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Cremonese J, Marcon M, Oppi L, Paletti G, Romolo V, Tozzo P, Caenazzo L. An Update on Planned Oocyte Cryopreservation (POC) in Italy: Medical, Epidemiological and Legal Consideration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042371. [PMID: 35206556 PMCID: PMC8872062 DOI: 10.3390/ijerph19042371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
Starting with a brief socioeconomic analysis of the phenomenon of female fertility, this narrative review aims to provide an analysis of the use and possibilities of medically assisted reproductive technology in combating fertility issues, adopting socioeconomic, legal and medical perspectives in Italy. The authors mainly employ data from the annual reports of the National Registry of Medically Assisted Reproduction (PMA Registry) and the Italian Statistical Institute (ISTAT) to understand the evolution of oocyte use in medically assisted reproductive technology in Italy from 2015 to 2018 and in particular to dissect the possibilities of oocyte cryopreservation as a measure to counteract age-related infertility, specifically through Planned Oocyte Cryopreservation (POC), also known as “social freezing”. It seems that the best course of action in the context of medically assisted reproduction would be the use of young and healthy cryopreserved oocytes (autologous or donated), preferably before the age of 40, while encouraging donation of oocytes whenever possible. Italy’s dependence on foreign biobanks for donated oocytes calls for the institution of a national biobank and further specific regulation of gamete donation. For this reason, it would be useful to encourage the acceptance of Planned Oocyte Cryopreservation to allow greater availability of healthy, younger oocytes.
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Affiliation(s)
- Jessica Cremonese
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Marianna Marcon
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Laura Oppi
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Giulia Paletti
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Vincenzo Romolo
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Pamela Tozzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
- Correspondence: ; Tel.: +39-049-827-2235
| | - Luciana Caenazzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
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Pimentel MML, Dos Santos FA, de Macêdo LB, de Brito PD, Lima GL, Barreto RA, Bezerra MB. Rescue of caprine fetal ovaries, vitrification and follicular development after xenotransplantation in two immunodeficient mice models. Anim Reprod 2020; 17:e20190115. [PMID: 32714451 PMCID: PMC7375861 DOI: 10.1590/1984-3143-ar2019-0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Domestic and wild goats are very susceptible animals to predation, specially when pregnancy occurs. This study aimed to evaluate the use of goat fetal ovarian tissue for vitrification followed by xenotransplantation and fresh xenotransplantation in two immunosuppressed mice models (C57BL/6 SCID and Balb-C NUDE). Goat fetus ovaries were collected in slaughterhouses, divided into small cortical pieces and were destined for fresh xenotransplantation (FX) and cryopreservation followed by xenotransplantation (CX). Five recipients from each lineage were used for FX and 10 animals from each lineage for CX. The mice were euthanized after 65 postoperative days, and the transplants were collected for microscopic assessment. The blood plasma was collected for estradiol measurement. Independently of mice strain, all recipients presented complete estrus cycle in FX and 80% after CX groups. Follicles were observed at all development stages without morphological changes. The volume density and total vessel surface observed in the transplants were different (p <0.01) between groups. The estradiol levels in the recipients did not differ (p <0.05) among the treatments. Thus, it is possible to activate the preantral follicles in the ovaries of fetuses by optimizing germplasm utilization and conservation of domestic and endangered wild goats that are in predatory situations, undesirable drowning or accidental death, since provided conditions for xenotransplantation are performed.
