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Johnston M, Fuscaldo G, Sutton E, Hunt S, Zander-Fox D, Rombauts L, Mills C. Storage trends, usage and disposition outcomes following egg freezing. Reprod Biomed Online 2024; 48:103728. [PMID: 38330858 DOI: 10.1016/j.rbmo.2023.103728] [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: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 02/10/2024]
Abstract
RESEARCH QUESTION What happens to eggs after egg freezing? DESIGN A retrospective cohort study was performed spanning 2012-2022. Data were obtained from seven assisted reproductive technology clinics in Victoria, Australia. Aggregated, de-identified data were collected on cycles that resulted in egg freezing and the following outcomes, including treatment involving thawed eggs and disposition outcomes of surplus eggs. RESULTS The number of patients with eggs in storage grew rapidly from 144 in 2012 to 2015 in 2022. In 2022, 73% of patients had stored their eggs for <5 years, 25% for 5-10 years, and 2% for ≥10 years. Most thaw cycles (600/645, 93%) involved eggs that had been frozen for <5 years, of which 47% had been frozen for <6 months. Overall, the live birth rate per initiated thaw cycle was 12%. Across the study period, 2800 eggs from 286 patients were either discarded, donated or exported. Of the 128 patients who discarded their eggs, 32% had stored their eggs for <5 years, 32% for 5-10 years and 36% for >10 years. Of the 23 patients who donated their eggs to someone else, all but four had stored their eggs for <5 years. No eggs were donated to research over the study period. CONCLUSIONS This study shows that very few patients have made the decision to use or relinquish their eggs. Strategies may be needed to address the prolonged storage of surplus eggs, and ensure that patients are supported to make decisions regarding the fate of their eggs which align with their preferences and values.
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Affiliation(s)
- Molly Johnston
- Monash Bioethics Centre, Monash University, Clayton, Australia.
| | | | | | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash IVF, Clayton, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Clayton, Australia; Biomedicine Discovery Institute, Monash University, Clayton, Australia; School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash IVF, Clayton, Australia
| | - Catherine Mills
- Monash Bioethics Centre, Monash University, Clayton, Australia
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White J, Jackson A, Druce I, Gale J. Oocyte cryopreservation and reciprocal in vitro fertilization in a transgender man on long term testosterone gender-affirming hormone therapy: a case report. F S Rep 2024; 5:111-113. [PMID: 38524208 PMCID: PMC10958692 DOI: 10.1016/j.xfre.2023.11.004] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To report a successful case of oocyte cryopreservation and subsequent in vitro fertilization (IVF) in a transgender male receiving continued testosterone gender-affirming hormone therapy, followed by reciprocal embryo transfer (ET). Design A case report of a rare case of fertility preservation in a transgender man with concomitant use of testosterone therapy for 4 years before and during ovarian stimulation. Setting Private fertility clinic with university affiliation. Patients A 26-year-old transgender man undergoing oocyte cryopreservation before gender-affirming surgery. Interventions Fertility preservation using oocyte cryopreservation and IVF with reciprocal fresh ET into a cisfemale partner. Main Outcome Measures Successful oocyte cryopreservation, oocyte thawing, and reciprocal IVF cycle. Results Oocyte cryopreservation of 29 mature oocytes. Sixteen mature oocytes survived the thaw, and 12 were fertilized with intracytoplasmic sperm injection. A fresh ET of an advanced blastocyst resulted in a clinical pregnancy and live birth. Conclusions Fertility preservation with oocyte cryopreservation or IVF with embryo cryopreservation is feasible for patients on continued long-term testosterone gender-affirming therapy. Future studies on egg quality and reproductive outcomes are required. Our case report demonstrates a promising outcome in this patient population.
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Affiliation(s)
- Justin White
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Irena Druce
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Yahyaei A, Moridi M, Ghaffari F. Controlled ovarian stimulation in cancer patients under 18 years old; a case series. J Ovarian Res 2024; 17:33. [PMID: 38317250 PMCID: PMC10840237 DOI: 10.1186/s13048-024-01352-0] [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: 06/11/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Fertility preservation for adolescent pubescent girls is a concern of the healthcare system and parents. Oocyte cryopreservation is regarded as a standard medical intervention for patients with a minimum age of 18 years. Evidence suggests that mature oocyte cryopreservation is possible for adolescent pubescent girls, although, ovarian stimulation for these patients remains a challenge. CASES PRESENTATION This case series is the first report regarding ovarian stimulation with oocyte cryopreservation in younger than 18 years cancerous girls, who refer to ROYAN institute, Tehran, Iran, prior to the start of the treatment of cancer (November 2015 to February 2021). The oocyte cryopreservation was carried out in the 7 patients (five patients with Hodgkin lymphoma, one patient with Ewing sarcoma, and one patient with osteogenic tumor), the embryo cryopreservation in one patient with dysgerminoma, and the oocyte and embryo cryopreservation in one patient with germ cell tumor. No oocytes were retrieved after ovarian stimulation in the patient with medulloblastoma. For one of the patients with Hodgkin lymphoma, half of the tissues of one ovary were cryopreserved prior to ovarian stimulation. CONCLUSIONS Oocyte cryopreservation is a feasible option of fertility preservation in the adolescent's patients with cancer. However, only if reported acceptable fertilization rates, as well as the successful cases of live birth from oocyte cryopreservation at the ages under 18, this option of preserving fertility can be applied to this age range.
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Affiliation(s)
- Azar Yahyaei
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Banihashem Street, Resalat Highway, Tehran, Iran
| | - Mahdieh Moridi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Banihashem Street, Resalat Highway, Tehran, Iran
| | - Firouzeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Banihashem Street, Resalat Highway, Tehran, Iran.
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Abstract
Although oocyte cryopreservation was initially used as a fertility preservation strategy for medical indications, it is now is increasingly used to circumvent age-related infertility. Outcomes following planned oocyte vitrification, also known as elective egg freezing, are limited. Current studies show higher success rates for individuals undergoing fertility preservation treatment under age 35. Additionally, while freezing 20 oocytes is optimal to achieve pregnancy, freezing at least 8-10 oocytes is recommended. While fertility is not guaranteed, current evidence demonstrates that planned oocyte vitrification is an overall safe, low risk method of fertility preservation to reduce the risk for age-related infertility.
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Affiliation(s)
- Bonnie B Song
- University of Southern California/Los Angeles General Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA.
| | - Molly M Quinn
- University of Southern California/Los Angeles General Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; HRC Fertility, 55 S Lake Avenue, Suite 900, Pasadena, CA 91101, USA
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5
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Marin L, Ambrosini G, Vio C, Conley J, Bordin L, Sabbadin C, Andrisani A. Fertility preservation in pregnant cancer patients after first-trimester abortion: a new challenge with possible solutions. J Assist Reprod Genet 2023; 40:2819-2825. [PMID: 37796419 PMCID: PMC10656411 DOI: 10.1007/s10815-023-02950-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Fertility preservation in pregnant women recently diagnosed with cancer can be a challenge. Raised levels of human chorionic gonadotropin (Beta-hCG) and progesterone in this population of patients may pose a problem for the prompt initiation of controlled ovarian stimulation (COS) due to a potential negative feedback of these hormones on folliculogenesis; however, it is not feasible to wait for negativization of serum beta-hCG levels before starting controlled ovarian stimulation. In literature, very few cases have been reported regarding the preservation of fertility in pregnant women recently diagnosed with cancer. We performed an extended revision of the literature to evaluate the current knowledge of the management of fertility preservation in women with cancer and we examined two cases closely. The first case study involved a cancer patient who underwent surgical abortion at 6.5 weeks of gestation followed by administration of mifepristone to detach any minimal residual trophoblast and consequently to decrease serum beta-hCG and progesterone levels before starting COS. In the second case study, the cancer patient underwent surgical abortion at 7.1 weeks of gestation and simultaneous unilateral oophorectomy for ovarian tissue cryopreservation due to a limited time for COS. By analyzing the results of these studies, it could be hypothesized that mifepristone administration may favor the decrease of serum beta-hCG and progesterone levels in order to permit rapid initiation of COS. In cases where COS is not feasible, ovarian tissue cryopreservation should be considered as an alternative fertility preservation technique.
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Affiliation(s)
- Loris Marin
- Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Chiara Vio
- Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Jordyn Conley
- Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padova, 35131, Padua, Italy
| | - Chiara Sabbadin
- Endocrinology Unit, Department of Medicine, University of Padova, 35128, Padua, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
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Cascante SD, Berkeley AS, Licciardi F, McCaffrey C, Grifo JA. Planned oocyte cryopreservation: the state of the ART. Reprod Biomed Online 2023; 47:103367. [PMID: 37804606 DOI: 10.1016/j.rbmo.2023.103367] [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: 05/31/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 10/09/2023]
Abstract
The objective of this review is to provide an update on planned oocyte cryopreservation. This fertility preservation method increases reproductive autonomy by allowing women to postpone childbearing whilst maintaining the option of having a biological child. Oocyte cryopreservation is no longer considered experimental, and its use has increased dramatically in recent years as more women delay childbearing for personal, professional and financial reasons. Despite increased usage, most patients who have undergone oocyte cryopreservation have not yet warmed their oocytes. Most women who cryopreserve oocytes wait years to use them, and many never use them. Studies have demonstrated that oocyte cryopreservation results in live birth rates comparable with IVF treatment using fresh oocytes, and does not pose additional safety risks to offspring. Based on current evidence, cryopreserving ≥20 mature oocytes at <38 years of age provides a 70% chance of one live birth. However, larger studies from a variety of geographic locations and centre types are needed to confirm these findings. Additional research is also needed to determine the recommended age for oocyte cryopreservation, recommended number of oocytes to cryopreserve, return and discard/non-use rates, cost-effectiveness, and how best to distribute accurate and up-to-date information to potential patients.
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Affiliation(s)
- Sarah Druckenmiller Cascante
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA.
| | - Alan S Berkeley
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - Frederick Licciardi
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - Caroline McCaffrey
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - James A Grifo
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
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Ito K, Takae S, Nakamura K, Furuyama S, Nakajima M, Suzuki Y, Iwahata H, Sugishita Y, Horage Y, Suzuki N. The study of the efficiency of in vitro maturation of ovarian tissue oocytes in pediatric patients. J Assist Reprod Genet 2023; 40:2787-2797. [PMID: 37779181 PMCID: PMC10656375 DOI: 10.1007/s10815-023-02958-x] [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: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE Although recent in vitro maturation (IVM) studies in pediatric patients have demonstrated successful retrieval and maturation of oocytes, the studies included only a small number of premenarchal patients. In the present study, we examined the potential use of oocyte retrieval and maturation for pediatric patients who undergo ovarian tissue cryopreservation (OTC). METHODS We retrospectively examined the clinical records of pediatric patients who underwent OTC at our institution between October 2015 and December 2022. Data on the age, primary disease, menstrual history, pre-procedure chemotherapy, anti-Müllerian hormone (AMH) level, number of oocytes collected ex vivo from ovarian tissue, and number of mature oocytes from IVM were examined. RESULTS Data of 60 pediatric patients (aged 1 to 17 years) were included for analysis. Oocytes were retrieved from 36 patients; the oocytes of 18 of these patients could be cryopreserved. The IVM rate was significantly lower in the premenarchal patients than in the postmenarchal patients. The number of mature oocytes retrieved from IVM was higher in the no-chemotherapy group than in the chemotherapy group. A significant positive correlation was observed between the AMH level and the IVM outcomes. CONCLUSION Oocyte retrieval and maturation in pediatric patients undergoing OTC is particularly useful in those not receiving chemotherapy. In patients receiving chemotherapy, the AMH level may be useful for predicting the IVM outcome. Activation of the oocyte maturation process in vivo in pediatric patients and better understanding of the major regulators of oocyte maturation are necessary to improve the utility of the IVM procedure.
