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Naredi N, Talwar P, Karunakaran S. Failed ovarian cortex transplant but successful ovulation induction in a cancer survivor with premature ovarian failure: A paradox. Med J Armed Forces India 2022; 78:S326-S329. [PMID: 36147435 PMCID: PMC9485763 DOI: 10.1016/j.mjafi.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
Better diagnostic and treatment modalities for malignancies occurring in childhood and young age have increased the overall survival of the affected young girls and boys, but this has come at a cost of developing premature ovarian failure in girls and azoospermia in boys because of the gonadotoxicity of chemotherapy and radiotherapy. Thus, young girls and women of reproductive age who are at risk of ovarian failure due to cancer treatment must be mandatorily offered fertility preservation in any form such as cryopreservation of mature metaphase II oocytes after ovarian stimulation with gonadotropins and oocyte recovery and cryopreservation of embryos if the young female has a partner. However, these modalities may require the postponement of chemotherapy. Thus, in such instances, cryopreservation of ovarian tissue remains the only option. Herein, we report a case of a nulligravid young female patient who had stage IV Hodgkin's lymphoma and had to be taken up for immediate fertility preservation owing to the advanced stage of the disease. Therefore, cryopreservation of ovarian tissue was performed. The uniqueness of the case is that after remission of the disease was achieved with chemotherapy, transplantation of the ovarian tissue was carried out which was not successful, but the desire for motherhood prompted to carry out an ovulation induction in the remnant native ovary with a severely compromised ovarian reserve, and she conceived.
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Affiliation(s)
- Nikita Naredi
- Senior Adviser (Obst & Gyane) & ART Specialist, Assisted Reproductive Technology Centre, Command Hospital (Southern Command), Pune, India
| | - Pankaj Talwar
- Head Medical Services (Fertility and IVF), CK Birla Hospital, Gurugram, Haryana, India
| | - Sandeep Karunakaran
- Clinical Head and Senior Consultant (Obst & Gynae), Oasis Fertility, Banjara Hills, Hyderabad, India
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2
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Jones GL, Moss RH, Darby F, Mahmoodi N, Phillips B, Hughes J, Vogt KS, Greenfield DM, Brauten-Smith G, Gath J, Campbell T, Stark D, Velikova G, Snowden JA, Baskind E, Mascerenhas M, Yeomanson D, Skull J, Lane S, Bekker HL, Anderson RA. Cancer, Fertility and Me: Developing and Testing a Novel Fertility Preservation Patient Decision Aid to Support Women at Risk of Losing Their Fertility Because of Cancer Treatment. Front Oncol 2022; 12:896939. [PMID: 35847858 PMCID: PMC9280471 DOI: 10.3389/fonc.2022.896939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Women with a new cancer diagnosis face complex decisions about interventions aiming to preserve their fertility. Decision aids are more effective in supporting decision making than traditional information provision. We describe the development and field testing of a novel patient decision aid designed to support women to make fertility preservation treatment decisions around cancer diagnosis. Methods A prospective, mixed-method, three stage study involving: 1) co-development of the resource in collaboration with a multi-disciplinary group of key stakeholders including oncology and fertility healthcare professionals and patient partners (n=24), 2) alpha testing with a group of cancer patients who had faced a fertility preservation treatment decision in the past (n=11), and oncology and fertility healthcare professionals and stakeholders (n=14) and, 3) beta testing with women in routine care who had received a recent diagnosis of cancer and were facing a fertility preservation treatment decision (n=41) and their oncology and fertility healthcare professionals (n=3). Ten service users recruited from a closed Breast Cancer Now Facebook group and the support group Cancer and Fertility UK also provided feedback on CFM via an online survey. Results A 60-page paper prototype of the Cancer, Fertility and Me patient decision aid was initially developed. Alpha testing of the resource found that overall, it was acceptable to cancer patients, healthcare professionals and key stakeholders and it was considered a useful resource to support fertility preservation treatment decision-making. However, the healthcare professionals felt that the length of the patient decision aid, and elements of its content may be a barrier to its use. Subsequently, the prototype was reduced to 40 pages. During beta testing of the shortened version in routine care, women who received the resource described its positive impact on their ability to make fertility preservation decisions and support them at a stressful time. However, practical difficulties emerged which impacted upon its wider dissemination in clinical practice and limited some elements of the evaluation planned. Discussion Women receiving the decision aid within the cancer treatment pathway found it helped them engage with decisions about fertility preservation, and make better informed, values-based care plans with oncology and fertility teams. More work is needed to address access and implementation of this resource as part of routine oncology care pathways.
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Affiliation(s)
- Georgina L. Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Rachael H. Moss
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Frances Darby
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Neda Mahmoodi
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Bob Phillips
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Jane Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Katharina S. Vogt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Diana M. Greenfield
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - Jacqui Gath
- Independent Cancer Patients’ Voice, London, United Kingdom
| | | | - Daniel Stark
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - John A. Snowden
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Ellissa Baskind
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Daniel Yeomanson
- Haematology and Oncology, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Jonathan Skull
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Sheila Lane
- Department of Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development (LUCID), School of Medicine, University of Leeds, Leeds, United Kingdom
- Research Centre for Patient Involvement (ResCenPI) Central Region Denmark, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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3
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Edens C. The Impact of Pediatric Rheumatic Diseases on Sexual Health, Family Planning, and Pregnancy. Rheum Dis Clin North Am 2021; 48:113-140. [PMID: 34798942 DOI: 10.1016/j.rdc.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comprehensive review of reproductive health subtopics, including sexual intercourse, romantic relationships, contraception, sexually transmitted infections, pregnancy, and infertility, as they pertain to patients with pediatric rheumatic diseases and those who care for them.
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Affiliation(s)
- Cuoghi Edens
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA; Department of Internal Medicine, Section of Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA.
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4
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Song Y, Liu H. A review on the relationship between anti-mullerian hormone and fertility in treating young breast cancer patients. BMC WOMENS HEALTH 2021; 21:295. [PMID: 34376160 PMCID: PMC8353739 DOI: 10.1186/s12905-021-01420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Despite the fact that the long-term survival rate of breast cancer patients had been significantly improved owing to the systemic breast cancer therapies, there are still some side effects such as amenorrhea and fertility retention to be resolved, leaving it an important thing to understand the possible side effects on fertility and fertility preservation strategies while undergoing breast cancer treatment, due to the fact that most young patients hope to become pregnant and have children after breast cancer treatment. With anti-müllerian hormone (AMH) being the most sensitive marker for predicting ovarian function in young premenopausal women with breast cancer, this review is aimed to provide the additional guidance for clinical application of AMH by exploring the impacts of AMH on the fertility of young breast cancer patients, the relationship between AMH and metabolism, and the relationship between BRAC gene mutation and fertility protection strategies.
