: 31931969 DOI: 10.1016/j.sempedsurg.2019.150861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Survival for children with cancer has improved significantly in recent decades, prompting an increasing emphasis on minimizing late effects of therapy, including infertility and premature gonadal insufficiency. The time interval after diagnosis and before therapy initiation can be stressful and overwhelming for patients and their families coming to terms with the implications of the diagnosis, but is also the optimal time to address oncofertility options. Pediatric surgeons are often an integral part of the care team for these patients during this vulnerable time period and play a key role in advocating for and performing oncofertility procedures. Children with cancer have both non-experimental and experimental fertility preservation options available depending on their pubertal status and a risk assessment performed based on their anticipated therapy. This review provides an oncofertility toolkit for pediatric surgeons to perform a risk assessment, counsel families on fertility preservation options, and establish an oncofertility program tailored to the resources available at their institutions.
Collapse
Affiliation(s)
- Timothy B Lautz
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, United States.
| | - Courtney J Harris
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, United States
| | - Monica M Laronda
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Laura L Erickson
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, United States
| | - Erin E Rowell
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, United States
| |
Collapse
|
7
|
Kolbe T, Walter I, Rülicke T. Influence of graft size, histocompatibility,and cryopreservation on reproductive outcome following ovary transplantation in mice. J Assist Reprod Genet 2019; 36:2583-2591. [PMID: 31741257 PMCID: PMC6910892 DOI: 10.1007/s10815-019-01620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Transplantation of ovarian tissue is a valuable method to rescue mouse strains with fertility problems and to revitalize archived strains. The purpose of this study was to investigate the effect of (i) different sizes of transplanted ovary pieces on reproductive outcome, (ii) use of immunodeficient recipients to overcome the limitation of histocompatibility, and (iii) to compare different protocols for cryopreservation of ovarian tissue. Methods Halves, quarters, and eights of mouse ovaries were transplanted. Half ovaries from B6 donors were transferred into immunodeficient mice. Halves of ovaries were frozen according to four different protocols, thawed and transferred. Results Pregnancy rate after transplantation of ovarian tissue was high (90–100%) independent of the transplant size. Although, the average litter size was significantly lower for recipients of quarters and eights (4.4 and 4.6 vs. 6.5), the total number of offspring produced per donor ovary was higher compared with recipients of halves. Pregnancy rate of immunodeficient recipients was 40% (mean 4.7 offspring per litter). All four cryopreservation protocols used were able to preserve functionality of the ovarian tissue. Conclusions Transplantation of ovarian tissue smaller than halves resulted in reduced litter sizes. The distribution of ovarian tissue of one donor female to 4 or 8 recipients will therefore yield in a higher total number of offspring in a certain time period. The use of immunodeficient recipients is an option for non-histocompatible donors. Cryopreservation of ovarian tissue is generally feasible but the function of frozen-thawed ovary halves after transplantation differs depending on the freezing protocol used.
Collapse
Affiliation(s)
- T Kolbe
- Biomodels Austria, University of Veterinary Medicine Vienna, Vienna, Austria. .,Department IFA Tulln, University of Natural Resources and Life Sciences, Tulln, Austria.
| | - I Walter
- Vetcore (VetBioBank), University of Veterinary Medicine Vienna, Vienna, Austria
| | - T Rülicke
- Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Vienna, Austria
| |
Collapse
|
8
|
Donfack NJ, Alves KA, Alves BG, Rocha RMP, Bruno JB, Lima LF, Lobo CH, Santos RR, Domingues SFS, Bertolini M, Smitz J, Rodrigues APR. In vivo and in vitro strategies to support caprine preantral follicle development after ovarian tissue vitrification. Reprod Fertil Dev 2018; 30:1055-1065. [DOI: 10.1071/rd17315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare fresh and vitrified goat ovarian tissue after autotransplantation and in vitro culture. Adult goats were completely ovariectomised and each ovarian pair was sliced and distributed among six different treatment groups: fresh control, fresh transplant, fresh culture, vitrified control, vitrified transplant and vitrified culture. Follicular morphology, development, growth, density, revascularisation and hormone production were evaluated in all groups. Three antral follicles (two in the fresh transplant and one in the vitrified transplant groups) were observed on the surface of the graft 90 days after transplantation. The percentage of morphologically normal follicles was similar in the fresh control, fresh transplant and vitrified transplant groups. The percentage of developing (transition, primary and secondary) follicles was higher after in vitro culture of fresh or vitrified tissue. Transplantation resulted in a lower follicle density. Serum oestradiol concentrations remained constant during the entire transplantation period. In contrast, progesterone production decreased significantly. Expression of CD31 mRNA was lower in fresh culture. In conclusion, restoration of goat ovarian function can be successfully achieved following transplantation of both fresh and vitrified goat ovarian tissue. However, transplantation induced higher follicle loss than in vitro culture.