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Affiliation(s)
- Kaoru Ito
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kentaro Nakamura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sayako Furuyama
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Mariko Nakajima
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yuki Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hideyuki Iwahata
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yodo Sugishita
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yuki Horage
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
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8
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Gayete-Lafuente S, Turan V, Oktay KH. Oocyte cryopreservation with in vitro maturation for fertility preservation in girls at risk for ovarian insufficiency. J Assist Reprod Genet 2023; 40:2777-2785. [PMID: 37715873 PMCID: PMC10656385 DOI: 10.1007/s10815-023-02932-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE To assess the feasibility and outcomes of oocyte cryopreservation with in vitro maturation (IVM) in post-pubertal girls undergoing fertility preservation (FP) for primary ovarian insufficiency (POI) risk. METHODS Ovarian stimulation was performed with an antagonist protocol or progesterone priming. Ultrasound monitoring was performed transabdominally. Oocytes were retrieved transvaginally under IV sedation. Immature oocytes were subjected to IVM for up to 36 h. All MII oocytes were vitrified. The main outcome measure was the total number of mature oocytes cryopreserved. The secondary outcome was the increase in the mature oocyte yield after IVM. RESULTS Indications for FP included mosaic Turner syndrome (mTS; n = 10), malignancy (n = 3), and POI risk (n = 2). The mean ± SD age, antral follicle count (AFC), and AMH levels were 14.2 ± 1.4 years, 8 ± 5.2 and 1.3 ± 1.3 ng/mL. In girls with mTS, the ovarian reserve was low for age (AFC 7.4 ± 4.7 and AMH 1.4 ± 1.6 ng/mL). Oocyte cryopreservation was possible in all girls with a range of 1-27 mature oocytes obtained, even in those who were previously exposed to chemotherapy or with low ovarian reserve, and no surgical complications were encountered. After IVM, the median mature oocyte yield increased significantly from 7.5 to 10.5 (p = 0.001). CONCLUSIONS Oocyte cryopreservation appears to be feasible and safe in girls as young as 12 years of age at risk for POI The utility of IVM increases the yield of cryopreserved mature oocytes. Prior exposure to chemotherapy or low ovarian reserve should not be an automatic reason to exclude these girls from FP consideration.
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Affiliation(s)
- Sonia Gayete-Lafuente
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, 310 Cedar Street, FMB Room 224. New Haven, CT, USA
| | - Volkan Turan
- Innovation Institute for Fertility Preservation, NY and CT, USA
- Istanbul Health and Technology University School of Medicine, Istanbul, Turkey
| | - Kutluk H Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, 310 Cedar Street, FMB Room 224. New Haven, CT, USA.
- Innovation Institute for Fertility Preservation, NY and CT, USA.
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9
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Tsonis O, Kopeika J. Fertility preservation in patients with gynaecologic malignancy: Response to ovarian stimulation and long-term outcomes. Eur J Obstet Gynecol Reprod Biol 2023; 290:93-100. [PMID: 37757729 DOI: 10.1016/j.ejogrb.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/19/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To the best of our knowledge, the available evidence on the effect and efficacy of controlled ovarian stimulation (COS) in this group of patients remains poorly reported. Concerns related to the impact of stimulation to cancer progression and recurrence, as well as the risk of disease dissemination during egg collection, might explain the aforementioned trend. METHODS Overall, our FP Service received 192 gynaecological referrals, between 2005 and 2021, regarding gynaecologic conditions mainly cancer related. A total of 68 (35.4%) patients underwent COS. These patients were diagnosed with the following gynaecologic pathologies: 33 cases (48,5%) of cervical cancer were noted (stage 1b1-2b), 25 ovarian pathology (36.7%), 9 cases (13.2%) of endometrial cancer, and a single case of vaginal cancer (1.5%). RESULTS The mean age of patients attending the fertility preservation service was 31.5 (std 5.8). The patients presenting to their initial appointment with a mean BMI 24.5 (IQR 6.9) and a median AFC of 12 (IQR 13). The mean duration of COS was 11 days (IQR 3), and the median dose of gonadotrophins was calculated at 300 IU (IQR 75 IU). In 95.4% of the cases, GnRH agonist was used as a trigger for final maturation. The median number of follicles measuring more than 14 mm at the time of trigger was 11 (IQR 8), whereas the median number of oocytes collected was 11 (IQR 9). The complication rate was reported at less than 2%. So far, one in four women of this FP group (17/68, 25% of the overall group) returned to our service to claim their cryopreserved eggs/embryos and successful livebirths were reported in 58.8% of this sample (10/17 cases). The mean time to return to use their oocytes/embryos was 36 months (min value 16 months - max value 85 months). There was no significant difference in mortality rate between patients who received FP vs those who did not (hazard ratio of mortality was estimated at 0.91 (p-value 0.88)). CONCLUSION Based on our findings, ovarian stimulation for patients presenting with gynaecologic malignancy is a safe and efficient method of fertility preservation. Undoubtedly, the sample size is limited, however our results are reassuring and highlight the efficacy of COS for the purpose of FP based on data coming from the largest Assisted Conception Unit of the South-East of the UK.
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Affiliation(s)
- Orestis Tsonis
- Senior Clinical Fellow in Reproductive Medicine and Assisted Conception, Fertility Preservation Service, ACU, Guy's Hospital, London, UK.
| | - Julia Kopeika
- Consultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery, ACU, Guy's Hospital, London, UK.
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10
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Duncan JP, Caughey LE, White KM. Examining willingness to donate frozen oocytes among women of reproductive age. Reprod Biomed Online 2023; 47:103294. [PMID: 37734120 DOI: 10.1016/j.rbmo.2023.103294] [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: 04/03/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
RESEARCH QUESTION What are the predictors of willingness to donate frozen oocytes among women of reproductive age in Australia? DESIGN An online survey involving 303 women of reproductive age (18-49 years) in Australia who had not frozen their oocytes or planned to freeze their oocytes in the next 12 months. The survey assessed demographic variables, prototype willingness model variables (attitude, subjective norm, prototype similarity and prototype favourability) and additional variables (altruism, empathy and infertility awareness) as predictors of hypothetical scenarios of willingness to donate frozen oocytes. A multivariate repeated measures analysis of variance explored differences in willingness to donate frozen oocytes. Hierarchical multiple regression analysis examined predictors of donor willingness. RESULTS Women's willingness to donate their frozen oocytes was higher for donating to a friend or family member and to research compared with an egg bank or fertility clinic, or a couple advertising online for an egg donor (all P < 0.001). The prototype willingness model variables were significant predictors of willingness to donate showing slightly varied patterns across four scenarios. After accounting for demographics, regression models including prototype willingness model variables and additional variables accounted for 45-64% of variance in donor willingness. CONCLUSIONS Frozen oocyte donation may be facilitated by improving attitudes towards donation and establishing positive images of donors. Professionals requiring frozen oocytes for research could focus on creating a sense of social approval for donating in this context. Encouraging frozen oocyte donation could increase access to oocytes for IVF treatment and aid in reducing the psychological burdens associated with involuntary childlessness.
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Affiliation(s)
- Jordan P Duncan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lucy E Caughey
- Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia..
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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Shirasawa H, Kumazawa Y, Sato W, Iwasawa T, Togashi K, Ono N, Fujishima A, Takahashi K, Maeda E, Terada Y. The first nationwide website survey of the availability and costs of medical and non-medical oocyte cryopreservation in Japan. Heliyon 2023; 9:e19074. [PMID: 37636403 PMCID: PMC10448461 DOI: 10.1016/j.heliyon.2023.e19074] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Research question How does the cost-related oocyte cryopreservation (OoC) vary by the facility in Japan, and what data is provided on the websites about OoC procedures? Design Website survey. The websites of all 621 facilities that provide assistive reproductive technology registered in Japan were surveyed in 2021. Data included the rates of explicit statements regarding the provision of OoC for only medical reasons (medical only group) or non-medical reasons (non-medical group). Based on whether or not facilities that perform OoC clearly stated the cost on their websites, we compared the costs of OoC and annual storage cost between medical only and non-medical groups. Furthermore, we examined the stated number of OoC procedures performed and their clinical outcomes. Results Of the 621 facilities, 146 (23.5%) clearly stated that they offer OoC on their websites. Of the 88 medical only groups and 58 non-medical groups, 24 (27.3%) and 42 (72.4%) clearly stated the OoC cost, and 27 (30.7%) and 44 (75.9%) clearly states the annual oocyte storage cost, respectively. The OoC costs were significantly higher for the non-medical group than in the medical group. In the medical only group, the annual storage cost remained almost the same regardless of the number of oocytes, while in the non-medical group, the annual storage cost was 2-3 times higher than in the medical only group. Only 16 facilities (16/146, 11.0%) had mentioned the number of OoC procedures, and five facilities (3.4%) provided information on the clinical outcomes after OoC. Conclusion Costs related to OoC are higher for the non-medical group in Japan. In addition, the websites contain scant information on the costs and clinical outcomes of OoC.
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Affiliation(s)
- Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Yukiyo Kumazawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Wataru Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Takuya Iwasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Kazue Togashi
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Natsuki Ono
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Ayaka Fujishima
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Kazumasa Takahashi
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
| | - Eri Maeda
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
- Department of Public Health, Hokkaido University, Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo City, Hokkaido, 60-8638, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan, Hondo 1-1-1, Akita City, Akita Prefecture, 10-0825, Japan
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Akhondi MM, Ardakani ZB, Warmelink JC, Haghani S, Ranjbar F. Knowledge and beliefs about oocyte cryopreservation for medical and social reasons in female students: a cross-sectional survey. BMC Womens Health 2023; 23:336. [PMID: 37355576 PMCID: PMC10290784 DOI: 10.1186/s12905-023-02481-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND With the increasing number of young women surviving cancer and a growing trend among highly educated women to postpone childbearing for educational or professional pursuits, there is a rising demand for egg freezing services to ensure a successful pregnancy. This study aims to assess the knowledge and beliefs surrounding oocyte cryopreservation, both for medical and social reasons, among female students in Tehran, Iran. METHODS An online cross-sectional survey was carried out from March to August of 2022, involving a total of 1279 childless students pursuing master's and doctoral degrees at universities in Tehran. The participants were between the ages of 18 and 38. Knowledge and beliefs about medical and social oocyte cryopreservation were assessed through Fertility Preservation Survey (FPS) instrument. RESULTS The mean age of the participants was 26.38 ± 4.9. The majority of students expected to be "30-34 years" when they become pregnant with their first child (41.1%, M: 30.3 ± 4.13 years) and "35-39 years" when they give birth to their last child (46.7%, M: 35.28 ± 4.18 years). The students agreed with preserving fertility with medical (93.3%) and social (86.9%) indications and believed the medical (95.1%) and social (87.4%) costs of cryopreservation should be covered by the healthcare system. Among the participants, 75.6% considered cost to be a definite or probable factor in their decision to pursue fertility preservation. The oncology team's recommendation was identified as the most important factor in deciding on medical egg freezing (92.6%, M: 3.46 ± 0.71). The overall correct response rate for the knowledge questions was 57.7%. The majority of participants (95.5%) agreed that physicians should routinely provide information about egg freezing to women of childbearing age during their regular healthcare visits. CONCLUSIONS The research results revealed that female students in Tehran universities have a positive attitude towards medical and social egg freezing, but lack sufficient knowledge about the ideal timing of childbearing. Health professionals could provide detailed information about fertility preservation and age-related infertility as part of routine healthcare visits or reproductive health planning. Additionally, expanding supportive policies and incentives for childbearing established by the government to cover the costs of fertility preservation would be beneficial.