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Affiliation(s)
- Yixuan Song
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hong Liu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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Ekiz Yılmaz T, Taşdemir M, Kaya M, Arıcan N, Ahıshalı B. The effects of magnesium sulfate on cyclophosphamide-induced ovarian damage: Folliculogenesis. Acta Histochem 2020; 122:151470. [PMID: 31812447 DOI: 10.1016/j.acthis.2019.151470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 01/18/2023]
Abstract
Cyclophosphamide (CYP) is one of the alkylating chemotherapeutic agents and its adverse effects on folliculogenesis in the ovary are well-known due to the previous scientific research on this topic. Magnesium has various effects in organisms, including catalytic functions on the activation and inhibition of many enzymes, and regulatory functions on cell proliferation, cell cycle, and differentiation. In this study, the effects of magnesium sulfate (MgSO4) on CYP induced ovarian damage were investigated. Immature Wistar-Albino female rats of 28-days were treated with pregnant mare serum gonadotrophin (PMSG) to develop the first generation of preovulatory follicles. Rats of the experimental groups were then treated with either CYP (100 mg/kg, i.p) and MgSO4 (270 mg/kg loading dose; 27 mg/kg maintenance doseX12, i.p) solely or in combination. Following in-vivo 5-bromo-2-deoxyuridine (BrdU) labeling, animals were sacrificed and ovaries were embedded in paraffin and Epon. In the ovaries, added to the evaluation of general morphology and follicle count; BrdU and TUNEL-labeling, cleaved caspase-3 and p27 (cyclin-dependent kinase inhibitor) staining was also performed immunohistochemically and an ultrastructural evaluation was performed by transmission electron microscopy (TEM). The number of primordial follicles were decreased and multilaminar primary and atretic follicles were increased in CYP group. After MgSO4 treatment, while primordial follicle pool were elevated, the number of atretic follicles were decreased. Additionally, decreased BrdU-labeling, increased cleaved caspase 3 immunoreactivity and increased TUNEL labeling were observed in CYP group. In CYP treated animals, observations showed that while MgSO4 administration caused no alterations in BrdU proliferation index and caspase-3 immunoreactivity, it significantly reduced the TUNEL labeling. It was also observed that, while p27 immunoreactivity significantly increased in the nuclei of granulosa and theca cells in the CYP group; MgSO4 treatment significantly reduced these immunoreactivities. The ultrastructural observations showed frequent apoptotic profiles in granulosa and theca cells in both early and advanced stages of follicles in the CYP group and the MgSO4 treatment before the CYP application led to ultrastructural alleviation of the apoptotic process. In conclusion, our data suggest that MgSO4 may provide an option of pharmacologic treatment for fertility preservation owing to the beneficial effects of on chemotherapy-induced accelerated follicular apoptotic process, and the protection of the primordial follicle pool.
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Affiliation(s)
- Tuğba Ekiz Yılmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Histology and Embryology, Istanbul 34093, Turkey.
| | - Müge Taşdemir
- Istanbul University, Istanbul Faculty of Medicine, Department of Histology and Embryology, Istanbul 34093, Turkey.
| | - Mehmet Kaya
- Istanbul University, Istanbul Faculty of Medicine, Department of Physiology, Istanbul 34093, Turkey.
| | - Nadir Arıcan
- Istanbul University, Istanbul Faculty of Medicine, Department of Forensic Medicine, Istanbul 34093, Turkey.
| | - Bülent Ahıshalı
- Istanbul University, Istanbul Faculty of Medicine, Department of Histology and Embryology, Istanbul 34093, Turkey.
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6
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Li Q, An X, Man X, Chu M, Zhao T, Yu H, Li Z. Transcriptome analysis reveals that cyclophosphamide induces premature ovarian failure by blocking cholesterol biosynthesis pathway. Life Sci 2019; 239:116999. [PMID: 31654746 DOI: 10.1016/j.lfs.2019.116999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023]
Abstract
AIMS The present study aimed to investigate the effects of cyclophosphamide (Cytoxan, CTX) on premature ovarian failure (POF) in mice and its regulatory mechanisms by transcriptome analysis. MAIN METHODS Female C57BL/6 mice were treated with a single intraperitoneal injection of 70 mg/kg CTX. Serum levels of estradiol (E2) and follicle stimulating hormone (FSH) were measured by enzyme-linked immunosorbent assay (ELISA), and follicular structure differences were observed by hematoxylin and eosin (H&E) staining. The main mechanism of POF was investigated by RNA-seq data, protein-protein interaction (PPI) networks and qPCR analysis. KEY FINDINGS The serum levels of E2 were significantly decreased and those of FSH were significantly increased compared to the control group. The ovarian weights of the mice in the CTX group were reduced, and abnormal follicular structures were also observed in the CTX group. The RNA-seq data show that the downregulated genes were related to the cholesterol biosynthesis pathway. The PPI network and qPCR analyses further confirm that the PPAR signaling pathway and the ovarian infertility genes were also involved in blocking the cholesterol biosynthesis pathway. The differences were statistically significant. SIGNIFICANCE Our results indicate that CTX may exert its anti-tumor effects by inactivating the cholesterol biosynthesis pathway, and simultaneously reducing the supply of estrogen precursor materials, ultimately leading to the occurrence of POF. Our data provided a preliminary theoretical basis for resolving the clinical toxicity and side effects of CTX.
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Affiliation(s)
- Qi Li
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital, Jilin University, Changchun, 130021, China.
| | - Xinglan An
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital, Jilin University, Changchun, 130021, China.
| | - Xiaxia Man
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital, Jilin University, Changchun, 130021, China.
| | - Meiran Chu
- College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Tianchuang Zhao
- College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Hao Yu
- College of Animal Sciences, Jilin University, Changchun, 130062, China.
| | - Ziyi Li
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital, Jilin University, Changchun, 130021, China.
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7
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Intravenous Infusion of Nucleated Peripheral Blood Cells Restores Fertility in Mice with Chemotherapy-Induced Premature Ovarian Failure. Biomedicines 2018; 6:biomedicines6030093. [PMID: 30223591 PMCID: PMC6163893 DOI: 10.3390/biomedicines6030093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022] Open
Abstract
Cancer treatment with specific chemotherapeutic agents has been well documented to have an adverse impact on female fertility leading to premature ovarian failure (POF). The objective of this study is to investigate if chemotherapeutic induced POF can be reversed by the infusion of autologous nucleated peripheral blood cells (PBMC). To reach our goal, mice were treated with a single intraperitoneal injections of busulfan and cyclophosphamide to induce POF. This was followed by transfusion of PBMC. The ovarian morphology and functional parameters were monitored by radioimmunoassay, real-time PCR, immunofluorescence and immunohistochemistry analysis. Our study showed that chemotherapy (CTX) protracted estrous cycle period and repressed E2 production. In addition, CTX decreased the expressions of steroidogenesis markers, CYP-17 synthesis, StAR (steroidogenic acute regulatory protein), and Connexin-43 protein expression in the ovarian follicles. We also observed reduced numbers and sizes of the primordial and primary follicles in CTX-treated mice compared to untreated controls (p < 0.05). When both CTX and untreated control groups were stimulated with gonadotrophin, the control group produced ten times more ova than the CTX group. Finally, the treatment of premature ovarian failure induced by CTX with autologous PBMC transfusion resulted in over-expression and a statistically significant increase in several stem cell markers and restoration of fertility. Infusion with PBMC in CTX further decreased the estrous cycle length by 2.5 times (p < 0.01). We found that transfusion of autologous PBMC to mice with chemotherapy induced POF was very effective at restoring fertility. These results are similar to other studies using bone marrow derived mesenchymal stem cells.