Collapse
|
9
|
Leonel EC, Vilela JM, Paiva RE, Jivago JL, Amaral RS, Lucci CM. Restoration of fresh cat ovarian tissue function by autografting to subcutaneous tissue: A pilot study. Theriogenology 2018; 105:97-106. [DOI: 10.1016/j.theriogenology.2017.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/04/2017] [Accepted: 09/09/2017] [Indexed: 11/25/2022]
|
10
|
Raffel N, Lotz L, Hoffmann I, Liebenthron J, Söder S, Beckmann MW, Dittrich R. Repetitive Maturation of Oocytes From Non-Stimulated Xenografted Ovarian Tissue From a Prepubertal Patient Indicating the Independence of Human Ovarian Tissue. Geburtshilfe Frauenheilkd 2017; 77:1304-1311. [PMID: 29269958 PMCID: PMC5734935 DOI: 10.1055/s-0043-122601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction
Modern anti-cancer strategies have distinctly increased survival rates; nevertheless, often accompanied by sterility. Currently, the only option for preserving fertility in prepubertal females is to cryopreserve ovarian tissue and re-transplant frozen-thawed tissue to restore fertility after treatment. Our aim was to report the occurrence of repetitive antral follicle formation and oocyte maturation in a prepubescent ovarian tissue xenograft without exogenous hormone stimulation.
Material and Methods
Frozen-thawed ovarian tissue from a 6-year-old patient suffering from nephroblastoma was xenotransplanted in oophorectomized severe combined immunodeficiency (SCID) mice to evaluate follicle development.
Ergebnisse
Repetitive follicle development to the antral stage occurred in the same xenograft of prepubertal ovarian tissue without exogenous hormone administration; 37 days after retrieving a maturing oocyte (this first retrieval has been previously published), another, completely mature oocyte was harvested from the xenograft. Subsequent histological evaluation of the grafted tissue showed primordial follicles, nearly all stages of developing follicles, as well as large atretic ones. Many clusters with dormant primordial follicles were also present.
Conclusion
Xenotransplanted prepubertal ovarian tissue has the potential for repetitive oocyte retrieval cycles without administering exogenous hormones. The results indicate that the human ovarian tissue might be able to synchronize the hypothalamus-hypophysis-axes of the mouse to the physiological human cycle; this should be investigated in future studies.
Collapse
Affiliation(s)
- Nathalie Raffel
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jana Liebenthron
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - Stephan Söder
- Institute of Pathology, University Hospital of Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
11
|
Abstract
Constant progress in the diagnosis and treatment of cancer disease has increased the number and prognosis of cancer survivors. However, the toxic effects of chemotherapy and radiotherapy on ovarian function have resulted in premature ovarian failure. Patients are, therefore, still expecting methods to be developed to preserve their fertility successfully. Several potential options are available to preserve fertility in patients who face premature ovarian failure, including immature or mature oocyte and embryo cryopreservation. However, for children or prepubertal women needing immediate chemotherapy, cryopreservation of ovarian tissue is the only alternative. The ultimate aim of this strategy is to implant ovarian tissue into the pelvic cavity (orthotopic site) or in a heterotopic site once oncological treatment is completed and the patient is disease free. Transplantation of ovarian tissue with sufficiently large numbers of follicles could potentially restore endocrine function and allow multiple cycles for conception. However, the success of ovarian tissue transplantation still has multiple challenges, such as the low number of follicles in the graft that may affect their longevity as well as the survival of the tissue during ex vivo processing and subsequent transplantation. Therefore, this review aims to summarize the achievements of ovary grafting and the potential techniques that have been developed to improve ovarian graft survival.
Collapse
|
12
|
Liebenthron J, Montag M. Chapter 15 Development of a Nationwide Network for Ovarian Tissue Cryopreservation. Methods Mol Biol 2017; 1568:205-220. [PMID: 28421499 DOI: 10.1007/978-1-4939-6828-2_15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Ovarian tissue cryopreservation is gaining much interest since the publication of the first live birth after retransplantation of frozen-thawed tissue in 2004 (Donnez et al., Lancet 364:1405-1410, 2004). In contrast to cryopreservation of gametes and embryos, ovarian tissue freezing is a complex requiring a proper approach in order to make this a viable option for fertility preservation of cancer patients. Due to the need in terms of laboratory space, equipment, personnel, and adequate logistics, an ovarian tissue cryobank is most economic if managed as a centralized service unit that interacts with numerous clinics covering the surgical part. Transportation of ovarian tissue under appropriate conditions from the surgical unit to the cryobank for subsequent preparation and freezing has been shown to have no impact on cryo-survival (Schmidt et al., Hum Reprod 18:2654-2659, 2003; Isachenko et al., Fertil Steril 91:1556-1559, 2009). Several children have been born after retransplantation of such tissue that was derived from the cryobank in Bonn, Germany (Homepage FertiPROTEKT. http://www.fertiprotekt.de ). This cryobank is one of the largest in the world with more than 1300 tissue samples that were frozen from 2003 until today. It is integrated in the network FertiPROTEKT (Homepage FertiPROTEKT. http://www.fertiprotekt.de ) and is served by 108 surgical centers that are located all over Germany. The concept of this cryobank is a blueprint for success and has recently been used for another regionally centralized cryobank in Beijing, China. In this chapter the most important topics that need to be considered while creating a centralized cryobank within a national or regional network are highlighted.