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Affiliation(s)
- Mohammad Mehdi Akhondi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Zohreh Behjati Ardakani
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - J. Catja Warmelink
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
| | - Shima Haghani
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ranjbar
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Attini R, Cabiddu G, Ciabatti F, Montersino B, Carosso AR, Gernone G, Gammaro L, Moroni G, Torreggiani M, Masturzo B, Santoro D, Revelli A, Piccoli GB. Chronic kidney disease, female infertility, and medically assisted reproduction: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology. J Nephrol 2023:10.1007/s40620-023-01670-4. [PMID: 37354277 DOI: 10.1007/s40620-023-01670-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
Fertility is known to be impaired more frequently in patients with chronic kidney disease than in the general population. A significant proportion of chronic kidney disease patients may therefore need Medically Assisted Reproduction. The paucity of information about medically assisted reproduction for chronic kidney disease patients complicates counselling for both nephrologists and gynaecologists, specifically for patients with advanced chronic kidney disease and those on dialysis or with a transplanted kidney. It is in this context that the Project Group on Kidney and Pregnancy of the Italian Society of Nephrology has drawn up these best practice guidelines, merging a literature review, nephrology expertise and the experience of obstetricians and gynaecologists involved in medically assisted reproduction. Although all medically assisted reproduction techniques can be used for chronic kidney disease patients, caution is warranted. Inducing a twin pregnancy should be avoided; the risk of bleeding, thrombosis and infection should be considered, especially in some categories of patients. In most cases, controlled ovarian stimulation is needed to obtain an adequate number of oocytes for medically assisted reproduction. Women with chronic kidney disease are at high risk of kidney damage in case of severe ovarian hyperstimulation syndrome, and great caution should be exercised so that it is avoided. The higher risks associated with the hypertensive disorders of pregnancy, and the consequent risk of chronic kidney disease progression, should likewise be considered if egg donation is chosen. Oocyte cryopreservation should be considered for patients with autoimmune diseases who need cytotoxic treatment. In summary, medically assisted reproduction is an option for chronic kidney disease patients, but the study group strongly advises extensive personalised counselling with a multidisciplinary healthcare team and close monitoring during the chosen medically assisted reproduction procedure and throughout the subsequent pregnancy.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gianfranca Cabiddu
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, G. Brotzu, University of Cagliari, Cagliari, Italy
| | - Francesca Ciabatti
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Benedetta Montersino
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Roberto Carosso
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Gernone
- UOSVD di Nefrologia e Dialisi ASL Bari. P.O. "S. Maria degli Angeli", Putignano, Italy
| | - Linda Gammaro
- Nephrology, Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | - Gabriella Moroni
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Torreggiani
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037, Le Mans, France
| | - Bianca Masturzo
- Division of Obstetrics and Gynaecology, Department of Maternal-Neonatal and Infant Health, Ospedale Degli Infermi, University of Turin, Biella, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. "G. Martino", University of Messina, 98125, Messina, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037, Le Mans, France.
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Armstrong AG, Woods M, Keomany J, Grainger D, Shah S, Pavone M. What do female medical students know about planned oocyte cryopreservation and what are their personal attitudes? J Assist Reprod Genet 2023:10.1007/s10815-023-02845-5. [PMID: 37347348 DOI: 10.1007/s10815-023-02845-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE This study aimed to assess medical student knowledge and attitudes regarding oocyte cryopreservation, as well as attitudes regarding future intentions of utilizing this procedure. METHODS This cross-sectional web-based survey study was distributed to 873 medical students at the University of Kansas from July through September 2018. The survey was self-reported and female medical student responses were analyzed. Students were surveyed through a variety of multiple-choice questions on demographics, knowledge of oocyte cryopreservation, and factors and attitudes that would impact personal and professional use of oocyte cryopreservation. RESULTS A total of 122 female responses were collected (30%). A majority of female medical students were aware of oocyte cryopreservation, less than half correctly identified a dramatic drop in female fertility as well as oocyte cryopreservation success and cost-effectiveness. Three-quarters felt pressure to delay childbearing and nearly two-thirds would consider freezing their oocytes. Several factors were found to alter their decision toward oocyte cryopreservation including personal factors, procedure complexity and availability, and outcomes. CONCLUSIONS A majority of female medical students are amenable to the possibility of using oocyte cryopreservation to delay childbearing. Though nearly all knew of oocyte cryopreservation, knowledge regarding fertility and oocyte cryopreservation was low.
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Affiliation(s)
- Austin G Armstrong
- University of Kansas School of Medicine-Wichita, Wichita, KS, 67214, USA
| | - Maggie Woods
- Departement of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, 67214, USA
| | - Jennifer Keomany
- Departement of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, 67214, USA
| | - David Grainger
- Departement of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS, 67214, USA
| | - Shriya Shah
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Ave, Suite 18-027, Chicago, IL, 60611, USA
| | - MaryEllen Pavone
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Ave, Suite 18-027, Chicago, IL, 60611, USA.
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Oreja-Guevara C, Rabanal A, Rodríguez CH, Benito YA, Bilbao MM, Gónzalez-Suarez I, Gómez-Palomares JL. Assisted Reproductive Techniques in Multiple Sclerosis: Recommendations from an Expert Panel. Neurol Ther 2023; 12:427-439. [PMID: 36746871 PMCID: PMC10043068 DOI: 10.1007/s40120-023-00439-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is mainly diagnosed in women of reproductive age. However, there is a paucity of guidelines jointly prepared by neurologists and gynaecologists on managing women with MS and the desire for motherhood. Therefore, in this review we propose recommendations for such cases, with an particular focus on those requiring assisted reproductive techniques (ART). METHODS A group of seven MS experts (4 neurologists and 3 gynaecologists) came together for three discussion sessions to achieve consensus. RESULTS The recommendations reported here focus on the importance of early preconception counselling, the management of disease-modifying therapies before and during ART procedures, important considerations for women with MS regarding ART (intrauterine insemination, in vitro fertilisation and oocyte cryopreservation) and the paramount relevance of multidisciplinary units to manage these patients. CONCLUSIONS Early preconception consultations are essential to individualising pregnancy management in women with MS, and an early, well-planned, spontaneous pregnancy should be the aim whenever possible. The management of women with MS and the desire for motherhood by multidisciplinary units is warranted to ensure appropriate guidance through the entire pregnancy.
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Affiliation(s)
- Celia Oreja-Guevara
- Department of Neurology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain. .,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
| | - Aintzane Rabanal
- Human Reproduction Unit, Obstetrics and Gynaecology Department, Biocruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | | | - Yolanda Aladro Benito
- Department of Neurology, Research Institute, Hospital Universitario de Getafe, Madrid, Spain
| | - Mar Mendibe Bilbao
- Neuroscience Department, Biocruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | | | - José Luis Gómez-Palomares
- Wilson Fertiliy-Balearic Center for In Vitro Fertilization CEFIVBA-Wilson Fertility, Mallorca, Spain
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Xu Z, Ibrahim S, Burdett S, Rydzewska L, Al Wattar BH, Davies MC. Long term pregnancy outcomes of women with cancer following fertility preservation: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 281:41-48. [PMID: 36535069 DOI: 10.1016/j.ejogrb.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/08/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE As cancer survivorship increases, there is higher uptake of fertility preservation treatments among affected women. However, there is limited evidence on the subsequent use of preserved material and pregnancy outcomes in women who underwent fertility preservation (FP) before cancer treatments. We aimed to systematically review the long-term reproductive and pregnancy outcomes in this cohort of women. PATIENTS Women who underwent any type of the following FP treatments: embryo cryopreservation (EC), oocyte cryopreservation (OC) and ovarian tissue cryopreservation (OTC)) before any planned cancer treatment. EVIDENCE REVIEW We searched electronic databases (MEDLINE, Embase, Cochrane CENTRAL, and HTA) from inception until May 2021 for all observational studies that met our inclusion criteria. We extracted data on reproductive and pregnancy outcomes in duplicate and assessed the risk of bias in included studies using the ROBINS-I tool. We pooled data using a random-effects model and reported using odds ratios (OR) with 95% confidence intervals (CI). MAIN OUTCOME MEASURES Our primary outcome was live birth rate and other important reproductive and pregnancy outcomes. RESULTS Of 5405 citations, we screened 103 and included 26 observational studies (n = 7061 women). Hematologic malignancy was the commonest cause for seeking FP treatments, followed by breast and gynecology cancers. Twelve studies reported on OTC (12/26, 46 %), eight included EC (8/26, 30 %), and twelve reported on OC (12/26, 46 %). The cumulative live birth rate following any FP treatment was 0.046 (95 %CI 0.029-0.066). Only 8 % of women returned to use their frozen reproductive material (558/7037, 8.0 %), resulting in 210 live births in total, including assisted conceptions following EC/OC/OTC and natural conceptions following OTC. The odds for live birth was OR 0.38 (95 %CI 0.29-0.48 I2 83.7 %). The odds for live birth was the highest among women who had EC (OR 0.45, 95 %CI 0.14-0.76, I2 95.1 %), followed by the OTC group (OR 0.37, 95 %CI 0.22-0.53, I2 88.7 %) and OC group (OR 0.31, 95 %CI 0.15-0.47, I2 78.2 %). CONCLUSIONS Fertility preservation treatments offered good long-term reproductive outcomes for women with cancer with a high chance to achieve a live birth. Further research is needed to evaluate the long-term pregnancy and offspring outcomes in this cohort.
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Affiliation(s)
- Zilin Xu
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Sameh Ibrahim
- UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Sarah Burdett
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Larysa Rydzewska
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Bassel H Al Wattar
- Beginings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, United Kingdom.
