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Roberts JE, Benoit J, Foong S, Saumet J, Korkidakis A, Marr K, McQuillan S, Todd N. Fertility preservation in patients undergoing gonadotoxic treatments: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2024; 48:103767. [PMID: 38458057 DOI: 10.1016/j.rbmo.2023.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 03/10/2024]
Abstract
The management of young patients with cancer presents several unique challenges. In general, these patients are ill prepared for the diagnosis and the impact on their fertility. With the improved survival for all tumour types and stages, the need for adequate fertility counselling and a multidisciplinary approach in the reproductive care of these patients is paramount. Recent advances in cryopreservation techniques allow for the banking of spermatozoa, oocytes, embryos and ovarian tissue without compromising survival. This Canadian Fertility and Andrology Society (CFAS) guideline outlines the current understanding of social and medical issues associated with oncofertility, and the medical and surgical technologies available to optimize future fertility.
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Affiliation(s)
- Jeffrey E Roberts
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada.
| | - Janie Benoit
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Shu Foong
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Julio Saumet
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Ann Korkidakis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard University, Boston, MA, USA
| | - Kristin Marr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
| | - Sarah McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
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Barry F, Rayssac M, Gala A, Ferrières-Hoa A, Loup V, Anahory T, Brouillet S, Hamamah S. [What issues, changes and adaptations for French ART centers in the context of the new bioethics law?]. Gynecol Obstet Fertil Senol 2022; 50:777-787. [PMID: 36096450 DOI: 10.1016/j.gofs.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This review intends to introduce the changes of the new Bioethics law in the reproductive field and its application in French ART centers. MATERIAL AND METHODS The review details the main provisions of the Bioethics Law of August 2nd 2021 as well as the three decrees published since: the first one on September 29th 2021, which specifies in particular the age conditions to benefit from ART and self-preservation of one's gametes; another decree on December 31st, 2021, to set the terms and conditions for gamete self-preservation activities for non-medical reasons and the last decree on April 14th 2022, relating to the allocation of donated gametes and embryo donation. RESULTS Since the law of August 2nd, 2021, access conditions to assisted reproductive technology (ART) have evolved in France. Previously based on pathological infertility or the risk of transmission of a serious disease, ART is now intended to respond to the parental project of a couple formed by a man and a woman, two women or an unmarried woman. With the widening of access conditions, the use of gamete donation will likely increase. The upcoming raise of children born from gamete donation has led the legislator to question their right to access their origin. From September 1st 2022, adults born from gamete donation will be able to request a special administrative authority in order to access the donor's non identifying data (age, physical characteristics, family and professional situation, motivation for the donation…) and/or the donor's identity. Moreover, the new bioethics law opens up the possibility of autologous gamete cryopreservation without medical reasons, under specific age conditions, in order to carry out an assisted reproduction technique later. If gametes are not used, autologous gamete preservation could also allow an increase in gamete donation. However, the modification of gamete donation conditions could suggest a short term decrease in donors' number. Finally, the new bioethics law further opens up research on human embryos and embryonic stem cells. CONCLUSION The arrangements introduced by the Bioethics Law promulgated on August 2nd, 2021 represent a major revolution in the field of Reproductive Medicine and are expected to transform the practices of reproductive biology centers and CECOS in France.
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Affiliation(s)
- F Barry
- UMR INSERM Développement Embryonnaire, Environnement et Fertilité (DEFE), Université de Montpellier, Montpellier, France; Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - M Rayssac
- Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - A Gala
- Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - A Ferrières-Hoa
- Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - V Loup
- Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - T Anahory
- Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - S Brouillet
- UMR INSERM Développement Embryonnaire, Environnement et Fertilité (DEFE), Université de Montpellier, Montpellier, France; Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France
| | - S Hamamah
- UMR INSERM Développement Embryonnaire, Environnement et Fertilité (DEFE), Université de Montpellier, Montpellier, France; Département de biologie de la reproduction/DPI et CECOS, CHU Arnaud de Villeneuve Montpellier, Montpellier, France.
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Candiani M, Vanni VS, Papaleo E, Delprato D, Tandoi I, Gervasio V, Parma M, Corti L, Girardelli S, Fedele L. Oocyte Retrieval during Laparoscopic Vaginoplasty to Reduce Invasiveness in the Treatment of Mayer-Rokitansky-Küster-Hauser Syndrome. J Minim Invasive Gynecol 2019; 27:74-79. [PMID: 31129299 DOI: 10.1016/j.jmig.2019.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To evaluate the treatment of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a combination of oocyte retrieval and surgical vaginoplasty in a single laparoscopic procedure. DESIGN A case series. SETTING The study was conducted at 2 tertiary referral facilities for MRKH syndrome in Milan, Italy, between July 2017 and September 2018. PATIENTS Eleven patients presented with MRKH and required surgical vaginoplasty while expressing a desire for future fertility. INTERVENTIONS Two experienced surgeons and an expert in assisted reproductive technology performed concomitant vaginoplasty according to the modified technique of Davydov and laparoscopic oocyte retrieval for gamete cryopreservation. MEASUREMENTS AND MAIN RESULTS Before the procedure, patients underwent extensive counseling and gave written consent. At the start of surgery, 10.4 ± 4.4 (mean ± standard deviation [SD]) oocytes were retrieved laparoscopically, and 8.8 ± 3.1 (SD) mean mature oocytes were cryopreserved. After oocyte retrieval, the steps of the modified Davydov technique were followed. The total operative time was 116 ± 16 minutes (mean ± SD), and no intraoperative/postoperative complications were observed. CONCLUSION This is the first report of combined oocyte retrieval and vaginoplasty for patients with MRKH syndrome. The approach was found to be feasible in patients with a desire for future fertility. It is our belief that physicians treating patients with MRKH should refer patients to centers with expertise in both vaginoplasty and assisted reproductive technology.
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Affiliation(s)
- Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria S Vanni
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Enrico Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti).
| | - Diana Delprato
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Iacopo Tandoi
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria Gervasio
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Marta Parma
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Laura Corti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Serena Girardelli
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Luigi Fedele
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr. Fedele)
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Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility Preservation for Transgender Adolescents. J Adolesc Health 2017; 61:120-123. [PMID: 28363716 PMCID: PMC5604229 DOI: 10.1016/j.jadohealth.2017.01.022] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe fertility preservation (FP) utilization by transgender adolescents within a pediatric gender clinic between July 2013 and July 2016. METHODS A retrospective chart review was conducted to abstract demographic and clinical information among adolescents initiating gender-affirming hormones, including patient age at initial FP consultation, birth-assigned sex, race/ethnicity, and outcome of FP consultation. RESULTS In our sample of 105 transgender adolescents, a total of 13 (seven transgender men and six transgender women) between the age of 14.2 and 20.6 years were seen in formal consultation for FP before initiating hormones. Of these adolescents, four completed sperm cryopreservation and one completed oocyte cryopreservation. CONCLUSIONS Rates of FP utilization among transgender youth were low, which is consistent with a recently published report of FP utilization among transgender youth at another pediatric institution. Identified barriers to FP in our sample included cost, invasiveness of procedures, and desire not to delay medical transition.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lisa Simons
- Division of Adolescent Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emilie K. Johnson
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Urology & Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Barbara A. Lockart
- Division of General Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Division of Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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