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Affiliation(s)
- Muriel Magda Lustosa Pimentel
- Centro Universitário Cesmac, Maceió, AL, Brasil.,Programa de Pós-graduação em Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
| | - Fernanda Araujo Dos Santos
- Programa de Pós-graduação em Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
| | - Luã Barbalho de Macêdo
- Programa de Pós-graduação em Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
| | - Parmênedes Dias de Brito
- Programa de Pós-graduação em Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
| | - Gabriela Liberalino Lima
- Departamento de Ciência Animal, Instituto Federal de Educação, Ciência e Tecnologia do Ceará, Crato, CE, Brasil
| | - Raimundo Alves Barreto
- Departamento de Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
| | - Marcelo Barbosa Bezerra
- Departamento de Ciência Animal, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
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3
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Mohsenzadeh M, Tabibnejad N, Vatanparast M, Anbari F, Ali Khalili M, Karimi-Zarchi M. Vitrification has detrimental effects on maturation, viability, and subcellular quality of oocytes post IVM in cancerous women: An experimental study. Int J Reprod Biomed 2019; 17. [PMID: 31435595 PMCID: PMC6661134 DOI: 10.18502/ijrm.v17i3.4516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/24/2018] [Accepted: 11/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background In vitro maturation (IVM) of immature oocytes retrieved from ovarian tissue has been considered as a valuable approach for fertility preservation in cancerous patients. Objective To evaluate the efficacy of vitrification on oocyte maturation, survival rates, as well as the subcellular oocyte quality post IVM. Materials and Methods The ovarian cortexes from 19 women with cervix and uterine malignancy aged 21-39 yr were collected. Cumulus-oocyte complexes were aspirated from all visible antral follicles. 102 immature oocytes were collected, and 43 oocytes were detected appropriately for IVM (control group). Also, 59 immature oocytes were vitrified, then matured in vitro (IVM) in two groups: with Growth/differentiation factor 9 (GDF9) (group 1) and without GDF9 (group 2) supplementation. Rates of oocytes viability, maturation, and survival along with meiotic spindle visualization and zona pellucida birefringence were assessed with Polyscope. Results The rate of maturation was significantly higher in controls (55.8%) compared to the other groups. Maturation rate was 23.3% in oocytes cultured in IVM medium enriched with GDF9, and 27.6% in those cultured in IVM medium lacking GDF9 (p = 0.86). Also, the meiotic spindle was present in 74.4% of control oocytes which was significantly higher than the other groups. The proportion of high zona pellucida birefringence was higher in the controls when compared with group 1 (51.2% vs. 23.3%, respectively, p = 0.04). Conclusion Vitrification had a detrimental effect on oocyte maturation, viability as well as the subcellular quality of the oocytes after IVM in cancerous women.
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Affiliation(s)
- Mehdi Mohsenzadeh
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Gerash Al-Zahra Fertility Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Nasim Tabibnejad
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Fatemeh Anbari
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Khalili
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Shahid Sadoughi Hospital, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Iran University of Medical Sciences, Tehran, Iran
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Moraes CCD, Marinho VFW, Campos ALM, Guedes JDS, Xavier ÉBDS, Caetano JPJ, Marinho RM. Oocyte cryopreservation for future fertility: comparison of ovarian response between cancer and non-cancer patients. JBRA Assist Reprod 2019; 23:91-98. [PMID: 30875168 PMCID: PMC6501752 DOI: 10.5935/1518-0557.20190010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: This study aimed to assess whether a diagnosis of cancer interferes with
ovarian function prior to the treatment of the disease. Methods: This observational retrospective study used data from medical records of
ovarian stimulation cycles performed for purposes of oocyte
cryopreservation. Results: The included patients had a mean age of 35.13±3.72 years and 51.6% of
them were aged between 36 and 40 years. More than half of the patients
(57.6%) were single and 82.1% had a normal body mass index (BMI). Most women
had not become pregnant (85.5%) or had babies (95.1%) or miscarriages
(89.6%) prior to cryopreservation. The mean number of oocytes obtained from
non-cancer patients was 11.4±8, while for cancer patients the number
was 13.8±9. The mean number of frozen mature oocytes was 9.7±7
for the non-cancer group and 11.2±7.2 for the cancer group. The
majority (63.1%) of the patients had up to 10 oocytes frozen per cycle.
Breast cancer had the highest incidence among the included patients. There
was no significant difference in ovarian response between patients with
different types of cancer. Conclusion: The number of harvested and frozen oocytes from cancer and non-cancer
patients indicated that in the two groups response to ovarian stimulation
was similar.