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
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Sönmezer M, Saçıntı KG, Gülümser Ç, Özkavukçu S, Atabekoğlu C, Şükür YE, Sönmezer M. Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach. J Assist Reprod Genet 2023; 40:399-405. [PMID: 36595090 PMCID: PMC9935757 DOI: 10.1007/s10815-022-02705-8] [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: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We aimed to compare the feasibility, effectiveness, and safety of transabdominal ultrasound-guided oocyte retrieval (TUGOR) using a vaginal probe and traditional vaginal approach in virgin patients undergoing oocyte cryopreservation. METHODS A total of 116 virgin patients who underwent transabdominal ultrasound-guided oocyte retrieval using a vaginal ultrasound probe and 33 patients matched for BMI, antral follicle count, age, day 3 FSH, estradiol, and AMH who underwent vaginal approach were enrolled. Mean number of total oocytes collected, mean number of cryopreserved MII oocytes, duration of the procedure, duration of stimulation, mean gonadotropin consumption, mature oocyte ratio, and a modified follicle-oocyte index were compared between the groups. RESULTS No statistical difference was found between the groups in mean number of follicles > 12 mm (4.62 ± 4.54 vs. 5.44 ± 4.52), mean number of oocytes collected (4.44 ± 4.14 vs. 5.33 ± 4.52), mean number of cryopreserved MII oocytes (4.01 ± 3.67 vs. 4.53 ± 4.13), mean duration of the procedure (12.4 ± 1.2 vs. 13.4 ± 1.6 min), mean days of stimulation (8.05 ± 1.91 vs. 8.35 ± 1.72 days), mean gonadotropin consumption (1507.9 ± 475.3 vs. 1571.74 ± 404.6 units), mature oocyte ratio (0.78 ± 0.24 vs. 0.82 ± 0.26), and modified follicle oocyte index (0.86 ± 0.63 vs. 0.84 ± 0.19). In the TUGOR group, superficial epigastric artery injury occurred in two patients and resolved spontaneously. CONCLUSION Transabdominal oocyte retrieval using a vaginal ultrasound is a safe, effective, and feasible method of oocyte retrieval in some selected patient groups.
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Affiliation(s)
| | - Koray Görkem Saçıntı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology, Yüksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Sinan Özkavukçu
- Department of Histology and Embryology, Ankara University School of Medicine, Ankara, Turkey
- School of Medicine, Postgraduate Medicine, Ninewells Medicine, Assisted Conception Unit, University of Dundee, Dundee, UK
| | - Cem Atabekoğlu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey.
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Hafezi M, Zameni N, Nemati Aghamaleki SZ, Omani-Samani R, Vesali S. Awareness and attitude toward oocyte cryopreservation for non-medical reasons: a study on women candidates for social egg freezing. J Psychosom Obstet Gynaecol 2022; 43:532-540. [PMID: 35998044 DOI: 10.1080/0167482x.2022.2090332] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
PURPOSE The present study was to investigate awareness and attitudes toward female fertility and aging, desire for a child and motherhood, and oocyte freezing for non-medical reasons among women candidates for Social Egg Freezing (SEF). MATERIALS AND METHODS This was a cross-sectional study on all 216 women who sought oocyte cryopreservation for nonmedical reasons at Royan Institute. A 24-item self-administered questionnaire measured knowledge and attitudes to SEF. Responses were as yes/no or a 4-point Likert scale. RESULTS Only 40% of participants accurately indicated that having a sexual partner does not help to preserve their fertility. A quarter of women correctly recalled chance of pregnancy with unprotected intercourse during a period of a year, for women 20 to 40 years old. Only one-third of respondents accurately identified the age-related fertility decline at 35-39 years. Only 6.9% correctly mentioned the low chance of pregnancy after egg freezing at 35 years old. Almost a third of women knew that the age range of 31-35 years is the right age to freeze an egg with the highest chance of pregnancy. Aging and health of offspring were most influential in women's decisions on SEF. CONCLUSION In conclusion, there was significant gaps in knowledge about age-related fertility decline, and egg cryopreservation conditions and its complications. It is crucial to impart to these women a better knowledge about fertility and a realistic picture about SEF, especially on the number of high-quality retrieved mature oocytes and live birth rates depend on women's age.
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Affiliation(s)
- Maryam Hafezi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nadia Zameni
- School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Seyyedeh Zahra Nemati Aghamaleki
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Martel RA, Blakemore JK, Fino ME. The use of oocyte cryopreservation for fertility preservation in patients with sex chromosome disorders: a case series describing outcomes. J Assist Reprod Genet 2022; 39:1143-1153. [PMID: 35320443 PMCID: PMC9107557 DOI: 10.1007/s10815-022-02469-1] [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: 01/13/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Characterize outcomes among adolescents and young adults (AYAs) with sex chromosome disorders (SCDs) after oocyte cryopreservation (OC) consultation. METHODS Retrospective case series of all AYA (< 25 years) patients with SCDs seen for OC consultation from 2011 to 2019 at a large, urban, academic fertility center. All AYA patients with an SCD seen for OC consult in the study time period were reviewed and included. Data collected included patient age, SCD type, number of patients who attempted OC, number of cycles attempted, and cycle outcomes. RESULTS Twenty-two patients were included: 9 with Turner syndrome, 12 with mosaic Turner syndrome, and 1 with 47,XXX. Mean age at consult was 14.7 ± 3.5 years. Fourteen patients elected for OC: 5 with Turner syndrome, 8 with mosaic Turner syndrome, and 1 47,XXX who pursued 31 OC cycles total. Of those 14 patients, 10 underwent retrieval, 9 froze oocytes, and 8 froze mature (MII) oocytes. Seven patients underwent > 1 cycle and 7 had ≥ 1 cancelation. 3/3 patients who pursued cycles after 1st cancelation never got to retrieval. Age, SCD type, and baseline FSH did not predict ability to freeze MIIs. One patient returned after OC and attempted 4 ovulation induction cycles and 2 IVF cycles; all were canceled for low response. CONCLUSIONS AYA patients with SCDs have a high risk of poor response and cycle cancelation but the majority froze MIIs. Thus, setting expectations is important. A larger sample size is needed to evaluate possible clinical predictors of success.
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Affiliation(s)
- Rachel A Martel
- New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Jennifer K Blakemore
- New York University Langone Prelude Fertility Center, 660 First Avenue, New York, NY, 10016, USA
| | - M Elizabeth Fino
- New York University Langone Prelude Fertility Center, 660 First Avenue, New York, NY, 10016, USA
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Rolfes V, Bittner U, Kruessel JS, Fehm T, Fangerau H. In vitro gametogenesis: A benefit for women at advanced and very advanced age? An ethical perspective. Eur J Obstet Gynecol Reprod Biol 2022; 272:247-250. [PMID: 35405453 DOI: 10.1016/j.ejogrb.2022.03.038] [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: 07/29/2020] [Revised: 07/08/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
Assisted reproductive technologies (ART) may be supplemented with in vitro gametogenesis (IVG). Although IVG is still experimental the question arises whether IVG offers any moral advantages compared to implemented methods. The aim of the paper is to present the landscape of ethical arguments in favour or against IVG. ART-related ethical issues in relation to reproductive autonomy, health risks for the woman and foetus, the welfare of the future child, the adverse effects of advanced motherhood, gender equality, and justice are similar for IVG, oocyte cryopreservation, and oocyte donation. IVG may have the following advantages: (I) the psychological and physical burden of stimulation and puncture of the oocyte could be avoided; (II) women do not necessarily have to cope with motherhood at young age; (III) ethical doubts associated with oocyte donation would be eliminated; (IV) by using IVG in combination with preimplantation diagnostics, it is more likely to find suitable oocytes or embryos to increase the probability of pregnancy; (V) women would have the opportunity to decide how many oocytes should be generated and how often an attempt should be made to achieve pregnancy. Simultaneously, however, the advent of IVG may lead to new moral disadvantages: pressure on women to give birth at an advanced age or pressure on women to follow 'male' career structures. Additionally, the reimbursement of costs related to IVG is an open question, especially if equal opportunities regarding motherhood are linked to demands for equal access to ART. An early discussion about the ethical, legal, and social consequences for IVG is necessary.
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Affiliation(s)
- Vasilija Rolfes
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, University Hospital Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany.
| | - Uta Bittner
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, University Hospital Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany.
| | - Jan-Steffen Kruessel
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Tanja Fehm
- Department of Obstetrics and Gynaecology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, University Hospital Dusseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany.
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De Proost M, Coene G, Nekkebroeck J, Provoost V. 'I feel that injustice is being done to me': a qualitative study of women's viewpoints on the (lack of) reimbursement for social egg freezing. BMC Med Ethics 2022; 23:35. [PMID: 35351108 PMCID: PMC8966350 DOI: 10.1186/s12910-022-00774-z] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background During the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium. Methods To understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis. Results We identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free. Conclusions This research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00774-z.
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Affiliation(s)
- Michiel De Proost
- RHEA (Research Centre Gender, Diversity and Intersectionality), Vrije Universiteit Brussel, Brussels, Belgium.
| | - Gily Coene
- RHEA (Research Centre Gender, Diversity and Intersectionality), Vrije Universiteit Brussel, Brussels, Belgium
| | - Julie Nekkebroeck
- Centre for Reproductive Medicine and Centre for Medical Genetics, UZ Brussel, Brussels, Belgium
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22
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Voigt P, Persily J, Blakemore JK, Licciardi F, Thakker S, Najari B. Sociodemographic differences in utilization of fertility services among reproductive age women diagnosed with cancer in the USA. J Assist Reprod Genet 2022; 39:963-972. [PMID: 35316438 PMCID: PMC9051007 DOI: 10.1007/s10815-022-02455-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. METHODS All women ages 15-45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. RESULTS Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. CONCLUSIONS In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status.
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Affiliation(s)
- Paxton Voigt
- NYU Grossman School of Medicine, NY, New York, USA.
| | - Jesse Persily
- NYU Langone Department of Urology, New York, NY, USA
| | | | | | | | - Bobby Najari
- NYU Langone Department of Urology, New York, NY, USA
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23
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Johnston M, Fuscaldo G, Gwini SM, Catt S, Richings NM. Financing future fertility: Women's views on funding egg freezing. Reprod Biomed Soc Online 2022; 14:32-41. [PMID: 34693043 PMCID: PMC8517713 DOI: 10.1016/j.rbms.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23-37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Giuliana Fuscaldo
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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24
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Tsai S, Truong T, Eaton JL. Fertility awareness and attitudes among resident physicians across different specialties. J Assist Reprod Genet 2022; 39:655-61. [PMID: 35132531 DOI: 10.1007/s10815-022-02425-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate knowledge of age-related fertility decline and oocyte cryopreservation among resident physicians in obstetrics and gynecology (ob-gyn) compared to residents in other specialties. METHODS An online survey was sent to the US residency program directors for ob-gyn, internal medicine, emergency medicine, family medicine, general surgery, pediatrics, and psychiatry. They were asked to forward the survey to their respective residents. The survey consisted of three sections: fertility knowledge, oocyte cryopreservation knowledge, and attitudes toward family building and fertility preservation. Multivariable logistic regression models were used to compare outcomes between ob-gyn and non-ob-gyn residents. RESULTS Of the 2,828 completed surveys, 450 (15.9%) were by ob-gyn residents and 2,378 (84.1%) were by residents in other specialties. 66.3% of respondents were female. The median number of correct answers was 2 out of 5 on the fertility knowledge section and 1 out of 3 on the oocyte cryopreservation knowledge section among both ob-gyn and non-ob-gyn residents. After adjusting for covariates, residents in ob-gyn were no more likely to answer these questions correctly than residents in other specialties (fertility knowledge, adjusted OR .97, 95% CI .88-1.08; oocyte cryopreservation knowledge, adjusted OR 1.05, 95% CI .92-1.19). Ob-gyn residents were significantly more likely than non-ob-gyn residents to feel "somewhat supported" or "very supported" by their program to pursue family building goals (83.5% vs. 75.8%, OR 1.62, 95% CI 1.23-2.14). CONCLUSIONS Resident physicians, regardless of specialty, have limited knowledge of natural fertility decline and the opportunity to cryopreserve oocytes. These data suggest need for improved fertility education.