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8
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Paradisi R, Macciocca M, Vicenti R, Rossi S, Morselli-Labate AM, Mastroroberto M, Seracchioli R, Fabbri R. New insights in the selection and management of cancer patients applicants for ovarian tissue cryopreservation. Gynecol Endocrinol 2016; 32:881-885. [PMID: 27227875 DOI: 10.1080/09513590.2016.1188373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Ovarian tissue cryopreservation (OTC), representing a promising strategy to preserve ovarian function in cancer patients, is recommended to women younger than 35 years. This study aimed to identify endocrine and biometric parameters as additional selection criteria for OTC. One hundred and ninety-one cancer patients before chemoradiotherapy and OTC and 43 controls were investigated. Mean ± SD, median, quartiles, 5th and 95th centiles and correlations of FSH, LH, estradiol, inhibin-B, anti-Mullerian hormone (AMH), ovarian volume and antral follicle count (AFC) were assessed. Most ovarian reserve parameters presented typical variations of ovulatory menstrual cycle, except AMH and AFC showing minimal fluctuations across the menstrual cycle. The 5th centiles of AMH (0.31and 0.4 ng/mL in controls and cancer patients, respectively) and AFC (five follicular structures in both groups) could be conjectured as minimum thresholds to include patients aged <35 years in OTC; below this threshold patients of any age should be excluded from OTC. Conversely, patients with AMH and AFC above the 25th centiles (1.2-1.6 ng/mL and 9-10 follicular structures in controls and cancer patients, respectively) might be inserted in OTC regardless of age. Baseline assessment of AMH and AFC might be considered as selection criteria, in addition to chronological age, to take decision of OTC in cancer patients.
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Affiliation(s)
- Roberto Paradisi
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
| | - Maria Macciocca
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
| | - Rossella Vicenti
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
| | - Stefania Rossi
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
| | - Antonio M Morselli-Labate
- b Department of Medical and Surgical Sciences (DIMEC) , S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Marianna Mastroroberto
- b Department of Medical and Surgical Sciences (DIMEC) , S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Renato Seracchioli
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
| | - Raffaella Fabbri
- a Gynecology and Pathophysiology of Human Reproduction Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy , and
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9
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Blumenfeld Z, Avivi I, Ritter M, Rowe JM. Preservation of Fertility and Ovarian Function and Minimizing Chemotherapy-Induced Gonadotoxicity in Young Women. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155769900600502] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Z. Blumenfeld
- Reproductive Endocrinology and Infertility Section, Departments of Obstetrics and Gynecology and Hematology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - J. M. Rowe
- Reproductive Endocrinology and Infertility Section, Departments of Obstetrics and Gynecology and Hematology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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Lee PA, Houk CP. Gonadotropin-releasing hormone analog therapy for central precocious puberty and other childhood disorders affecting growth and puberty. ACTA ACUST UNITED AC 2016; 5:287-96. [PMID: 17002488 DOI: 10.2165/00024677-200605050-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Gonadotropin-releasing hormone (GnRH) analog therapy relies primarily on the ability of these compounds to bind to and modulate GnRH-receptor activity. GnRH analogs have been used in pediatric patients where endogenous gonadotropin release is undesirable or potentially harmful, such as in: (i) patients with central precocious puberty (CPP); (ii) healthy short children where pubertal delay would provide an opportunity to supplement pre-pubertal linear growth; and (iii) children with malignancies and other disorders where treatment requires the use of gonadotoxic compounds. In the first two groups of patients, GnRH agonists may be used alone or in conjunction with somatropin (growth hormone [GH]) to prevent early skeletal maturation and increase the subsequent adult height, while in the latter case, GnRH agonists are used alone or in conjunction with GnRH antagonists in an attempt to preserve gonadal function.In children and adolescents with CPP, timely use of GnRH agonists alone can result in an adult height within the genetic potential of the individual (target height); however, minimal height is gained when GnRH agonist therapy is commenced after a marked advancement of skeletal age. This provides the rationale for combined therapy with GnRH agonists and somatropin in such patients, and studies have shown improved growth with this approach compared with GnRH agonists alone. Combination therapy with GnRH agonists and somatropin has also been shown to increase adult heights to a greater extent than GnRH agonists alone in pediatric patients with concomitant CPP and GH deficiency, those with idiopathic short stature, and those born small for gestational age; however, such combination therapy has shown no increased benefit over somatropin alone in pediatric patients with GH deficiency. Limited results in children and adolescents with congenital adrenal hyperplasia and chronic primary hypothyroidism have also shown increased growth rates, while no growth benefit was seen in pediatric renal transplant recipients.GnRH analogs also have potential as gonadoprotective agents; studies of GnRH agonists used alone and in combination with GnRH antagonists in women undergoing cytotoxic therapy have shown increased preservation of reproductive potential in patients who were receiving GnRH analog therapy versus those who were not.The adverse effects of GnRH analogs mainly consist of menopausal-like complaints. Increases in bodyweight and body mass index in children receiving GnRH agonist therapy have been shown; however, these increases do not persist after discontinuation of therapy. Adult bone mineral density and fertility are also not adversely affected by childhood GnRH agonist therapy.GnRH analog therapy appears to be both well tolerated and effective in pediatric patients, as it allows the preservation or improvement of adult height, and shows no longstanding negative effects on body composition, bone density, reproductive function, or endocrine physiology. These agents may also be useful for preservation of gonadal function in children and adolescents undergoing cytotoxic therapy.
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Affiliation(s)
- Peter A Lee
- Department of Pediatrics, Penn State College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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11
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Knickelbein JE, Armbrust KR, Kim M, Sen HN, Nussenblatt RB. Pharmacologic Treatment of Noninfectious Uveitis. Handb Exp Pharmacol 2016; 242:231-268. [PMID: 27848029 DOI: 10.1007/164_2016_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis encompasses a spectrum of diseases whose common feature is intraocular inflammation, which may be infectious or noninfectious in etiology (Nussenblatt and Whitcup 2010). Infectious causes of uveitis are typically treated with appropriate antimicrobial therapy and will not be discussed in this chapter. Noninfectious uveitides are thought have an autoimmune component to their etiology and are thus treated with anti-inflammatory agents.
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Affiliation(s)
- Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Karen R Armbrust
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Meredith Kim
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA.
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12
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Knickelbein JE, Jaworski L, Hasan J, Kaushal P, Sen HN, Nussenblatt RB. Therapeutic options for the treatment of non-infectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1047826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Barry RJ, Nguyen QD, Lee RW, Murray PI, Denniston AK. Pharmacotherapy for uveitis: current management and emerging therapy. Clin Ophthalmol 2014; 8:1891-911. [PMID: 25284976 PMCID: PMC4181632 DOI: 10.2147/opth.s47778] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Uveitis, a group of conditions characterized by intraocular inflammation, is a major cause of sight loss in the working population. Most uveitis seen in Western countries is noninfectious and appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. In this educational review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging therapies in this context. It is crucial that we continue to develop new therapies for use in uveitis that aim to suppress disease activity, prevent accumulation of damage, and preserve visual function for patients with the minimum possible side effects.
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Affiliation(s)
- Robert J Barry
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard W Lee
- Inflammation and Immunotherapy Theme, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK ; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
Younger women diagnosed with cancer often face compromised fertility as a result of their treatment. However, previous research has adopted a biomedical model of fertility and utilised hypothetico-deductive research methods which have not allowed for full exploration of women's subjectivity. This study explored younger women's construction of their fertility post-cancer, and their discussions of fertility with healthcare professionals, from a social constructionist epistemology. Semi-structured one-to-one interviews were conducted with eight women aged 18-26, across a variety of cancer types. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: 'Inadequate woman: Accepting the motherhood mandate'; 'Adequate woman: Resisting the motherhood mandate'; and 'Survival of the fittest: Woman as genetically defective'. Implications of these subject positions included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners; and concern about passing on cancer-positive genes. In describing healthcare professional interactions, women adopted positions of 'Satisfied patient'; 'Passive recipient patient'; or 'Resisting the passive patient position'. Accounts of inadequate information provision were associated with anger and frustration, whereas feeling adequately informed was associated with satisfaction at making decisions about fertility preservation. These results suggest that fertility is of importance to young women cancer survivors, and that compromised fertility can negatively impact subjectivity.