Collapse
Affiliation(s)
- Jana Liebenthron
- Cryobank at the Department of Gynecological Endocrinology and Reproductive Medicine, University Clinic of Bonn, Sigmund-Freud-Str. 25, 53125, Bonn, Germany
| | - Markus Montag
- ilabcomm GmbH, Eisenachstr. 34, 53757, St. Augustin, Germany.
| |
Collapse
|
13
|
Duncan FE, Pavone ME, Gunn AH, Badawy S, Gracia C, Ginsberg JP, Lockart B, Gosiengfiao Y, Woodruff TK. Pediatric and Teen Ovarian Tissue Removed for Cryopreservation Contains Follicles Irrespective of Age, Disease Diagnosis, Treatment History, and Specimen Processing Methods. J Adolesc Young Adult Oncol 2016; 4:174-83. [PMID: 26697267 DOI: 10.1089/jayao.2015.0032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Fertility preservation in a pediatric and teen female population is challenging because standard technologies of egg and embryo freezing may not be possible due to premenarcheal status. Ovarian tissue cryopreservation (OTC) with the intent of future ovarian tissue transplantation or in vitro follicle growth may be the only option to preserve fertility. The purpose of this study was to add to the general understanding of primordial follicle dynamics in young patients. METHODS First, the unique infrastructure of the Oncofertility Consortium National Physicians Cooperative (OC-NPC) is described, which simultaneously drives clinical fertility preservation and basic research to explore and expand the reproductive options for those in need. Then, the OC-NPC research resource is used to perform a histological evaluation of ovarian tissue from 24 participants younger than 18 years of age. RESULTS Primordial follicles, which comprise the ovarian reserve, were observed in all participant tissues, irrespective of variables, including age, diagnosis, previous treatment history, tissue size, and tissue processing methods. Primordial follicles were present in ovarian tissue, even in participants who had a previous history of exposure to chemotherapy and/or radiation treatment regimens, which placed them at risk for iatrogenic infertility or premature ovarian failure. CONCLUSION Primordial follicles were observed in ovarian tissue from all participants examined, despite population and tissue heterogeneity. These results increase the understanding of human follicle dynamics and support OTC as a promising fertility preservation modality in the young female population. Future studies to evaluate follicle quality within these tissues are warranted.
Collapse
Affiliation(s)
- Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Alexander H Gunn
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Sherif Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; Department of Pediatrics, Faculty of Medicine, Zagazig University , Zagazig, Egypt
| | - Clarisa Gracia
- Department of Obstetrics and Gynecology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Jill P Ginsberg
- Division of Pediatric Oncology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Barbara Lockart
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Yasmin Gosiengfiao
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| |
Collapse
|
14
|
Abstract
Fertility preservation is the process by which either oocytes (eggs) or sperm undergo an intervention to preserve their use for future attempts at conception. Consideration of fertility preservation in the pediatric and adolescent population is important, as future childbearing is usually a central life goal. For postpubertal girls, both oocyte and embryo cryopreservation are standard of care and for postpubertal boys, sperm cryopreservation continues to be recommended. Although all the risks are unknown, it appears that fertility preservation in most cases does not worsen prognosis, allows for the birth of healthy children, and does not increase the chance of recurrence.
Collapse
Affiliation(s)
- Stephanie J Estes
- Donor Oocyte Program, Robotic Surgical Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Pennsylvania State University, College of Medicine, Hershey Medical Center, Mail Code H103, 500 University Drive, Hershey, PA 17033-0850, USA.