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25
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Wan Q, Meng XQ, Chen YL, Zheng A. Oocyte cryopreservation in a patient with paroxysmal nocturnal hemoglobinuria: A case report. Asian J Surg 2022; 45:908-911. [PMID: 35016817 DOI: 10.1016/j.asjsur.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Qi Wan
- The Reproductive Center, Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, China; Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Xiang-Qian Meng
- The Reproductive Center, Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, China
| | - Ya-Li Chen
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
| | - Ai Zheng
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
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26
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Ma Y, Long C, Liu G, Bai H, Ma L, Bai T, Zuo Y, Li S. WGBS combined with RNA-seq analysis revealed that Dnmt1 affects the methylation modification and gene expression changes during mouse oocyte vitrification. Theriogenology 2022; 177:11-21. [PMID: 34653792 DOI: 10.1016/j.theriogenology.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023]
Abstract
Understanding the molecular level changes of oocyte cryopreservation and the subsequent warming process is essential for improving the oocyte cryopreservation technologies. Here, we collected the mature metaphase II (MII) oocytes from mice and vitrified. After thawing, single-cell whole-genome bisulphite sequencing (scWGBS) and single-cell RNA sequencing (scRNA-seq) were used to investigate the molecular attributes of this process. Compared to the fresh oocytes, the vitrified oocytes had lower global methylation and gene expression levels, and 1426 genes up-regulated and 3321 genes down-regulated. The 1426 up-regulated differentially expressed genes (DEGs) in the vitrified oocytes were mainly associated with the histone ubiquitination, while the 3321 down-regulated genes were mainly enriched in the mitochondrion organisation and ATP metabolism processes. The differentially methylated regions (DMRs) were mainly located in promoter, intron and exon region of genes, and the length of DMRs in the vitrified oocytes were also significantly lower than that of the fresh oocytes. Notably, there were no significant difference in the expression levels of DNA demethylases (Tet1, Tet2 and Tet3) and methyltransferases (Dnmt3a and Dnmt3b) between two treatments of oocytes. However, Dnmt1 and kcnq1ot1, which are responsible for maintaining DNA methylation, were significantly down regulated in the vitrified oocytes. Gene regulatory network (GRN) analysis showed the Dnmt1 and kcnq1ot1 play a core role in regulating methylation and expression levels of downstream genes. Moreover, some genes associated with oocyte quality were significantly down-regulated in the vitrified oocytes. The present data provides a new perspective for understanding the impact of vitrification on oocytes.
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27
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Agarwal S, Trolice MP, Madeira JL, Lindheim SR. Boutique Egg Freezing: Empowering Technology or Marketing Phenomenon? A Word of Caution. J Obstet Gynaecol India 2021; 71:560-561. [PMID: 34602772 DOI: 10.1007/s13224-021-01528-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
The introduction of oocyte vitrification has propelled the field of oncofertility. However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of a partner or other personal issues. The aim of this article is to discuss the pros and cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies. This article further encourages obstetricians and gynecologists to discuss these issues of planned oocyte cryopreservation with their patients to empower them to make an educated decision based on research and science rather than be susceptible to entities that stand to gain monetarily by prompting women to fear a childless future.
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Affiliation(s)
- Shruti Agarwal
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827 USA
| | - Mark P Trolice
- Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827 USA.,Fertility CARE: The IVF Center, 5901 Brick Court, Winter Park, FL 32792 USA
| | - Jody Lyneé Madeira
- Maurer School of Law, Indiana University, 211 S. Indiana Avenue, Bloomington, IN 47405 USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple Street, Suite 3800 Weber CHE, Dayton, OH 45409 USA.,Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Lingshan Road, Shanghai, 200135 People's Republic of China
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28
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Buonomo B, Massarotti C, Dellino M, Anserini P, Ferrari A, Campanella M, Magnotti M, De Stefano C, Peccatori FA, Lambertini M. Reproductive issues in carriers of germline pathogenic variants in the BRCA1/2 genes: an expert meeting. BMC Med 2021; 19:205. [PMID: 34503502 PMCID: PMC8431919 DOI: 10.1186/s12916-021-02081-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Healthy individuals and patients with cancer who are carriers of germline pathogenic variants in the BRCA1/2 genes face multiple reproductive challenges that require appropriate counseling and specific expertise. MAIN BODY On December 5th-7th, 2019, patient advocates and physicians with expertise in the field of reproductive medicine, fertility preservation, and oncology were invited to "San Giuseppe Moscati" Hospital in Avellino (Italy) for a workshop on reproductive management of women with germline pathogenic variants in the BRCA1/2 genes. From the discussion regarding the current evidence and future prospective in the field, eight main research questions were formulated and eight recommendations were developed regarding fertility, fertility preservation, preimplantation genetic testing, and pregnancy in healthy carriers and patients with cancer. CONCLUSION Several misconceptions about the topic persist among health care providers and patients often resulting in a discontinuous and suboptimal management. With the aim to offer patient-tailored counseling about reproductive issues, both awareness of current evidences and research should be promoted.
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Affiliation(s)
- Barbara Buonomo
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), School of Medicine, University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Miriam Dellino
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - Maria Campanella
- aBRCAdabra, National Patient Advocacy Association for carriers of BRCA genes mutation, Palermo, Italy
| | - Mirosa Magnotti
- ACTO Campania, Alleanza Contro il Tumore Ovarico, Avellino, Italy
| | - Cristofaro De Stefano
- Department of Women's and Children's Health, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy. .,Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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29
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Leung AQ, Baker K, Vaughan D, Shah JS, Korkidakis A, Ryley DA, Sakkas D, Toth TL. Clinical outcomes and utilization from over a decade of planned oocyte cryopreservation. Reprod Biomed Online 2021; 43:671-679. [PMID: 34474973 DOI: 10.1016/j.rbmo.2021.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/19/2021] [Revised: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION What is the clinical experience of patients who have undergone planned oocyte cryopreservation and oocyte thawing and warming? DESIGN Retrospective observational cohort study. All women who completed planned oocyte cryopreservation at a single large university-affiliated fertility centre between June 2006 and October 2020 were identified, including the subset who returned to use their oocytes. Patients who underwent oocyte cryopreservation for medical reasons were excluded. Baseline demographics, oocyte cryopreservation and thawing-warming cycle parameters, and clinical outcomes, were extracted from the electronic medical record. The primary outcome was cumulative live birth rate (LBR), and secondary outcomes were cumulative clinical pregnancy rate (CPR), and CPR and LBR per transfer. Results were stratified by age at time of cryopreservation (<38 and ≥38 years). RESULTS Of 921 patients who underwent planned oocyte cryopreservation, 68 (7.4%) returned to use their oocytes. Forty-six patients (67.6%) completed at least one embryo transfer. The CPR per transfer was 47.5% and LBR was 39.3%. The cumulative LBR per patient who initiated thawing-warming was 32.4%. Cycle outcomes were not significantly different in patients aged younger than 38 years and those aged 38 years or over. No patient aged 40 years or older (n = 6) was successful with their cryopreserved oocytes. Ten patients (14.7%) who were unsuccessful with their cryopreserved oocytes achieved a live birth using donor oocytes, with most (7/10) of these patients aged 38 years and older. CONCLUSION Only a small percentage of patients returned to use their oocytes, and 32% of those were able to achieve a live birth.
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Affiliation(s)
- Angela Q Leung
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA.
| | - Katherine Baker
- Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Denis Vaughan
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Jaimin S Shah
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - Ann Korkidakis
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
| | - David A Ryley
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA
| | - Denny Sakkas
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA
| | - Thomas L Toth
- Boston IVF, 130 2nd Avenue, Waltham Massachusetts 02451, USA; Division of Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston Massachusetts 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA
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30
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Chung EH, Lim SL, Myers E, Moss HA, Acharya KS. Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study. J Assist Reprod Genet 2021; 38:2435-2443. [PMID: 33977465 PMCID: PMC8490495 DOI: 10.1007/s10815-021-02222-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/08/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an alternative to oocyte cryopreservation (OC) for women receiving gonadotoxic therapy. Anticipating increased use of OTC, we compare the cost-effectiveness of OC versus OTC for fertility preservation in oncofertility patients. METHODS A cost-effectiveness model to compare OC versus OTC was built from a payer perspective. Costs and probabilities were derived from the literature. The primary outcome for effectiveness was the percentage of patients who achieved live birth. Strategies were compared using incremental cost-effectiveness ratios (ICER). All inputs were varied widely in sensitivity analyses. RESULTS In the base case, the estimated cost for OC was $16,588 and for OTC $10,032, with 1.56% achieving live birth after OC, and 1.0% after OTC. OC was more costly but more effective than OTC, with an ICER of $1,163,954 per live birth. In sensitivity analyses, OC was less expensive than OTC if utilization was greater than 63%, cost of OC prior to chemotherapy was less than $8100, cost of laparoscopy was greater than $13,700, or standardized discounted costs were used. CONCLUSIONS With current published prices and utilization, OC is more costly but more effective than OTC. OC becomes cost-saving with increased utilization, when cost of OC prior to chemotherapy is markedly low, cost of laparoscopy is high, or standardized discounted oncofertility pricing is assumed. We identify the critical thresholds of OC and OTC that should be met to deliver more cost-effective care for oncofertility patients.
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Affiliation(s)
- Esther H Chung
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Duke University, 200 Trent Drive (Baker House 236), Durham, NC, 27713, USA.
| | - Stephanie L Lim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27710, USA
| | - Kelly S Acharya
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Duke University, 200 Trent Drive (Baker House 236), Durham, NC, 27713, USA
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Gale J, Magee B, Forsyth-Greig A, Visram H, Jackson A. Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report. F S Rep 2021; 2:249-251. [PMID: 34278362 PMCID: PMC8267393 DOI: 10.1016/j.xfre.2021.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy. Design Report of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy. Setting Private fertility clinic with university affiliation. Patients A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy. Interventions Fertility preservation through oocyte cryopreservation. Main Outcome Measures This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk. Results Cryopreservation of 22 mature oocytes. Conclusions Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area.