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Affiliation(s)
- Camila Cruz de Moraes
- Pró-Criar Medicina Reprodutiva, Belo Horizonte, MG, Brazil.,Faculdade Ciências Médicas Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ana Luísa Menezes Campos
- Pró-Criar Medicina Reprodutiva, Belo Horizonte, MG, Brazil.,Faculdade Ciências Médicas Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Érica Becker de Sousa Xavier
- Pró-Criar Medicina Reprodutiva, Belo Horizonte, MG, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ricardo Mello Marinho
- Pró-Criar Medicina Reprodutiva, Belo Horizonte, MG, Brazil.,Faculdade Ciências Médicas Minas Gerais, Belo Horizonte, MG, Brazil
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5
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Borovecki A, Tozzo P, Cerri N, Caenazzo L. Social egg freezing under public health perspective: Just a medical reality or a women's right? An ethical case analysis. J Public Health Res 2018; 7:1484. [PMID: 30687678 PMCID: PMC6321944 DOI: 10.4081/jphr.2018.1484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
Abstract
In recent years, a social trend toward delaying childbearing has been observed in women of reproductive age. A novel technomedical innovation was commercialized for non-medical reasons to healthy, ostensibly fertile women, who wished to postpone motherhood for various reasons such as educational or career demands, or because they had not yet found a partner. As a consequence, these women may be affected by age-related infertility when they decide to conceive, and fertility preservation techniques can be obtained through the so-called social egg freezing. This paper examines, from an ethical point of view, the impact of social egg freezing under some aspects that can involve policy making and resources allocation in public health. Due to the increasing demand for this procedure, some debated issues regard if it is reasonable to include social egg freezing in Public Healthcare System and consequently how to manage the storage of cryopreserved oocytes also from individual donors, how to support these egg banks and how to face, in the future, with the possibility that egg freezing will play a role in enabling childbearing for gays, lesbians, and unmarried persons. Social freezing may be advertised to harmonise gender differences, but we wonder if it is the proper solution to the problem or if it could also create further challenges. An ethical argumentation on these topics should address some questions that will be discussed. Significance for public health One of the purposes of medicine in health policies is the recognition of the different health needs of men and women because of their differences, that we can define gender equity, which should be guaranteed. Social egg freezing means to preserve and store a woman’s oocytes for non-medical purposes. This paper discusses how social freezing may be advertised to harmonise these incompatibilities and, if oocyte cryopreservation is an accepted procedure to counter infertility and if fertility treatment is covered by public healthcare, the consequence may be that it may also be covered by public national healthcare system or we have to admit that there is a distinction between assisted reproductive technologies for medical reasons and assisted reproductive technologies with oocytes previously stored for non-medical reasons.
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Affiliation(s)
- Ana Borovecki
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - Pamela Tozzo
- Department of Molecular Medicine, University of Padua, Italy
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6
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Praxedes ÉCG, Lima GL, Bezerra LGP, Santos FA, Bezerra MB, Guerreiro DD, Rodrigues APR, Domingues SFS, Silva AR. Development of fresh and vitrified agouti ovarian tissue after xenografting to ovariectomised severe combined immunodeficiency (SCID) mice. Reprod Fertil Dev 2018; 30:459-468. [PMID: 28784201 DOI: 10.1071/rd17051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to evaluate the development of fresh and vitrified agouti ovarian tissue after xenografting to C57Bl/6 severe combined immunodeficiency (SCID) female mice. Ovaries were obtained from five female agoutis and divided into 16 fragments. Five fragments were transplanted immediately to ovariectomised SCID mice and the others were vitrified, stored for 2 weeks and transplanted only after rewarming. Tissue fragments were transplanted under the kidney capsule in recipients. The return of ovarian activity in recipients was monitored by the observation of external signs of oestrus and vaginal cytology over a period of 40 days after transplantation, after which the grafts were removed and evaluated for morphology, cell proliferation and the occurrence of DNA fragmentation. Ovarian activity returned in four of five mice that received fresh ovarian tissue from agoutis and in one of six mice that had received vitrified tissue a mean (±s.e.m.) 20.6±8.6 days after xenotransplantation. After graft removal, a predominance of primordial and primary follicles was observed in all grafts. Vitrification reduced cell proliferation and increased the occurrence of DNA fragmentation in grafted agouti ovarian tissue. In conclusion, the present study demonstrates that xenografted agouti ovarian tissue, fresh or vitrified, is able to promote the return of ovarian activity in ovariectomised SCID C57B1/6 mice. However, improvements to vitrification protocols for agouti ovarian tissue are necessary.