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Affiliation(s)
- Amy Dryden
- a Centre for Health Research , University of Western Sydney , Penrith , Australia
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15
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16
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Wakefield D. Does Cyclophosphamide Still Have a Role in the Treatment of Severe Inflammatory Eye Disease? Ocul Immunol Inflamm 2013; 22:306-10. [DOI: 10.3109/09273948.2013.854395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Giuseppe L, Attilio G, Edoardo DN, Loredana G, Cristina L, Vincenzo L. Ovarian function after cancer treatment in young women affected by Hodgkin disease (HD). Hematology 2013; 12:141-7. [PMID: 17454195 DOI: 10.1080/10245330600954072] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We have evaluated the best method to assess the ovarian reserve and the ovarian protective effect of GnRH-analog (GnRH-a), in 29 women with Hodgkin's disease (HD) treated with chemotherapy (CHT). The ovarian reserve was studied by measuring the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, antimullerian hormone (AMH) and the ultrasound antral follicular count (AFC). The patients were randomly treated with or without GnRH-a. At the time of study menstrual function was normal in 21 cases (72.4%), but absent in 8 (27.5%). Mean basal values of FSH, LH, AMH, inhibin B and AFC were normal in patients less than 30 years old and in the group treated four years or less before observation. AFC appeared to be the best marker of reduced ovarian reserve and a combination of AFC-AMH or inhibin B appeared the best predictor. In the GnRH-a group, no women had amenorrhoea, although ovarian reserve assessment was not significantly different from those who were not treated. The time-interval from CHT was the only significant predictor of ovarian function in GnRH-a treated patients. In conclusion, ovarian reserve evaluation, in young patients treated by CHT, can be performed by AFC. GnRH-a treatment does not have a protective effect, but could delay the development of ovarian failure.
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Affiliation(s)
- Loverro Giuseppe
- Department of Obstetric and Gynecology, University of Bari, Policlinico of Bari, Italy
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18
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19
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Durrani K, Zakka FR, Ahmed M, Memon M, Siddique SS, Foster CS. Systemic Therapy With Conventional and Novel Immunomodulatory Agents for Ocular Inflammatory Disease. Surv Ophthalmol 2011; 56:474-510. [DOI: 10.1016/j.survophthal.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/18/2011] [Accepted: 05/24/2011] [Indexed: 12/19/2022]
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20
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Grynberg M, Hesters L, Bénard J, Trèves R, Fanchin R, Frydman R, Frydman N. Préservation de la fertilité féminine : place de la maturation ovocytaire in vitro. ACTA ACUST UNITED AC 2011; 40:103-8. [DOI: 10.1016/j.jgyn.2010.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 07/30/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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21
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Imai A, Furui T. Chemotherapy-induced female infertility and protective action of gonadotropin-releasing hormone analogues. J OBSTET GYNAECOL 2009; 27:20-4. [PMID: 17365452 DOI: 10.1080/01443610601056467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review aimed to critically discuss the current protocols using gonadotropin-releasing hormone analogue (GnRHa) for the management of chemotherapy-induced premature ovarian failure. In in-vitro experiments, GnRHa retards doxorubicin-induced granulosa cell damage, suggesting an additional GnRH's activity to protect the gonads during chemotherapy through GnRH receptor-mediated mechanism(s). GnRHa acts to protect the gonads during radiation and/or chemotherapy by preferentially steering cells into cell cycle arrest with a decline in response to the chemotherapeutic agents. The ovarian protection by GnRHa co-treatment against chemotherapy can enable the preservation of future fertility in survivors and prevent the bone demineralisation and osteoporosis associated with hypooestrogenism and ovarian failure.
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Affiliation(s)
- A Imai
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Japan.
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22
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Abstract
Survival for cancer has improved significantly in the last 25 years with excellent overall 5- and 10-year survival rates. Hence, the majority of young women diagnosed with cancer can expect to live for decades, making quality of life issues such as fertility increasingly important. Risks of infertility vary based on the chemotherapy and treatments employed, as well as a woman's age. In general, younger women are less likely to experience permanent amenorrhea than older women, but even women who continue to menstruate have a greatly increased risk of premature menopause. Options for patients with cancer entering chemotherapy treatment, who wish to preserve fertility range from clinically well-established techniques such as embryo cryopreservation to more experimental techniques such as ovarian tissue cryopreservation. Pregnancy does not appear to increase the risk of cancer recurrence. Discussions of fertility issues in premenopausal women diagnosed with cancer present important challenges to the provider and to the patient. However, failure to discuss these options adequately can have lasting negative consequences on a woman's quality of life. Physician education interventions should seek to improve the knowledge of fertility preservations options, and of locally and nationally available resources.
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Azem F, Samara N, Cohen T, Ben-Yosef D, Almog B, Lessing JB, Goor O, Amit A. Assessment of ovarian reserve following ovarian tissue banking and/or GnRH-a co-treatment prior to chemotherapy in patients with Hodgkin's disease. J Assist Reprod Genet 2008; 25:535-8. [PMID: 19015974 DOI: 10.1007/s10815-008-9276-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To examine ovarian reserve following chemotherapy in women with Hodgkin's disease. METHODS The study included nine patients who underwent ovarian tissue cryopreservation (OTCP) prior to chemotherapy consisting of the ABVD regimen (Adriamycin, bleomycin, vinblastine, and dacarbazine) and co-treatment with gonadotropin-releasing hormone agonist (GnRH-a) (Group A), and 13 patients treated by the ABVD protocol only without GnRH-a (Group B). The average age was 25.2 +/- 2.7 years for the women in Group A and 31.8 +/- 6.8 years for those in Group B. RESULTS Six months following the end of chemotherapy, the menstrual cycle resumed in all Group A patients and in four Group B patients who had amenorrhea. Eight Group B patients had regular menses during and after chemotherapy. None of the patients suffered from ovarian failure. Two Group A patients conceived in the first year after completing chemotherapy. CONCLUSIONS Co-treatment with GnRH-a has little effect on ovarian protection in women with Hodgkin's disease.
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Affiliation(s)
- Foad Azem
- Institute of Hematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, 64239, Israel.