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Affiliation(s)
- Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
| | - Bryden Magee
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada.,Centre for Excellence in Transgender Medicine, West Ottawa Specialty Care, Ottawa, Ontario, Canada
| | - Amanda Forsyth-Greig
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hasina Visram
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
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Herzberger EH, Knaneh S, Amir H, Reches A, Ben-Yosef D, Kalma Y, Azem F, Samara N. Gonadotropin-Releasing Hormone Agonist Versus Recombinant Human Chorionic Gonadotropin Triggering in Fertility Preservation Cycles. Reprod Sci 2021. [PMID: 34076872 DOI: 10.1007/s43032-021-00622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
The purpose of this research is to study the efficacy of GnRH-a versus r-hCG triggering in patients who go through fertility preservation cycles. This retrospective cohort study was performed in a tertiary university-affiliated medical center. It includes 191 patients undergoing fertility preservation cycles between May 2013 and September 2018, in which ovulation was induced by either GnRH-a or r-hCG. Main outcome measures were number and rate of mature oocyte. Among treatment cycles with medical indication, GnRH agonist significantly increases the odds for high mature rate by 3.55 (1.30-9.66), while in treatment cycles with social indication, there is no significant effect of the triggering agent. An advantage for GnRH-a triggering was observed in medically indicated preservation cycles.
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Gurbuz A, Cil AP, Karakis LS, Abali R, Ceyhan M, Aksakal E, Kilic A, Bahceci M, Urman B. Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline. J Assist Reprod Genet 2021; 38:1469-1479. [PMID: 33797008 PMCID: PMC8266947 DOI: 10.1007/s10815-021-02164-7] [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: 12/01/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the prevalence and factors associated with decision regret following oocyte cryopreservation (OC) in women with diminished ovarian reserve (DOR) and/or age-related fertility decline (ARFD). METHODS A cross-sectional survey study was conducted to five hundred fifty-two women with DOR and/or ARFD who underwent OC between 2014 and 2019 in two private-assisted reproductive units in Istanbul, Turkey. Decision regret was measured using the validated Decision Regret Scale (DRS). RESULTS The median and mean DRS scores were 10 (interquartile range: 25) and 13.4 (SD: 13.2, range 0-70), respectively. Eighty-five (52.5%) women reported mild regret and 26 (16%) had moderate to severe regret. Decision regret was inversely associated with the belief in fate regarding childbearing and trust in the efficacy of OC. CONCLUSIONS The prevalence of severe decision regret among patients with DOR and/or ARFD undergoing OC is low. Women who had belief in fate and trusted in the efficacy of oocyte cryopreservation had significantly lower decisional regret.
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Affiliation(s)
- Aysen Gurbuz
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Aylin Pelin Cil
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey.
| | | | - Remzi Abali
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Mehmet Ceyhan
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Ece Aksakal
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Azer Kilic
- Department of Sociology, Istanbul Bilgi University, 34060, Istanbul, Turkey
| | - Mustafa Bahceci
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
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Yee S, Goodman CV, Fu V, Lipton NJ, Dviri M, Mashiach J, Librach CL. Assessing the quality of decision-making for planned oocyte cryopreservation. J Assist Reprod Genet 2021; 38:907-916. [PMID: 33575856 PMCID: PMC8079493 DOI: 10.1007/s10815-021-02103-6] [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: 12/01/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This survey study aims to examine the quality of planned oocyte cryopreservation (POC) decision-making in the domains of decision change, decision difficulty, decision regret and informed choice. METHODS Of the 224 women who completed at least one POC cycle between 2012 and 2018 at a Canadian academic IVF centre, 198 were reachable by email for anonymous survey participation. RESULTS Ninety-eight questionnaires were returned (response rate 49.5%). Of these, 86 fully completed questionnaires were analyzed for this study. Eighty-eight percent of respondents stated that it was a 'good decision' to cryopreserve oocytes, in retrospect. Despite this, 31% found the decision-making process to be 'difficult'. Three in five (61%) would have made 'exactly the same' decision without any change, yet slightly over a third (35%) would have made a 'similar' decision, but with option-related changes and process-related changes. A negative correlation between 'decision regret' and 'informed choice' was found (p < .005). Those who stated that they would have made exactly the 'same' POC decision were found to have a significantly higher 'informed choice' score compared to others who would have made a 'similar' or 'completely different' decision, in retrospect (p < .001). Respondents with lesser 'decision regret' were significantly more likely to appraise their decision as a well-informed choice (p < .001). CONCLUSIONS Our findings show that high-quality POC decision-making is accompanied by the perception of being able to make an informed choice, which can be achieved by providing patients with adequate information and individualized counselling to help patients set realistic expectations of cycle outcomes.
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Affiliation(s)
- Samantha Yee
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada.
| | - Carly V Goodman
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
| | - Vivian Fu
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
| | - Nechama J Lipton
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Michal Dviri
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jordana Mashiach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Clifford L Librach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Gynecology, Women's College Hospital, Toronto, ON, Canada
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Mayeur A, Puy V, Windal V, Hesters L, Gallot V, Benoit A, Grynberg M, Sonigo C, Frydman N. Live birth rate after use of cryopreserved oocytes or embryos at the time of cancer diagnosis in female survivors: a retrospective study of ten years of experience. J Assist Reprod Genet 2021; 38:1767-1775. [PMID: 33797007 DOI: 10.1007/s10815-021-02168-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the outcomes of frozen oocytes or embryos cryopreserved after controlled ovarian stimulation (COS) or in vitro maturation (IVM) for female cancer patients who underwent a fertility preservation (FP) prior to gonadotoxic therapy. METHODS A retrospective cohort study from 2009 to December 2017 was conducted. Among the 667 female cancer patients who underwent oocytes or embryos cryopreservation for FP, 40 (6%) have returned to the fertility clinic between 2011 and 2019 to use their frozen material after being cured. We compared these thaw cycles outcomes according to the techniques used at the time of cryopreservation. RESULTS Among the 40 women cancer survivors who used their cryopreserved material, thirty patients have benefited from at least one embryo transfer. Ten patients did not have an embryo transfer since the oocytes did not survive after the thawing process or because no embryo was obtained after fertilization. We related three live births following FP using IVM (two from frozen oocytes and one after embryo cryopreservation). Five live births were obtained when COS was performed at the time of FP (one from frozen oocytes and four after embryo cryopreservation). CONCLUSIONS Our preliminary results, although they are obtained in a small sample, are encouraging and show that different FP techniques can be used in female cancer patients and lead to live births. IVM is one of the options available that does not delay the start of chemotherapy or if ovarian stimulation using gonadotropins is contraindicated.
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Affiliation(s)
- Anne Mayeur
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.
| | - Vincent Puy
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
| | - Victoria Windal
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Laetitia Hesters
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Vanessa Gallot
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Nelly Frydman
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
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Seyhan A, Akin OD, Ertaş S, Ata B, Yakin K, Urman B. A Survey of Women Who Cryopreserved Oocytes for Non-medical Indications (Social Fertility Preservation). Reprod Sci 2021; 28:2216-22. [PMID: 33449346 DOI: 10.1007/s43032-021-00460-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the expectations, experiences, and fertility awareness status of women who underwent social oocyte cryopreservation. Cohort survey study was conducted at an academic medical center. All women who underwent social oocyte cryopreservation between January 2015 and June 2016 were recruited. One hundred thirty-three women were contacted by phone to participate in a survey. The questionnaire investigated the initial motivation towards freezing, intentions to use cryopreserved oocytes, treatment experience, awareness of fertility and knowledge about chances of having a live birth with their frozen oocytes. The mean age at the time of oocyte freezing was 38.5 ± 2.68 years. The average number of mature oocytes cryopreserved was 5.48 ± 6.6 (1-16). Two major motivations were absence of a male partner (40%) and an anticipated age-related fertility decline (42%). Almost 60% overestimated the chances of natural conception, as well as the success of IVF at the age of 40 years. Half of the oocyte bankers reported that fertility declined between ages 35 and 39, but only 28% of patients estimated the live birth rate per cryopreserved oocyte correctly. Overall 98.8% stated that they would recommend oocyte cryopresevation to a friend, and 72% felt more secure in terms of reproductive potential. Despite comprehensive personalized counseling prior to the start of ovarian stimulation, many women do not seem to have a realistic understanding of reproductive aging. Even though gamete cryopreservation provides some insurance, overestimating the effectiveness of oocyte cryopreservation can also lead to a false sense of security. Clinical Trial Registration: 2016.086.IRB1.006.
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Shulman Y, Almog B, Kalma Y, Fouks Y, Azem F, Cohen Y. Effects of letrozole or tamoxifen coadministered with a standard stimulation protocol on fertility preservation among breast cancer patients. J Assist Reprod Genet 2021; 38:743-750. [PMID: 33409757 DOI: 10.1007/s10815-020-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/01/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the effects of letrozole or tamoxifen coadministration on fertility preservation treatment outcomes. METHODS Retrospective cohort study of 118 breast cancer patients undergoing fertility preservation treatment between 2008 and 2018. Patients who received letrozole (n = 36) or tamoxifen (n = 30) were compared to controls (n = 52) who underwent standard ovarian stimulation protocols. The primary outcome measures included the number of retrieved oocytes, mature oocytes (MII), fertilization, and top-quality embryo rates. The secondary outcome measures included duration of stimulation, gonadotropin dose and peak estradiol level. RESULTS The number of oocytes retrieved, MII oocytes, fertilization rate, duration of stimulation, or gonadotropin dose were similar in the letrozole and tamoxifen groups, compared to controls. Top-quality embryo rate was lower in the tamoxifen group compared to controls (25% vs 39.4%, respectively, P = 0.034). The abnormal fertilization rate was higher in the letrozole group compared to controls (7.8% vs 3.60%, respectively, P = 0.015). A stepwise logistic regression analysis revealed that letrozole and peak estradiol were significantly associated with abnormal fertilization (OR 11.94; 95% CI 2.35-60.4, P = 0.003 for letrozole and OR 1.075; 95% CI 1.024-1.12, P = 0.004 per 100 unit change in estradiol). CONCLUSIONS There may be a negative effect of letrozole or tamoxifen on fertilization and embryo quality, in fertility preservation cycles. Further studies are needed to confirm these findings.
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Affiliation(s)
- Yael Shulman
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
| | - Benny Almog
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Yael Kalma
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Yuval Fouks
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Foad Azem
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Yoni Cohen
- IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
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Kostenzer J, de Bont A, van Exel J. Women's viewpoints on egg freezing in Austria: an online Q-methodology study. BMC Med Ethics 2021; 22:4. [PMID: 33407392 PMCID: PMC7789674 DOI: 10.1186/s12910-020-00571-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background Egg freezing has emerged as a technology of assisted reproductive medicine that allows women to plan for the anticipated loss of fertility and hence to preserve the option to conceive with their own eggs. The technology is surrounded by value-conflicts and is subject to ongoing discussions. This study aims at contributing to the empirical-ethical debate by exploring women’s viewpoints on egg freezing in Austria,
where egg freezing for social reasons is currently not allowed. Methods Q-methodology was used to identify prevailing viewpoints on egg freezing. 46 female participants ranked a set of 40 statements onto a 9-column forced choice ranking grid according to the level of agreement. Participants were asked to explain their ranking in a follow-up survey. By-person factor analysis was used to identify distinct viewpoints which were interpreted using both the quantitative and the qualitative data. Results Three distinct viewpoints were identified: (1) “women should decide for themselves”, (2) “we should accept nature but change policy”, and (3) “we need an informed societal debate”. These viewpoints provide insights into how biomedical innovations such as egg freezing are perceived by women in Austria and illustrate the normative tensions regarding such innovations. Conclusions Acknowledging the different prioritizations of values regarding assisted reproductive technologies is important to better understand the underlying normative tensions in a country where egg freezing for social reasons is currently not allowed. The study adds new empirical insights to the ongoing debate by outlining and discussing viewpoints of those directly affected: women. Following up on the lay persons perspective is particularly important in the context of future biomedical innovations that may challenge established norms and create new tensions. It therefore also adds to the societal debate and supports evidence-informed policy making in that regard.