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Affiliation(s)
- Érica C G Praxedes
- Laboratory of Animal Germplasm Conservation, Universidade Federal Rural do Semi-Árido, BR 110, Km 47, Costa e Silva, 59625-900, Mossoró, RN, Brazil
| | - Gabriela L Lima
- Department of Animal Sciences, Instituto Federal de Educação, Ciência e Tecnologia do Ceará (IFCE), CE-292, KM 15, Gisélia Pinheiro, 63115-500, Crato-CE, Brazil
| | - Luana G P Bezerra
- Laboratory of Animal Germplasm Conservation, Universidade Federal Rural do Semi-Árido, BR 110, Km 47, Costa e Silva, 59625-900, Mossoró, RN, Brazil
| | - Fernanda A Santos
- Laboratory of Gonadal Transplantation and Embryo Production, Universidade Federal Rural do Semi-Árido, BR 110, Km 47, Costa e Silva, 59625-900, Mossoró, RN, Brazil
| | - Marcelo B Bezerra
- Laboratory of Gonadal Transplantation and Embryo Production, Universidade Federal Rural do Semi-Árido, BR 110, Km 47, Costa e Silva, 59625-900, Mossoró, RN, Brazil
| | - Denise D Guerreiro
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), Faculdade de Veterinária, Universidade do Ceará, Av. Paranjana 1700, Campus do Itaperi, 60714-903, Fortaleza, CE, Brazil
| | - Ana P R Rodrigues
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), Faculdade de Veterinária, Universidade do Ceará, Av. Paranjana 1700, Campus do Itaperi, 60714-903, Fortaleza, CE, Brazil
| | - Sheyla F S Domingues
- Laboratory of Amazon Wild Animals Biology and Medicine, Universidade Federal do Pará, Jaderlândia, 68746-360,Castanhal, PA, Brazil
| | - Alexandre R Silva
- Laboratory of Animal Germplasm Conservation, Universidade Federal Rural do Semi-Árido, BR 110, Km 47, Costa e Silva, 59625-900, Mossoró, RN, Brazil
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Uribe P, Rojas C, Meriño J, Zambrano F, Villegas JV, Treulen F, Boguen R, Isachenko V, Isachenko E, Sánchez R. Effect of incubation temperature after devitrification on quality parameters in human sperm cells. Cryobiology 2017; 79:78-81. [DOI: 10.1016/j.cryobiol.2017.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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8
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Batchvarov IS, Taylor RW, Bustamante-Marín X, Czerwinski M, Johnson ES, Kornbluth S, Capel B. A grafted ovarian fragment rescues host fertility after chemotherapy. Mol Hum Reprod 2016; 22:842-851. [PMID: 27698028 DOI: 10.1093/molehr/gaw064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/15/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Can host fertility be rescued by grafting of a fragment of a healthy ovary soon after chemotherapy? SUMMARY ANSWER We found that grafting a green fluorescent protein (GFP)-positive fragment from a healthy isogenic ovary to the left ovary of a chemo-treated host rescued function and fertility of the grafted host ovary, and resulted in the production of host-derived offspring as late as the sixth litter after chemotherapy (CTx) treatment, whereas none of the ungrafted controls produced a second litter. WHAT IS KNOWN ALREADY In women and girls undergoing chemotherapy, infertility and premature ovarian failure are frequent outcomes. There are accumulating reports of improved endocrine function after autotransplantation of an ovarian fragment, raising the possibility that the transplant is beneficial to the endogenous ovary. STUDY DESIGN, SIZE, DURATION We first established a CTx treatment regimen that resulted in the permanent loss of fertility in 100% of female mice of the FVB inbred strain. We grafted an isogenic ovary fragment from a healthy female homozygous for a GFP transgene to the left ovary of 100 CTx-treated hosts, and compared fertility to 39 ungrafted controls in 6 months of continuous matings, using GFP to distinguish offspring derived from the graft, and those derived from the host. PARTICIPANTS/MATERIALS, SETTING, METHODS Immunofluoresece and western blot analysis of 39 treated ovaries during and 15 days after CTx treatment revealed elevated apoptosis, rapid loss of granulosa cells and an increased recruitment of growing follicles. Using immunofluorescence and confocal imaging, we tracked the outcome of the grafted tissue over 4 months and its effect on the adjacent and contralateral ovary of the host. MAIN RESULTS AND THE ROLE OF CHANCE Fifty-three percent of grafted females produced a second litter whereas none of the ungrafted females produced a second litter. The likelihood that this could occur by chance is very low (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION These results are shown only in mice, and whether or how they might apply to chemotherapy patients subjected to different CTx regimens is not yet clear. WIDER IMPLICATIONS OF THE FINDINGS Our experiments prove that rescue of a chemo-treated ovary is possible, and establish a system to investigate the mechanism of rescue and to identify the factors responsible with the long-term goal of developing therapies for preservation of ovarian endocrine function and fertility in women undergoing chemotherapy. LARGE SCALE DATA No large datasets were produced. STUDY FUNDING/COMPETING INTERESTS Duke University Medical Center Chancellor's Discovery Grant to BC; ESJ was supported by an NRSA 5F31CA165545; SK was supported by NIH RO1 GM08033; RWT was supported by the Duke University School of Medicine Ovarian Cancer Research Fellowship; XBM was supported by CONICYT. The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Rachel Williamson Taylor
- Department of Cell Biology, Duke University Medical Center, Durham, NC 27710, USA.,School of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Ximena Bustamante-Marín
- Department of Cell Biology, Duke University Medical Center, Durham, NC 27710, USA.,Facultad de Ciencias de la Salud, Departamento Biomédico Universidad de Antofagasta, Antofagasta, Chile
| | - Michael Czerwinski
- Department of Cell Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Erika Segear Johnson
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sally Kornbluth
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Blanche Capel
- Department of Cell Biology, Duke University Medical Center, Durham, NC 27710, USA
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9
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Voultsos P, Raikos N, Vasileiadis N, Spiliopoulou C, Tarlatzis B. Ethico-legal issues related to ovarian tissue transplantation. MEDICINE, SCIENCE, AND THE LAW 2016; 56:293-304. [PMID: 27381404 DOI: 10.1177/0025802416657685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.