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Present and Future Fertility Preservation Strategies for Female Cancer Patients. Obstet Gynecol Surv 2008; 63:725-32. [DOI: 10.1097/ogx.0b013e318186aaea] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Pregnancy and Assisted Reproduction Techniques in Men and Women after Cancer Treatment. Placenta 2008; 29 Suppl B:152-9. [DOI: 10.1016/j.placenta.2008.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/15/2008] [Accepted: 07/17/2008] [Indexed: 01/15/2023]
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26
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Beck-Fruchter R, Weiss A, Shalev E. GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data. Hum Reprod Update 2008; 14:553-61. [DOI: 10.1093/humupd/dmn041] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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27
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Incidence of reversible amenorrhea in women with breast cancer undergoing adjuvant anthracycline-based chemotherapy with or without docetaxel. BMC Cancer 2008; 8:56. [PMID: 18291033 PMCID: PMC2287183 DOI: 10.1186/1471-2407-8-56] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 02/21/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the incidence of reversible amenorrhea in women with breast cancer undergoing adjuvant anthracycline-based chemotherapy with or without docetaxel. METHODS We studied the incidence and duration of amenorrhea induced by two chemotherapy regimens: (i) 6 cycles of 5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2 on day 1 every 3 weeks (6FEC) and (ii) 3 cycles of FEC 100 followed by 3 cycles of docetaxel 100 mg/m2 on day 1 every 3 weeks (3FEC/3D). Reversible amenorrhea was defined as recovery of regular menses and, where available (101 patients), premenopausal hormone values (luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol) in the year following the end of chemotherapy. RESULTS One hundred and fifty-four premenopausal patients were included: 84 treated with 6FEC and 70 with 3FEC/3D. The median age was 43.5 years (range: 28-58) in the 6FEC arm and 44 years (range: 29-53) in the 3FEC/3D arm. Seventy-eight percent of patients were treated in the context of the PACS 01 trial. The incidence of chemotherapy-induced amenorrhea at the end of chemotherapy was similar in the two groups: 93 % in the 6FEC arm and 92.8 % in the 3FEC/3D arm. However, in the year following the end of chemotherapy, more patients recovered menses in the 3FEC/3D arm than in the 6FEC arm: 35.5 % versus 23.7 % (p = 0.019). Among the 101 patients for whom hormone values were available, 43 % in the 3FEC/3D arm and 29 % in the 6FEC arm showed premenopausal levels one year after the end of chemotherapy (p < 0.01). In the 3FEC/3D group, there was a statistically significant advantage in disease-free survival (DFS) for patients who were still amenorrheic after one year, compared to patients who had recovered regular menses (p = 0.0017). CONCLUSION Our study suggests that 3FEC/3D treatment induces more reversible amenorrhea than 6FEC. The clinical relevance of these findings needs to be investigated further.
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Abstract
Improvements in the success of cancer treatments have resulted in increased awareness of the long-term effects of treatment, of which gonadal failure is the most significant. Thus, preservation of fertility potential has become a major goal and could be realized by preventing ovarian toxicity or by cryopreservation of reproductive cells/tissues. This review aimed to critically discuss the current protocols for the management of chemotherapy-inducced/radiotherapy-induced premature ovarian failure (POF). A medical approach using the gonadotropin-releasing hormone analog (GnRHa) may act to protect the gonads during radiation and/or chemotherapy by preferentially steering cells into cell cycle arrest with a decline in responsibility to the chemotherapeutic agents. Ovarian protection by GnRHa cotreatment against chemotherapy can enable the preservation of future fertility in survivors and prevent the bone demineralization and osteoporosis associated with hypestrogenism and POF. In vitro fertilization of retrieved oocytes could enable embryo freezing in some patients. Embryo cryopreservation is considered standard practice and widely available, but may seldom be used because of a lack of a male partner, the need to postpone cancer therapy for a few weeks and the possibility that an estrogen rise may be undesirable in sensitive cancer patients. Improvement in oocyte cryopreservation may offer additional possibilities; the prolonged culture of primordial and primary follicles in vitro is still unfeasible. Currently, the cryopreservation of ovarian cortex, which hosts thousands of immature follicles, is an investigational method, but has the advantage of requiring neither a sperm donor nor ovarian stimulation. Fertility preservation is often possible in women undergoing cancer treatment. To preserve the full range of options, fertility preservation procedures should be considered as early as possible during therapy planning. (Reprod Med Biol 2008; 7: 17-27).
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Affiliation(s)
- Atsushi Imai
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Akio Yamamoto
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
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29
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Technical and ethical challenges of fertility preservation in young cancer patients. Reprod Biomed Online 2008; 16:784-91. [DOI: 10.1016/s1472-6483(10)60143-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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30
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Blumenfeld Z. How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries. Oncologist 2007; 12:1044-54. [PMID: 17914074 DOI: 10.1634/theoncologist.12-9-1044] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The possibilities to preserve fertility in women exposed to chemotherapy are: in vitro fertilization plus embryo cryopreservation, ovarian cryopreservation, unfertilized ova cryopreservation, and the administration of a gonadotropin-releasing hormone (GnRH) agonist. Because none of these methods is ideal, combination of several methods should be considered. Because the chances of preserving gonadal function following combined-modality treatment are significantly better for girls than for boys, simulation of a prepubertal milieu was applied only to women of reproductive age. The administration of GnRH agonists to women with Hodgkin's disease, breast cancer, and other malignancies, or to patients with lupus nephropathy, in parallel with chemotherapy, by others and by us, has demonstrated a significantly lower rate of premature ovarian failure in survivors than in nonrandomized controls. Several prospective, randomized studies are ongoing. A recent meta-analysis found that the administration of a GnRH agonist, in addition to chemotherapy, to patients with breast cancer was associated with less recurrence and superior survival. Several possibilities to explain the beneficial effect of GnRH agonists to minimize chemotherapy-associated gonadotoxicity are suggested: (a) The hypogonadotropic milieu decreases the number of primordial follicles entering the differentiation stage, which is more vulnerable to chemotherapy; (b) The hypoestrogenic state decreases ovarian perfusion and delivery of chemotherapy to the ovaries; (c) A direct effect of the GnRH agonist on the ovary occurs independently of the gonadotropin level; (d) GnRH agonists may upregulate an intragonadal antiapoptotic molecule such as sphingosine-1-phosphate; (e) The GnRH agonist may protect ovarian germline stem cells.
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Affiliation(s)
- Zeev Blumenfeld
- Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Faculty of Medicine, Haifa 31096, Israel.
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31
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GILANI MM, HASANZADEH M, GHAEMMAGHAMI F, RAMAZANZADEH F. Ovarian preservation with gonadotropin-releasing hormone analog during chemotherapy. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2007.00089.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Imai A, Sugiyama M, Furui T, Tamaya T, Ohno T. Direct Protection by a Gonadotropin-Releasing Hormone Analog from Doxorubicin-Induced Granulosa Cell Damage. Gynecol Obstet Invest 2006; 63:102-6. [PMID: 17028438 DOI: 10.1159/000096062] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 08/08/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Recent clinical applications suggest a beneficial effect of gonadotropin-releasing hormone analog (GnRHa) as a gonadal protector from chemotherapy-induced premature ovarian failure. This study aimed to determine cellular mechanisms involved in the protective action of GnRHa against granulosa cell damage caused by doxorubicin. METHODS Granulosa cells were obtained by ultrasound-guided follicular aspiration from patients undergoing in vitro fertilization, and screened for GnRH receptor expression prior to analyses. The cellular function was assessed by measuring the conversion of exogenously supplied androstenedione to estradiol-beta (E2) in response to follicle-stimulating hormone (FSH) (1 microM). RESULTS Exposing to doxorubicin for 12 h before FSH stimulation caused a concentration-dependent inhibition of the E2 secretion to a minimum level of 20% of control. When the cells were incubated with a GnRHa for 12 h before and during exposure to doxorubicin, granulosa cells produced an equal level of E2 to that of control cells. The protective action of GnRHa was dose-dependent; a half-maximal effect occurred at 10 nM. Preincubation with GnRHa alone had no effect on FSH-induced E2 production. CONCLUSION These findings demonstrate that a GnRHa may retard doxorubicin-induced granulosa cell damage, suggesting an additional GnRH activity to protect the gonads during chemotherapy through GnRH receptor-mediated mechanism(s).
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Affiliation(s)
- Atsushi Imai
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan.