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Affiliation(s)
- Johanna Kostenzer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Antoinette de Bont
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Spurlin E, Brady P. Oocyte cryopreservation in the setting of a vascular endothelial growth factor (VEGF)-producing paraneoplastic syndrome: a case report and review of literature. Fertil Res Pract 2020; 6:18. [PMID: 33133631 PMCID: PMC7592535 DOI: 10.1186/s40738-020-00086-z] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many reproductive aged women with new oncologic diagnoses choose to undergo emergency oocyte or embryo cryopreservation prior to initiating potentially gonadal toxic oncologic therapies. Ovarian hyperstimulation syndrome (OHSS) is a potential complication of these treatments and can be particularly dangerous in these patients due to their underlying medical illness and by delaying lifesaving oncology treatment. This case report details a multipronged approach to OHSS prevention in a patient with a paraneoplastic syndrome defined by overproduction of vascular endothelial growth factor (VEGF), which is also primarily responsible for OHSS. CASE PRESENTATION A 29 year old nulligravid woman was diagnosed with a rare multisystem paraneoplastic syndrome (Polyradiculoneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder and skin changes, known as POEMS) and presented for fertility preservation consultation prior to autologous stem cell transplant. She successfully underwent oocyte cryopreservation without complications due to aggressive OHSS prophylaxis with both a dopamine agonist and aromatase inhibitor during and after stimulation and a gonadotropin releasing hormone agonist (GnRH-A) for final oocyte maturation, without delay in her subsequent oncology treatment. CONCLUSIONS This is the first report of a patient with POEMS undergoing controlled ovarian hyperstimulation (COH). Oocyte cryopreservation was successful and without complications due to a combination of prophylactic measures against OHSS (cabergoline, letrozole and GnRH-A trigger) and close collaboration between reproductive endocrinology and oncology. This case demonstrates the use of combined measures in targeting VEGF overproduction and OHSS risk during COH.
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Affiliation(s)
- Emily Spurlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th St., New York, NY 10032 USA
| | - Paula Brady
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Irving Medical Center, 5 Columbus Circle, Penthouse, New York, NY 10019 USA
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Voigt PE, Blakemore JK, McCulloh D, Fino ME. Equal opportunity for all? An analysis of race and ethnicity in fertility preservation in New York City. J Assist Reprod Genet 2020; 37:3095-102. [PMID: 33085025 DOI: 10.1007/s10815-020-01980-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare the racial and ethnic make-up of patients who accessed medically indicated fertility preservation services (MIFP) against the overall racial diversity (including Hispanic origin) across women of reproductive age diagnosed with cancer in New York City (NYC). Methods All patients who completed at least one MIFP between January 2017 and December 2018 were reviewed. Race was self-reported. A calculation of the expected racial distribution across women of reproductive age with cancer in NYC was determined using the most recent NYC census data. Statistical analysis included chi-square goodness of fit and test for independence and Kruskal-Wallis H test, with p < 0.05 considered significant. Results A total of 107 patients who accessed MIFP were included. A total of 55 (51.4%) identified as White, 3 (2.8%) as Black, 13 (12.2%) as Asian, 6 (5.6%) as Hispanic, 3 (2.8%) as other, and 27 (25.2%) did not report. A total of 78.5% of patients had insurance. There was no significant difference in racial distribution by cancer type (p = 0.255). A subgroup analysis excluding the BRCA+ patients and races not reported by the census (n = 69) was then performed, showing a statistically significant difference between observed (O) and expected (E) cases of fertility preservation (FP) by race at our center—White 47O/32E, Black 3O/15E, Asian 13O/7E, and Hispanic 6O/15E (p < 0.001). A statistically significant difference in racial distribution by FP type was observed. Conclusions There is a difference in the observed vs expected racial distribution of patients accessing MIFP. Further studies are needed to identify modifiable factors to better ensure equal opportunity to all patients.
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Yee S, Goodman CV, Fu V, Lipton NJ, Librach CL. Parenthood desire, childbearing plans and oocyte utilization among women who previously underwent planned oocyte cryopreservation. Reprod Biomed Online 2020; 42:442-450. [PMID: 33246804 DOI: 10.1016/j.rbmo.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/02/2020] [Revised: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION To examine the motivations, life circumstances and parenthood aspirations of a cohort of women who underwent planned oocyte cryopreservation (POC) at a Canadian academic IVF centre. DESIGN A single-site, cross-sectional, anonymous quantitative study using a study-specific questionnaire administrated via SurveyMonkey®. Of the 224 women who completed at least one POC cycle between 2012 and 2018, 198 were reached by email and invited to participate. RESULTS Of the 98 (49.5%) questionnaires returned, 86 were fully completed and were analysed. Mean age at first POC cycle was 35.7 ± 2.4 (range 27-43) and at survey was 37.7 ± 2.5 years. At POC, 77% were single and 97.7% childless. At survey, 96% had not attempted to use their cryopreserved oocytes, yet 26 (30%) had tried natural conception or fertility treatments. Of these, three conceived naturally and two by assisted reproduction. Eighty-five per cent expressed a strong motherhood desire and 67.1% indicated that usage of their cryopreserved oocytes was mostly contingent on relationship status. Many expressed a desire for shared genetic parenthood within a committed relationship. Forty-seven per cent did not want to carry a pregnancy beyond the age of 46. CONCLUSION The findings of this study confirm the central role of age and relationship status in influencing women's POC decisions and oocyte utilization plans. The late age at POC could be explained by women using it toward the end of their peak reproductive years to leverage their remaining chances of genetic motherhood. Surveying women at later points following POC would help to gain a more comprehensive picture of their oocyte utilization and disposition plans.
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Affiliation(s)
| | | | - Vivian Fu
- CReATe Fertility Centre, Toronto, Canada
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, Canada
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Pluchino N, Roman H. Oocyte vitrification offers more space for a tailored surgical management of endometriosis. Reprod Biomed Online 2020; 41:753-755. [PMID: 32819840 DOI: 10.1016/j.rbmo.2020.07.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Oocyte vitrification is an attractive and efficient option in the long-term management of endometriosis patients. Which women would benefit from banked oocytes when pregnancy is attempted, and whether oocyte vitrification should be carried out before or after the surgical management of endometriosis, is still debated. On the basis of recent data, and in the absence of cost-effective modelling, a personalized strategy should assess crucial variables, such as type of surgery, effect on oocyte yield and the huge heterogeneity of the clinical scenarios possibly requiring surgery. Research into a more tailored approach to maximize the result of each available intervention, e.g. hormones, surgery, assisted reproductive technology or their combination to prevent infertility and reduce the actual burden of personal and societal cost of the disease, is recommended.
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Affiliation(s)
- Nicola Pluchino
- Division of Obstetrics and Gynecology, University Hospital of Geneva and Faculty of Medicine, Bd de la Cluse 30, 1205 Geneva, Switzerland.
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, rue Mandron 220, 33000 Bordeaux, France; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, Denmark
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Khiat S, Provansal M, Bottin P, Saias-Magnan J, Metzler-Guillemain C, Courbiere B. Fertility preservation after fertility-sparing surgery in women with borderline ovarian tumours. Eur J Obstet Gynecol Reprod Biol 2020; 253:65-70. [PMID: 32784054 DOI: 10.1016/j.ejogrb.2020.07.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present a case series of women with borderline ovarian tumours (BOTs) who underwent oocyte vitrification in addition to fertility-sparing surgery. STUDY DESIGN Observational study of all women referred to a French fertility preservation unit between 2015 and 2019 for counselling regarding a fertility preservation (FP) strategy after BOT fertility-sparing surgery. All eligible women underwent one or more cycles of controlled ovarian stimulation (COS) using an antagonist protocol, followed by oocyte retrieval. Metaphase II (MII) oocytes were vitrified. RESULTS Twenty-five women with BOTs were referred during the study period. Among them, 11 women underwent at least one cycle of COS. One hundred and seven MII oocytes were vitrified. The mean number of vitrified MII oocytes per woman was 9.7 (standard deviation 5.2). Five live births were reported during follow-up of four women with vitrified oocytes: three spontaneous pregnancies, one in-vitro fertilization cycle with fresh embryo transfer, and one live birth after return of vitrified oocytes. CONCLUSION Conservative surgery for BOTs offers a high spontaneous pregnancy rate but has a higher risk of relapse than radical treatment. Furthermore, women who undergo conservative BOT surgery have a higher risk of surgery-induced premature ovarian failure. Oocyte cryopreservation after COS appears to be an effective technique after the conservative management of BOTs in women of reproductive age. Although the available short-term data are reassuring, further long-term studies evaluating the safety and cost-effectiveness of this systematic FP strategy after BOT fertility-sparing surgery are required.
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Parmegiani L, Minasi MG, Arnone A, Casciani V, Cognigni GE, Viñoles R, Varricchio MT, Quintero LA, Greco E, Filicori M. "Universal Warming" protocol for vitrified oocytes to streamline cell exchange for transnational donation programs: a multi-center study. J Assist Reprod Genet 2020; 37:1379-1385. [PMID: 32363563 PMCID: PMC7311616 DOI: 10.1007/s10815-020-01798-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/29/2019] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the clinical efficacy of a "Universal Warming" protocol, based on subsequent steps with 1 M and 0.5 M concentration of extracellular cryoprotectant (ECCP), on shipped oocytes. Oocytes are vitrified using different brands of ready-to-use kits which recommend that the use of their own warming kit and combining different vitrification/warming kits may have legal consequences for assisted reproductive (AR) centers, until this practice has been validated with clinical studies. METHODS Retrospective multi-center transnational observational study. Number of oocytes warmed 1.898. Vitrification performed with vitrification kit (Kitazato, Japan); warming carried out randomly with two different kits: Kitazato warming kit and Vit Kit®-Thaw (FujiFilm Irvine, USA). Warmed oocytes were assigned to 2 groups: KK (Kitazato/Kitazato) 939, and KI (Kitazato/Irvine) 959. Primary endpoint: survival rate. Secondary endpoints: fertilization rate; blastulation rate; implantation rate; live birth rate. RESULTS Survival was comparable between the groups: 84.6% (795/939) in group KK vs 82.1% (787/959) in group KI. Fertilization rate was lower (P = 0.027) in group KK (75.7%-602/795) than in group KI (80.4%-633/787). Blastulation and implantation and live birth rates were all statistically comparable between the study groups: blastulation rate was 58.5% (352/602) vs 57.8% (366/633); implantation rate was 41.5% (80/193) vs 45.9% (84/183); live birth rate was 52.5% (62/118) in KK and 45.0% (54/120) in KI. CONCLUSION The use of this "Universal Warming" protocol simplifies vitrified oocyte exchange between AR centers in different countries, and overcomes potential regulatory/commercial/availability differences affecting clinical practice.