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Affiliation(s)
- P Voultsos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Raikos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Vasileiadis
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ch Spiliopoulou
- 2 Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - B Tarlatzis
- 3 Infertility and IVF Center, Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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10
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Affiliation(s)
- Christopher L R Barratt
- Editor In Chief, MHR Reproductive and Developmental Biology, Medical School, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK Assisted Conception Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK
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11
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Gajjar R, Miller SD, Meyers KE, Ginsberg JP. Fertility preservation in patients receiving cyclophosphamide therapy for renal disease. Pediatr Nephrol 2015; 30:1099-106. [PMID: 25190492 DOI: 10.1007/s00467-014-2897-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/21/2014] [Accepted: 06/24/2014] [Indexed: 12/15/2022]
Abstract
Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.
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Affiliation(s)
- Radha Gajjar
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,
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12
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Biglia N, Torrisi R, D'Alonzo M, Codacci Pisanelli G, Rota S, Peccatori FA. Attitudes on fertility issues in breast cancer patients: an Italian survey. Gynecol Endocrinol 2015; 31:458-64. [PMID: 25982361 DOI: 10.3109/09513590.2014.1003293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fertility issues should be discussed with young women before the start of any anticancer treatment. The study is aimed to investigate the attitude on fertility among Italian oncologists and breast surgeons dealing with BCa, and to report the consensus achieved on specific statements. METHODS One hundred and sixty-two panelists anonymously expressed an opinion through a web-based platform on 19 statements based on the Delphi method. RESULTS Ninety-one percent of oncologists considered important to discuss with patients about fertility issues and 83% believed estrogens could stimulate the growth of hidden cancer cells in ER(+) tumors. Difficulties in accessing fertility preservation procedures were mainly due to patients' reluctance, but also to lack of coordination with the assisted reproduction specialists. No full consensus was reached on the prognostic role of pregnancy after BCa. Fifty-four percent of oncologists declared that pregnancy does not affect oncologic prognosis. Treatment with GnRHa during chemotherapy was considered the only mean for preserving ovarian function. CONCLUSIONS Fertility preservation in BCa patients is a well-accepted practice among Italian oncologists. A poor knowledge of this specific issue emerged from the survey, even if a certain degree of agreement was observed on most fertility-related issues.
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Affiliation(s)
- Nicoletta Biglia
- Department of Gynaecology and Obstetrics, University of Turin , Turin , Italy
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Damous LL, Nakamuta JS, de Carvalho AETS, Soares JM, de Jesus Simões M, Krieger JE, Baracat EC. Adipose tissue-derived stem cell therapy in rat cryopreserved ovarian grafts. Stem Cell Res Ther 2015; 6:57. [PMID: 25889829 PMCID: PMC4416311 DOI: 10.1186/s13287-015-0068-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/27/2015] [Accepted: 03/25/2015] [Indexed: 01/14/2023] Open
Abstract
The preliminary results of ovarian transplantation in clinical practice are encouraging. However, the follicular depletion caused by ischemic injury is a main concern and is directly related to short-term graft survival. Cell therapy with adipose tissue-derived stem cells (ASCs) could be an alternative to induce early angiogenesis in the graft. This study aimed to evaluate ASCs therapy in rat cryopreserved ovarian grafts. A single dose of rat ASC (rASCs) or vehicle was injected into the bilateral cryopreserved ovaries of twelve adult female rats immediately after an autologous transplant. Daily vaginal smears were performed for estrous cycle evaluation until euthanasia on postoperative day 30. Follicle viability, graft morphology and apoptosis were assessed. No differences were found with respect to estrous cycle resumption and follicle viability (P > 0.05). However, compared with the vehicle-treated grafts, the morphology of the ASCs-treated grafts was impaired, with diffuse atrophy and increased apoptosis (P < 0.05). ASCs direct injected in the stroma of rat cryopreserved ovarian grafts impaired its morphology although may not interfere with the functional resumption on short-term. Further investigations are necessary to evaluated whether it could compromise their viability in the long-term.