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33
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Maltaris T, Seufert R, Fischl F, Schaffrath M, Pollow K, Koelbl H, Dittrich R. The effect of cancer treatment on female fertility and strategies for preserving fertility. Eur J Obstet Gynecol Reprod Biol 2006; 130:148-55. [PMID: 16979280 DOI: 10.1016/j.ejogrb.2006.08.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 07/21/2006] [Accepted: 08/16/2006] [Indexed: 12/31/2022]
Abstract
Aggressive chemotherapy and radiotherapy in young patients with cancer has greatly enhanced the life expectancy of these patients, but these treatments often cause infertility because of the massive destruction of the ovarian reserve resulting in premature ovarian failure (POF). This review focuses on the effect of cancer treatments on fertility and on the various surgical and assisted-reproduction innovations that are available to provide the patient with the option of future pregnancies. As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better interdisciplinary cooperation between gynecological and pediatric oncologists, surgeons, immunologists and endocrinologists is necessary so that individualized options for fertility preservation can be offered in advance of surgical procedures or cancer treatments. GnRH analog treatment can preserve fertility in some patients, but not in all. At present, cryopreservation of ovarian tissue appears as a very promising method of providing the cancer patient with a realistic chance of preserving fertility-a prospect that is also extremely important to patients for psychological reasons.
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Affiliation(s)
- Theodoros Maltaris
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany.
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Fénichel P. [Medical preservation of ovarian function before and during radiochemotherapy]. ACTA ACUST UNITED AC 2005; 33:610-4. [PMID: 16126441 DOI: 10.1016/j.gyobfe.2005.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 07/08/2005] [Indexed: 11/29/2022]
Abstract
Intensive use of radiochemotherapy has greatly improved the prognosis associated with cancer in young women patients. However, improvement of the vital prognosis is frequently associated with impairment of fertility and premature ovarian failure. Cryopreservation of ovarian tissues has been developed but effective secondary use of cryopreserved tissue by means of autograft or through in vitro follicular maturation need yet to be clarified even though first success seemed to be recently obtained. Infant ovaries have been considered to be less sensitive than adult ovaries, which has suggested that hypophysal blockage could protect adult ovaries against fertility impairment before and during radiochemotherapy. Non-randomized studies using LHRH agonists support such a hypothesis. However what we know about physiopathology of follicular destruction involving exaggerated apoptosis and several animal models do not fit with these results. By consequence randomized studies need to be performed to verify the benefit, which one could expect from such a systematic clinical use.
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Affiliation(s)
- P Fénichel
- Service d'endocrinologie et médecine de la reproduction, CECOS, CHU de Nice, BP 3079, 06202 Nice cedex 03, France.
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35
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Abstract
Premature ovarian failure (POF) causing hypergonadotrophic hypogonadism occurs in 1% of women. In majority of cases the underlying cause is not identified. The known causes include: (a) Genetic aberrations, which could involve the X chromosome or autosomes. A large number of genes have been screened as candidates for causing POF; however, few clear causal mutations have been identified. (b) Autoimmune ovarian damage, as suggested by the observed association of POF with other autoimmune disorders. Anti-ovarian antibodies are reported in POF by several studies, but their specificity and pathogenic role are questionable. (c) Iatrogenic following surgical, radiotherapeutic or chemotherapeutic interventions as in malignancies. (d) Environmental factors like viral infections and toxins for whom no clear mechanism is known. The diagnosis is based on finding of amenorrhoea before age 40 associated with FSH levels in the menopausal range. Screening for associated autoimmune disorders and karyotyping, particularly in early onset disease, constitute part of the diagnostic work-up. There is no role of ovarian biopsy or ultrasound in making the diagnosis. Management essentially involves hormone replacement and infertility treatment, the only proven means for the latter being assisted conception with donated oocytes. Embryo cryopreservation, ovarian tissue cryopreservation and oocyte cryopreservation hold promise in cases where ovarian failure is foreseeable as in women undergoing cancer treatments.
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Affiliation(s)
- Deepti Goswami
- Department of Endocrinology, The Middlesex Hospital, London W1T 3AA, UK
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Franke HR, Smit WM, Vermes I. Gonadal protection by a gonadotropin-releasing hormone agonist depot in young women with Hodgkin's disease undergoing chemotherapy. Gynecol Endocrinol 2005; 20:274-8. [PMID: 16019373 DOI: 10.1080/09513590400027414] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To explore the effects of a gonadotropin-releasing hormone (GnRH) agonist depot (goserelin acetate) in women with Hodgkin's disease receiving chemotherapy while taking a continuous combined estrogen-progestin preparation as add-back on the prevention of premature ovarian failure (POF). METHODS In a prospective pilot study, five premenopausal women with Hodgkin's disease received a GnRH agonist depot plus add-back until polychemotherapy was completed. Every 4 weeks during treatment and thereafter, a hormonal profile (follicle-stimulating hormone (FSH), luteinizing hormone, 17beta-estradiol, progesterone and inhibin B) was measured until resumption of menstruation or the development of a hypergonadotropic state (2 x FSH > 30 U/l). RESULTS All patients reached prepubertal status during treatment. After discontinuation of goserelin acetate, one patient developed a hypergonadotropic state and four patients resumed menstruation. One of those patients became pregnant and delivered a healthy son. CONCLUSIONS The effectiveness of GnRH agonist plus add-back on the prevention of POF during polychemotherapy in women with Hodgkin's disease needs further elucidation in randomized controlled trials. The results of our pilot study are promising.
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Affiliation(s)
- Henk R Franke
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente Hospital Group, PO Box 50000, 7500 KA Enschede, The Netherlands.
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Kazlow Stern D, Tripp JM, Ho VC, Lebwohl M. The Use of Systemic Immune Moderators in Dermatology: An Update. Dermatol Clin 2005; 23:259-300. [PMID: 15837155 DOI: 10.1016/j.det.2004.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In addition to corticosteroids, dermatologists have access to an array of immunomodulatory therapies. Azathioprine, cyclophosphamide, methotrexate, cyclosporine, and mycophenolate mofetil are the systemic immunosuppressive agents most commonly used by dermatologists. In addition, new developments in biotechnology have spurred the development of immunobiologic agents that are able to target the immunologic process of many inflammatory disorders at specific points along the inflammatory cascade. Alefacept, efalizumab, etanercept, and infliximab are the immunobiologic agents that are currently the most well known and most commonly used by dermatologists. This article reviews the pharmacology, mechanism of action, side effects, and clinical applications of these therapies.
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Affiliation(s)
- Dana Kazlow Stern
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Mercadal L, Deray G. Lupus nephritis: a review of the current pharmacological treatments. Expert Opin Pharmacother 2005; 5:2263-77. [PMID: 15500373 DOI: 10.1517/14656566.5.11.2263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Proliferative lupus glomerulonephritis World Health Organization Class III and IV patients should benefit from an induction and maintenance therapy with a combined immunosuppressive treatment. Cyclophosphamide is the main recommended drug in induction therapy for a 3- to 6-month treatment period. Refractory lupus nephritis may be considered for immunoablative cyclophosphamide treatment with or without haematopoietic CD34(+) stem-cell transplantation or rituximab. Maintenance therapy should contain either quarterly cyclophosphamide pulses, azathioprine or mycophenolate mofetil for a total treatment duration of at least 2 years. Recent studies suggested a similar efficacy of mycophenolate mofetil and cyclophosphamide in induction and maintenance therapy. This result has to be confirmed in long-term studies.
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Affiliation(s)
- Lucile Mercadal
- Pitié-Salpêtrière Hospital, Nephrology Department, 83 bd de l hopital, 75013 Paris, France.