| |
Collapse
|
15
|
Dittrich R, Lotz L, Fehm T, Krüssel J, von Wolff M, Toth B, van der Ven H, Schüring AN, Würfel W, Hoffmann I, Beckmann MW. Xenotransplantation of cryopreserved human ovarian tissue--a systematic review of MII oocyte maturation and discussion of it as a realistic option for restoring fertility after cancer treatment. Fertil Steril 2015; 103:1557-65. [PMID: 25881879 DOI: 10.1016/j.fertnstert.2015.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To systematically review the reporting of MII (MII) oocyte development after xenotransplantation of human ovarian tissue. DESIGN Systematic review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). SETTING Not applicable. PATIENT(S) Not applicable. INTERVENTION(S) Formation of MII oocytes after xenotransplantation of human ovarian tissue. MAIN OUTCOME MEASURE(S) Any outcome reported in Pubmed. RESULT(S) Six publications were identified that report on formation of MII oocytes after xenotransplantation of human ovarian tissue. CONCLUSION(S) Xenografting of human ovarian tissue has proved to be a useful model for examining ovarian function and follicle development in vivo. With human follicles that have matured through xenografting, the possibility of cancer transmission and relapse can also be eliminated, because cancer cells are not able to penetrate the zona pellucida. The reported studies have demonstrated that xenografted ovarian tissue from a range of species, including humans, can produce antral follicles that contain mature (MII) oocytes, and it has been shown that mice oocytes have the potential to give rise to live young. Although some ethical questions remain unresolved, xenotransplantation may be a promising method for restoring fertility. This review furthermore describes the value of xenotransplantation as a tool in reproductive biology and discusses the ethical and potential safety issues regarding ovarian tissue xenotransplantation as a means of recovering fertility.
Collapse
Affiliation(s)
- Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Jan Krüssel
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Michael von Wolff
- Division of Gynecologic Endocrinology and Reproductive Medicine, University Women's Hospital, Berne, Switzerland
| | - Bettina Toth
- Department of Gynecologic Endocrinology and Fertility Disorders, Ruprecht-Karls University Hospital, Heidelberg, Germany
| | - Hans van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, Bonn, Germany
| | - Andreas N Schüring
- Department of Obstetrics and Gynecology, UKM Kinderwunschzentrum, Münster University Hospital, Münster, Germany
| | | | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
16
|
Wallace WHB, Smith AG, Kelsey TW, Edgar AE, Anderson RA. Fertility preservation for girls and young women with cancer: population-based validation of criteria for ovarian tissue cryopreservation. Lancet Oncol 2014; 15:1129-36. [PMID: 25130994 PMCID: PMC4153375 DOI: 10.1016/s1470-2045(14)70334-1] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ovarian tissue cryopreservation with later reimplantation has been shown to preserve fertility in adult women, but this approach remains unproven and experimental in children and adolescents. We aimed to assess the use of the Edinburgh selection criteria for ovarian tissue cryopreservation in girls and young women with cancer to determine whether we are offering this invasive procedure to the patients who are most at risk of premature ovarian insufficiency. METHODS Cryopreservation of ovarian tissue has been selectively offered to girls and young women with cancer who met the Edinburgh selection criteria since 1996. Between Jan 1, 1996, and June 30, 2012, 410 female patients younger than 18 years at diagnosis were treated for cancer (including leukaemia and brain tumours) at the Edinburgh Children's Cancer Centre, which serves the whole South East of Scotland region. We determined the ovarian status of these patients from review of clinical records and classified them as having premature ovarian insufficiency or not, or as unable to be determined. Patients younger than 12 years at time of data cutoff (Jan 31, 2013) were excluded from the analysis. FINDINGS 34 (8%) of the 410 patients met the Edinburgh selection criteria and were offered ovarian tissue cryopreservation before starting cancer treatment. 13 patients declined the procedure and 21 consented, and the procedure was completed successfully in 20 patients. Of the 20 patients who had ovarian tissue successfully cryopreserved, 14 were available for assessment of ovarian function. Of the 13 patients who had declined the procedure, six were available for assessment of ovarian function. Median age at the time of follow-up for the 20 assessable patients was 16·9 years (IQR 15·5-21·8). Of the 14 assessable patients who had successfully undergone ovarian cryopreservation, six had developed premature ovarian insufficiency at a median age of 13·4 years (IQR 12·5-14·6), one of whom also had a natural pregnancy. Of the six assessable patients who had declined the procedure, one had developed premature ovarian insufficiency. Assessment of ovarian function was possible for 141 of the 376 patients who were not offered cryopreservation; one of these patients had developed premature ovarian insufficiency. The cumulative probability of developing premature ovarian insufficiency after treatment was completed was significantly higher for patients who met the criteria for ovarian tissue cryopreservation than for those who did not (15-year probability 35% [95% CI 10-53] vs 1% [0-2]; p<0·0001; hazard ratio 56·8 [95% CI 6·2-521·6] at 10 years). INTERPRETATION The results of this analysis show that the Edinburgh selection criteria accurately identify the few girls and young women who will develop premature ovarian insufficiency, and validate their use for selection of patients for ovarian tissue cryopreservation. Further follow-up of this cohort of patients is likely to allow refinement of the criteria for this experimental procedure in girls and young women with cancer. FUNDING UK Medical Research Council.
Collapse
Affiliation(s)
- W Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
| | - Alice Grove Smith
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Thomas W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Angela E Edgar
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| |
Collapse
|