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Affiliation(s)
- Luciana Lamarão Damous
- Gynecology Discipline, Laboratory of Structural and Molecular Gynecology (LIM-58), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, São Paulo, 01246-903, Brazil. .,, Galvão Bueno St, 499, Bloco A. Apto31, Liberdade, São Paulo, 01506-000, Brazil.
| | - Juliana Sanajotti Nakamuta
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, São Paulo, 05403-000, Brazil.
| | - Ana Elisa Teófilo Saturi de Carvalho
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, São Paulo, 05403-000, Brazil.
| | - José Maria Soares
- Gynecology Discipline, Laboratory of Structural and Molecular Gynecology (LIM-58), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, São Paulo, 01246-903, Brazil.
| | - Manuel de Jesus Simões
- Department of Morphology and Genetics, Universidade Federal de São Paulo (UNIFESP), Botucatu St 740. Ed. Lemos Torres, 2nd floor, Vila Clementino, São Paulo, 04023-009, Brazil.
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (Incor), Faculdade de Medicina da Universidade de São Paulo, Dr Enéas de Carvalho Aguiar Av 44, 10th floor, Cerqueira Cesar, São Paulo, 05403-000, Brazil.
| | - Edmund C Baracat
- Gynecology Discipline, Laboratory of Structural and Molecular Gynecology (LIM-58), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr Arnaldo av 455, 2nd floor, room 2113, Pacaembu, São Paulo, 01246-903, Brazil.
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14
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Kläver R, Sánchez V, Damm OS, Redmann K, Lahrmann E, Sandhowe-Klaverkamp R, Rohde C, Wistuba J, Ehmcke J, Schlatt S, Gromoll J. Direct but no transgenerational effects of decitabine and vorinostat on male fertility. PLoS One 2015; 10:e0117839. [PMID: 25692788 PMCID: PMC4334483 DOI: 10.1371/journal.pone.0117839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
Establishment and maintenance of the correct epigenetic code is essential for a plethora of physiological pathways and disturbed epigenetic patterns can provoke severe consequences, e.g. tumour formation. In recent years, epigenetic drugs altering the epigenome of tumours actively have been developed for anti-cancer therapies. However, such drugs could potentially also affect other physiological pathways and systems in which intact epigenetic patterns are essential. Amongst those, male fertility is one of the most prominent. Consequently, we addressed possible direct effects of two epigenetic drugs, decitabine and vorinostat, on both, the male germ line and fertility. In addition, we checked for putative transgenerational epigenetic effects on the germ line of subsequent generations (F1-F3). Parental adult male C57Bl/6 mice were treated with either decitabine or vorinostat and analysed as well as three subsequent untreated generations derived from these males. Treatment directly affected several reproductive parameters as testis (decitabine & vorinostat) and epididymis weight, size of accessory sex glands (vorinostat), the height of the seminiferous epithelium and sperm concentration and morphology (decitabine). Furthermore, after decitabine administration, DNA methylation of a number of loci was altered in sperm. However, when analysing fertility of treated mice (fertilisation, litter size and sex ratio), no major effect of the selected epigenetic drugs on male fertility was detected. In subsequent generations (F1-F3 generations) only subtle changes on reproductive organs, sperm parameters and DNA methylation but no overall effect on fertility was observed. Consequently, in mice, decitabine and vorinostat neither affected male fertility per se nor caused marked transgenerational effects. We therefore suggest that both drugs do not induce major adverse effects-in terms of male fertility and transgenerational epigenetic inheritance-when used in anti-cancer-therapies.