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Takada K, Arefayene M, Desta Z, Yarboro CH, Boumpas DT, Balow JE, Flockhart DA, Illei GG. Cytochrome P450 pharmacogenetics as a predictor of toxicity and clinical response to pulse cyclophosphamide in lupus nephritis. ACTA ACUST UNITED AC 2004; 50:2202-10. [PMID: 15248218 DOI: 10.1002/art.20338] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pulse cyclophosphamide is the treatment of choice for severe lupus nephritis. However, not all patients respond to this therapy, and gonadal toxicity is of particular concern. Cyclophosphamide is a prodrug that requires activation by cytochrome P450 (CYP) enzymes. We conducted a retrospective cohort study to test whether genetic polymorphisms of these enzymes are associated with the toxicity of, and clinical response to, cyclophosphamide in patients with lupus nephritis. METHODS Sixty-two patients with proliferative lupus nephritis treated with cyclophosphamide were genotyped for common variant alleles of CYP2B6, 2C19, 2C9, and 3A5. We examined the association between these genotypes and the following clinical end points: development of premature ovarian failure, end-stage renal disease (ESRD), doubling of serum creatinine level, and achievement of complete renal response. RESULTS The observed frequencies of the variant alleles CYP2B6*5, CYP2C19*2, CYP2C9*2, and CYP3A5*3 were 12.1%, 25.0%, 4.0%, and 75.8%, respectively. Patients who were either heterozygous or homozygous for CYP2C19*2 had a significantly lower risk of developing premature ovarian failure (relative risk 0.10; 95% confidence interval 0.02-0.52), after adjustment for age and total number of cyclophosphamide pulses received. In a survival analysis, patients homozygous for CYP2B6*5 (n = 3) or CYP2C19*2 (n = 4) had a higher probability of reaching ESRD (P = 0.0005) and of doubling the creatinine level (P = 0.0005) as well as a trend toward a lower probability of achieving a complete renal response (P = 0.051). CONCLUSION Determination of selected cytochrome P450 enzyme genotypes may be valuable for predicting the risk of premature ovarian failure in lupus nephritis patients treated with cyclophosphamide. The association of these genotypes with renal response needs further validation.
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Affiliation(s)
- Kazuki Takada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland 20892, USA
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Durrani K, Papaliodis GN, Foster CS. Pulse IV cyclophosphamide in ocular inflammatory disease. Ophthalmology 2004; 111:960-5. [PMID: 15121375 DOI: 10.1016/j.ophtha.2003.08.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2002] [Accepted: 08/04/2003] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess the efficacy and short-term safety of appropriately monitored pulse IV cyclophosphamide therapy in the treatment of patients with severe or treatment-resistant autoimmune ocular inflammatory disease. DESIGN Retrospective noncomparative interventional case series. PARTICIPANTS Thirty-eight patients with severe or recalcitrant ocular inflammation of diverse etiologies. METHODS Charts of patients seen on the Ocular Immunology & Uveitis Service at the Massachusetts Eye & Ear Infirmary were reviewed. Thirty-eight consecutive patients treated with pulse IV cyclophosphamide between January 1995 and March 2002 were analyzed. MAIN OUTCOME MEASURES The control of inflammation, steroid-sparing effect, visual acuity, and adverse reactions. RESULTS A positive response to treatment occurred in 68% of patients during the study period, with 55% achieving complete quiescence. A steroid-sparing effect was achieved in all patients previously on systemic steroid, allowing successful discontinuation of the drug in 41%. Visual acuity was maintained in 66% and improved in 21% of involved eyes. The most common side effects observed were fatigue (63%), nausea (32%), and headache (22%). None required a permanent discontinuation of therapy. CONCLUSIONS Pulse IV cyclophosphamide is an effective therapeutic modality in patients with severe or treatment-resistant ocular inflammatory disease.
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Affiliation(s)
- Khayyam Durrani
- Immunology & Uveitis Service, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts 02114, USA
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Pendse S, Ginsburg E, Singh AK. Strategies for preservation of ovarian and testicular function after immunosuppression. Am J Kidney Dis 2004; 43:772-81. [PMID: 15112167 DOI: 10.1053/j.ajkd.2004.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Gonadal toxicity as a side effect of cyclophosphamide therapy is a common long-term problem in the treatment of a variety of glomerular diseases. In both men and women treated with cyclophosphamide, the consequences of infertility can have great physical and emotional consequences; thus, this issue often has a critical role in the decision to decline treatment with cyclophosphamide. There exists a critical need for strategies for preservation of fertility in both men and women who require treatment with cyclophosphamide. This review explores emerging therapeutic options in this arena, which include sperm and oocyte cryopreservation, medical treatments such as testosterone therapy for men and gonadotropin-releasing hormone agonist therapy for both men and women, and, finally, the relatively new strategy of germ-cell transplantation for both ovarian and testicular tissue, which still remains in the experimental stages.
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Affiliation(s)
- Shona Pendse
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Lo Presti A, Ruvolo G, Gancitano RA, Cittadini E. Ovarian function following radiation and chemotherapy for cancer. Eur J Obstet Gynecol Reprod Biol 2004; 113 Suppl 1:S33-40. [PMID: 15041128 DOI: 10.1016/j.ejogrb.2003.11.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
High-dose chemotherapy and radiotherapy have increased the long-term survival of young patients with cancer; nevertheless, the toxic effects on ovarian function causing amenorrhoea, premature menopause and infertility, are still severe.
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Affiliation(s)
- A Lo Presti
- Centro di Biologia della Riproduzione, Palermo, Italy.
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Falcone T, Attaran M, Bedaiwy MA, Goldberg JM. Ovarian function preservation in the cancer patient. Fertil Steril 2004; 81:243-57. [PMID: 14967351 DOI: 10.1016/j.fertnstert.2003.06.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Revised: 06/23/2003] [Accepted: 06/23/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the clinical modalities that are available to women receiving potentially sterilizing cancer therapy. DESIGN The MEDLINE database was reviewed for all publications on medication, surgery, or assisted reproductive technology that could potentially preserve fertility in women who are receiving cancer therapy. CONCLUSION(S) There are many options available to a patient undergoing a treatment that will negatively impact her fertility. Many procedures and medical interventions have been proven successful both in terms of ovarian function and pregnancy rates. Other techniques have great potential but do not have long-term clinical data. It is important that the patient's primary care physician understand the methods available to preserve fertility in cancer patients and communicate this information to the patient.
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Affiliation(s)
- Tommaso Falcone
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Schr??der AK, Diedrich K, Ludwig M. Strategies for Preventing Chemotherapy- and Radiotherapy-Induced Gonadal Damage. ACTA ACUST UNITED AC 2004. [DOI: 10.2165/00024669-200403020-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Harden SV, Twyman N, Lomas DJ, Williams D, Burnet NG, Williams MV. A method for reducing ovarian doses in whole neuro-axis irradiation for medulloblastoma. Radiother Oncol 2003; 69:183-8. [PMID: 14643956 DOI: 10.1016/j.radonc.2003.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Cranio-spinal irradiation for medulloblastoma can impair fertility in girls. The literature indicates that an ovarian dose of 4 Gy causes permanent infertility in 30% of young females and that doses of <1.5 Gy over the whole treatment are desirable. We report a modified radiotherapy technique using a non-divergent beam edge inferiorly to reduce the ovarian dose. PATIENTS AND METHODS Eight female patients with medulloblastoma had magnetic resonance imaging (MRI) studies in the treatment position to identify the position of their ovaries relative to the radiation field. The information was transferred to the radiotherapy planning system and plans were generated using conventional spinal fields and modified fields with a half beam block at the inferior border. RESULTS Identifying the position of the ovaries by MRI enabled the dose to be estimated for the two techniques. Using a non-divergent beam inferiorly, the mean ovarian dose was reduced in all cases by a median value of 2.45 Gy (range 0.6-19.5 Gy) and the median percentage reduction was 66.8% (range 2.6-84.6%). The position of the ovary relative to the beam edge was critical in determining the dose reduction for each case. The modified technique doubled the number of patients receiving <4 Gy to a single ovary from three to six. With this alteration, three patients also had an ovary receiving <1.5 Gy whereas all exceeded this dose with conventional treatment. CONCLUSION We recommend using asymmetry at the inferior spinal border to achieve a non-divergent edge to the treatment field to reduce the dose to the ovary. Using MRI to localise the ovaries is important in estimating their dose and in assisting the counselling of patients and their families about future fertility.
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Affiliation(s)
- Susan V Harden
- Department of Oncology, Addenbrooke's NHS Trust, Addenbrooke's Hospital, Box 193, Hills Road, Cambridge CB2 2QQ, UK
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Abstract
PURPOSE OF REVIEW Due to the improved long-term survival of adolescents and young women with systemic malignancies such as lymphomas and leukaemia undergoing gonadotoxic chemotherapy, preservation of future fertility has been the focus of recent ubiquitous interest. This review summarizes, in brief, the recent progress in the various attempts to prevent premature ovarian failure in these young women with unconsumed fertility potential. RECENT FINDINGS The investigational endeavours of ovarian cryopreservation await the clinical experience of auto- or xenotransplantation, or in-vitro maturation of thawed primordial follicles, and in-vitro fertilization. Although promising, this procedure is not available yet. Moreover, the risk of possible reimplantation of malignant stem cells with the thawed cryopreserved ovary has been highlighted following experimental animal observations. The gonadotropin-releasing hormone agonist has been efficient in primates in a prospective study, and in young women in several nonrandomized series. The disruption of the acid sphingomyelinase gene, or sphingosine-1-phosphate, in rodents can prevent follicle destruction by ionizing radiation, possibly indicating in-vivo protection in cancer patients at risk of iatrogenic sterilization. SUMMARY The recent enormous scientific advance lends hope that the future may hold answers to the questions regarding safety and efficiency of oocyte, follicle, or ovarian tissue cryopreservation, and the most efficient means of using the thawed tissue - auto-, hetero-, or xenotransplantation versus IVM on the one hand, and in-vivo pharmacological attempts to minimize follicle depletion by gonadotropin-releasing hormone agonist or other modalities on the other hand. Until then, a combination of all the clinically available modalities should be offered to these young women with unconsumed fertility potential who face gonadotoxic therapy.
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Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Rambam medical Center, Israel Institute of Technology, Haifa, Israel.
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Ludwig M, Diedrich K. Ovarian infertility--reasons and treatment paradigms. ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2003:137-60. [PMID: 12402544 DOI: 10.1007/978-3-662-04960-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- M Ludwig
- Department of Gynecology and Obstetrics, Medical University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Abstract
Transplantation of ovarian and testicular tissue has been practised for over a century, mainly for experimental purposes. It is now being considered as a potential strategy for preserving fertility in young patients, including children, undergoing sterilizing treatment for cancer and other diseases. Ovarian tissue biopsies can be stored at liquid nitrogen temperatures indefinitely so that, after thawing, they can be returned as either ortho- or heterotopic grafts to the original patient. A different approach is needed for preserving male germ cells to restore fertile potential. Experimental studies have shown that spermatogonial stem cells injected into the rete testis/seminiferous tubules can re-initiate spermatogenesis after sterilizing treatment with alkylating agents; alternatively, in prepubertal cases, testicular biopsies that have been cryopreserved can be grafted subcutaneously to generate enough spermatozoa for intracytoplasmic sperm injection (ICSI). These strategies have been demonstrated in animal models and are now undergoing clinical testing.
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Affiliation(s)
- R G Gosden
- Department of Obstetrics and Gynecology, McGill University, Women's Pavilion (F3.38), Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ H3A 1A1, Canada.
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Maeda N, Kato K, Matsuyama T, Kojima S, Ohyama K. High-Dose Busulfan is a Major Risk Factor for Ovarian Dysfunction in Girls After Stem Cell Transplantation. Clin Pediatr Endocrinol 2003. [DOI: 10.1297/cpe.12.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Naoko Maeda
- Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital
| | - Koji Kato
- Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital
| | - Takaharu Matsuyama
- Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University School of Medicine
| | - Kenji Ohyama
- Department of Clinical Nursing, Faculty of Medicine, University of Yamanashi
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Blumenfeld Z, Dann E, Avivi I, Epelbaum R, Rowe JM. Fertility after treatment for Hodgkin's disease. Ann Oncol 2002; 13 Suppl 1:138-47. [PMID: 12078896 DOI: 10.1093/annonc/13.s1.138] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The investigational endeavors of ovarian cryopreservation await the clinical experience of auto- or xenotransplantation, in vitro maturation of thawed primordial follicles, their in vitro fertilization and embryo transfer. Although promising, this experience is not yet available. Moreover, the risk of possible reimplantation of malignant stem cells with the thawed cryoperserved ovary has been raised following experimental animal observations. Therefore, until these innovative endeavors prove successful, we have attempted to minimize the gonadotoxic effect of chemotherapy by the co-treatment with a gonadotropin-releasing hormone agonistic analog (GnRH-a) to induce a temporary prepubertal milieu. The immunoreactive inhibin-A and -B in these patients was measured before, during and following the gonadotoxic chemotherapy. METHODS A prospective clinical protocol was undertaken in 60 women aged 15-40 years with lymphoma, 10 with leukemia and 10 undergoing chemotherapeutic treatments for non-malignant diseases such as systemic lupus erythematosus or other autoimmune diseases. A monthly injection of depot D-TRP(6)-GnRH-a was administered from before starting the chemotherapy until its conclusion, up to a maximum of 6 months. Hormonal profile [follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2, T, P4, insulin-like growth factor (IGF)-1, IGF-BP3 and prolactin) was taken before starting the GnRH-a/chemotherapy co-treatment, and monthly thereafter until resumtion of spontaneous ovulation. This group was compared with a control group of 60 women who have been treated with similar chemotherapy. RESULTS Whereas all but three (40, 36 and 34 year old) of the surviving patients within the GnRH-a/ chemotherapy co-treatment group resumed spontaneous ovulation and menses within 12 months, less than half of the patients in the 'control' group (chemotherapy without GnRH-a co-treatment) resumed ovarian function and regular cyclic activity (P <0.05). The remaining 55% experienced premature ovarian failure (POF). Temporarily increased FSH concentrations were experienced by about one-third of the patients resuming cyclic ovarian function, suggesting reversible ovarian damage in a larger proportion of women than those experiencing POF. Inhibin-A and -B decreased during the GnRH-a/ chemotherapy co-treatment but increased to normal levels in patients who resumed regular ovarian cyclicity, and/or spontaneously conceived, as compared with low levels in those who developed POF. CONCLUSIONS If these preliminary data are consisent in a larger group of patients, GnRH-a co-treatment should be considered in every woman of reproductive age receiving chemotherapy, in addition to assisted reproductive technologies and the investigation into ovarian cryopreservation for future in vitro maturation, autotransplantation or xenotransplantation.
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Affiliation(s)
- Z Blumenfeld
- Department of Obstetrics/Gynecology, Hematology and Oncology, Rambam Medical Center, The B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
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