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Affiliation(s)
- Ruth Kläver
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Victoria Sánchez
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Oliver S Damm
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Klaus Redmann
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Elisabeth Lahrmann
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Reinhild Sandhowe-Klaverkamp
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Christian Rohde
- Department of Hematology and Oncology, University of Halle, Halle, Germany
| | - Joachim Wistuba
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jens Ehmcke
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany; Central Animal Facility of the Medical Faculty, University of Münster, Münster, Germany
| | - Stefan Schlatt
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jörg Gromoll
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
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Abstract
Since inception, the use of assisted reproductive technologies (ART) has been accompanied by ethical, legal, and societal controversies. Guidelines have been developed to address many of these concerns; however, the rapid evolution of ART requires their frequent re-evaluation. We review the literature on ethical and legal aspects of ART, highlighting some of the most visible and challenging topics. Of specific interest are: reporting of ART procedures and outcomes; accessibility to ART procedures; issues related to fertility preservation, preimplantation genetic testing, gamete and embryo donation, and reproductive outcomes after embryo transfer. Improvements in ART reporting are needed nationally and worldwide. Reporting should include outcomes that enable patients to make informed decisions. Improving access to ART and optimizing long-term reproductive outcomes, while taking into account the legal and ethical consequences, are challenges that need to be addressed by the entire community of individuals involved in ART with the assistance of bioethicists, legal counselors, and members of society in general.
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Affiliation(s)
- Laura Londra
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA
| | - Edward Wallach
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA
| | - Yulian Zhao
- Department of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology and Infertility, Lutherville, MD, USA.
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Gheorghisan-Galateanu AA, Hinescu ME, Enciu AM. Ovarian adult stem cells: hope or pitfall? J Ovarian Res 2014; 7:71. [PMID: 25018783 PMCID: PMC4094411 DOI: 10.1186/1757-2215-7-71] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 06/29/2014] [Indexed: 12/22/2022] Open
Abstract
For many years, ovarian biology has been based on the dogma that oocytes reserve in female mammals included a finite number, established before or at birth and it is determined by the number and quality of primordial follicles developed during the neonatal period. The restricted supply of oocytes in adult female mammals has been disputed in recent years by supporters of postnatal neo-oogenesis. Recent experimental data showed that ovarian surface epithelium and cortical tissue from both mouse and human were proved to contain very low proportion of cells able to propagate themselves, but also to generate immature oocytes in vitro or in vivo, when transplanted into immunodeficient mice ovaries. By mentioning several landmarks of ovarian stem cell reserve and addressing the exciting perspective of translation into clinical practice as treatment for infertility pathologies, the purpose of this article is to review the knowledge about adult mammalian ovarian stem cells, a topic that, since the first approach quickly attracted the attention of both the scientific media and patients.
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Affiliation(s)
- Ancuta Augustina Gheorghisan-Galateanu
- Department of Cellular and Molecular Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania ; C.I.Parhon National Institute of Endocrinology, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Mihail Eugen Hinescu
- Department of Cellular and Molecular Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania ; V.Babes National Institute of Pathology, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Ana Maria Enciu
- Department of Cellular and Molecular Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania ; V.Babes National Institute of Pathology, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
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Turan V, Oktay K. Sexual and fertility adverse effects associated with chemotherapy treatment in women. Expert Opin Drug Saf 2014; 13:775-83. [PMID: 24784147 DOI: 10.1517/14740338.2014.915940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Earlier diagnosis and novel chemotherapy strategies have resulted in a considerable improvement in cancer survival, but the quality of that survival is influenced by late effects of chemotherapy. Premature ovarian failure is a common consequence of chemotherapy in reproductive-aged women, and, as a result, fertility issues and sexual dysfunction occur frequently in women who have undergone chemotherapy. AREAS COVERED This article reviews what is known about the effects of chemotherapy on fertility and sexuality. We also discuss risk factors for premature ovarian failure, fertility preservation options in patients willing to have a child after treatment, and sexual changes associated with estrogen withdrawal and psychological factors. EXPERT OPINION Chemotherapy-induced ovarian failure in young women is associated with poorer quality of life, decreased sexual functioning, psychosocial distress related to fertility concerns, and infertility. Fertility preservation options should be considered in women at risk of premature ovarian failure caused by chemotherapy. Sexual dysfunction associated with estrogen withdrawal and psychological stress is common in cancer survivors. Women who suffer from sexual dysfunction may benefit from brief counseling and targeted intervention.
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Affiliation(s)
- Volkan Turan
- New York Medical College, Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology , Valhalla, NY , USA
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