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Affiliation(s)
- Lodovico Parmegiani
- Reproductive Medicine Unit- GynePro Medical Centers, GynePro Medical, Via T. Cremona, 8 -, 40137, Bologna, Italy.
- NextClinics International, Aystetten, Germany.
| | - M G Minasi
- Center for Reproductive Medicine European Hospital, Rome, Italy
| | - A Arnone
- Reproductive Medicine Unit- GynePro Medical Centers, GynePro Medical, Via T. Cremona, 8 -, 40137, Bologna, Italy
- NextClinics International, Aystetten, Germany
| | - V Casciani
- Center for Reproductive Medicine European Hospital, Rome, Italy
| | - G E Cognigni
- Reproductive Medicine Unit- GynePro Medical Centers, GynePro Medical, Via T. Cremona, 8 -, 40137, Bologna, Italy
- NextClinics International, Aystetten, Germany
| | - R Viñoles
- NextClinics International, Aystetten, Germany
- Instituto de Medicina Reproductiva (IMER), Valencia, Spain
| | - M T Varricchio
- Center for Reproductive Medicine European Hospital, Rome, Italy
| | - L A Quintero
- NextClinics International, Aystetten, Germany
- Instituto de Medicina Reproductiva (IMER), Valencia, Spain
| | - E Greco
- Center for Reproductive Medicine European Hospital, Rome, Italy
| | - M Filicori
- Reproductive Medicine Unit- GynePro Medical Centers, GynePro Medical, Via T. Cremona, 8 -, 40137, Bologna, Italy
- NextClinics International, Aystetten, Germany
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Insogna IG, Ginsburg E, Srouji S. Fertility Preservation for Adolescent Transgender Male Patients: A Case Series. J Adolesc Health 2020; 66:750-753. [PMID: 32001141 DOI: 10.1016/j.jadohealth.2019.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/20/2019] [Accepted: 12/04/2019] [Indexed: 12/31/2022]
Abstract
This case series from a hospital-based academic in vitro fertilization clinic outlines the feasibility of oocyte cryopreservation for transgender male adolescents after varying degrees of exposure to pubertal blockers and/or testosterone. A description of each patient's oocyte cryopreservation cycle is reviewed, including prior exposure to pubertal blockers and/or testosterone, anti-Mullerian hormone level, stimulation medications, trigger injections, number of oocytes retrieved and cryopreserved, and complications. All patients tolerated stimulation and retrieval well and had mature oocytes cryopreserved in each cycle. There were no complications. Adolescent transgender males who choose to undergo oocyte cryopreservation tolerate the process well, reinforcing the importance of fertility preservation in providing comprehensive care for transgender patients.
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Affiliation(s)
- Iris G Insogna
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Elizabeth Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Serene Srouji
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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Amir H, Oren A, Klochendler Frishman E, Sapir O, Shufaro Y, Segev Becker A, Azem F, Ben-Haroush A. Oocyte retrieval outcomes among adolescent transgender males. J Assist Reprod Genet 2020; 37:1737-1744. [PMID: 32430731 DOI: 10.1007/s10815-020-01815-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females. METHODS This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017-April 2019 and September 2013-April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups. RESULTS Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261). CONCLUSIONS Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Klochendler Frishman
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Maslow BSL, Guarnaccia MM, Ramirez L, Klein JU. Likelihood of achieving a 50%, 60%, or 70% estimated live birth rate threshold with 1 or 2 cycles of planned oocyte cryopreservation. J Assist Reprod Genet 2020; 37:1637-1643. [PMID: 32418136 DOI: 10.1007/s10815-020-01791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/12/2019] [Accepted: 04/22/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To characterize the likelihood of cryopreserving enough oocytes for 50%, 60%, or 70% estimated live birth rate (eLBR) with 1-2 planned oocyte cryopreservation (Pl-OC) cycles. METHODS We performed a retrospective cohort study utilizing all patients completing ≥ 1 Pl-OC cycle from 2016 to 2018 at a large single-center OC program. Subjects were categorized by age at retrieval and number of cycles. We extrapolated age-based oocyte thresholds for 50%, 60%, or 70% eLBR from previously published data. We calculated the proportion of subjects overall, and for each age group, whose number of frozen oocytes was greater than or equal to their age-based threshold for a 50%, 60%, or 70% eLBR after 1 and 2 cycles. OR for 60% eLBR with one cycle was calculated for age and AMH cutoff values and corroborated with logistic regression. RESULTS A total of 1241 subjects, completing 1799 Pl-OC cycles, were included. With one cycle, 66% (819/1241) achieved ≥ 50% eLBR and 51% (634/1241) achieved 70% eLBR. With two cycles, 79.6% (988/1241) attained ≥ 50% eLBR and 65.5% (813/1241) achieved 70% eLBR. Achieving 50%, 60%, or 70% eLBR with 1-2 cycles was significantly associated with both age (p < 0.001) and AMH (p < 0.001). Age < 37.5 and AMH > 1.995 were independently associated with attaining 60% eLBR with one cycle (age: OR 13.73; 95%CI 9.16-20.57, p < 0.001; AMH: OR 7.32; 95% CI 5.50-9.76, p < 0.001). CONCLUSIONS Younger age and higher AMH were associated with achieving 50%, 60%, or 70% eLBR thresholds with Pl-OC. Nevertheless, almost all subjects were successfully able to preserve enough oocytes for ≥ 50% eLBR in 1-2 cycles.
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Affiliation(s)
- Bat-Sheva L Maslow
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA.
| | - Michael M Guarnaccia
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
| | - Leslie Ramirez
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
| | - Joshua U Klein
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
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Klüber CM, Greene BH, Wagner U, Ziller V. Cost-effectiveness of social oocyte freezing in Germany: estimates based on a Markov model. Arch Gynecol Obstet 2020; 301:823-829. [PMID: 32034506 DOI: 10.1007/s00404-020-05449-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/11/2019] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Is oocyte freezing for non-medical reasons-the so-called "social freezing" (SF)-cost-effective compared to standard in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in Germany today? METHODS We developed a model based on three strategies for women planning to postpone pregnancy. In each strategy, women actively practiced contraception until 40 then tried to conceive naturally for 1 year. If unsuccessful, women using strategy I (oocyte cryopreservation) attempted ICSI with frozen oocytes in the 2nd year, while women using strategy II (no action) further attempted natural conception. In strategy III (IVF/ICSI), women underwent 1 year of IVF/ICSI. If still unsuccessful, each strategy was followed by attempting natural conception again until 45. We used an adaptive Markov model to estimate and compare live birth rates and cost-effectiveness measures. RESULTS For strategy I, cumulative live birth rates at age 45 generally declined with the woman's age at freezing and were between 71.4% (25 years) and 67.6% (38 years), while the cumulative success rate was 51.5% for strategy II and 60.8% for strategy III. The costs per live birth of egg freezing were age-dependent ranging between 22,418 € (30 years) and 25,590 € (38 years). The costs for strategy III were lower at 20,293 € per live birth. CONCLUSION Based on our results, social freezing in Germany may lead to additional pregnancies among women over 40 but also to significantly higher costs, since given the current live birth success rates and pricing, social freezing does not appear to be cost-effective.
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Affiliation(s)
- C M Klüber
- Department of Endocrinology, Reproductive Medicine and Osteology, University Hospital Gießen and Marburg, Gynaecology and Obstetrics, Philipps-University of Marburg, Baldinger Str, 35043, Marburg, Germany.
| | - B H Greene
- Institute of Medical Bioinformatics and Biostatistics, Philipps-University Marburg, Bunsenstrasse 3, 35037, Marburg, Germany
| | - U Wagner
- Department of Endocrinology, Reproductive Medicine and Osteology, University Hospital Gießen and Marburg, Gynaecology and Obstetrics, Philipps-University of Marburg, Baldinger Str, 35043, Marburg, Germany
| | - V Ziller
- Department of Endocrinology, Reproductive Medicine and Osteology, University Hospital Gießen and Marburg, Gynaecology and Obstetrics, Philipps-University of Marburg, Baldinger Str, 35043, Marburg, Germany
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Inhorn MC, Birenbaum-Carmeli D, Patrizio P. Elective egg freezing and male support: a qualitative study of men's roles in women's fertility preservation. HUM FERTIL 2020; 25:99-106. [PMID: 31920127 DOI: 10.1080/14647273.2019.1702222] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
How do men participate in women's fertility preservation decisions and procedures? This binational, qualitative study assessed whether men play supportive roles either before, during or after women's elective egg freezing (EEF) cycles. From June 2014 to August 2016, 150 women (114 in the USA and 36 in Israel) who had completed at least one cycle of EEF were interviewed by two medical anthropologists, one in each country. The majority (85%) of women in the study identified the lack of a male partner as their main reason for pursuing EEF. However, nearly two-thirds (63%) of women relied on some form of male support during their EEF decision making processes and procedures. Five categories of men, in order of support, included: (i) fathers (or other male father figures), (ii) male partners (past or present), (iii) male friends, (iv) brothers and (v) male judges (some of whom supported EEF in divorce settlements). More than a dozen different forms of assistance were offered by men in four major categories: (i) instrumental, (ii) financial, (iii) physical and (iv) psychological. Although one-third (37%) of women went through EEF alone or with only female support, this study reveals the 'hidden' roles men play in supporting the reproductive aspirations of women.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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Porcu E, Cillo GM, Cipriani L, Sacilotto F, Notarangelo L, Damiano G, Dirodi M, Roncarati I. Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer. J Assist Reprod Genet 2020; 37:709-15. [PMID: 31872386 DOI: 10.1007/s10815-019-01658-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose To determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcome. The main purpose and research question of the study is to determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes. Methods Prospective study: 67 breast cancer patients between 18 and 40 years old, undergoing a fertility preservation by means of oocyte storage were considered. Inclusions criteria for the study were age between 18 and 40 years old, BMI between 18 and 28, breast cancer neoplasm stage I and II according to American Joint Committee on Cancer classification (2017) and no metastasis. Exclusion criteria: age over 40 years old, BMI < 18 and > 28, breast cancer neoplasm stage III and IV and do not performed the BRCA test. A total of 21 patients had not performed the test and were excluded. Patients were divided into four groups: Group A was composed by 11 breast cancer patients with BRCA 1 mutations, Group B was composed by 11 breast cancer patients with BRCA 2 mutations, Group C was composed by 24 women with breast cancer without BRCA mutations, and Group D (control) was composed by 181 normal women. Results Group A showed significant lower AMH levels compared to Group C and D (1.2 ± 1.1 vs 4.5 ± 4.1 p < 0.05 and 1.2 ± 1.1 vs 3.8 ± 2.5 p < 0.05). BRCA1 mutated patients showed a significant lower rate of mature oocytes (MII) compared to Group C (3.1 ± 2.3 vs 7.2 ± 4.4 p < 0,05) and Group D (3.1 ± 2.3 vs 7.3 ± 3.4; p < 0,05). Breast cancer patients needed a higher dose of gonadotropins compared to controls (Group A 2206 ± 1392 Group B2047.5 ± 829.9 Group C 2106 ± 1336 Group D 1597 ± 709 p < 0,05). No significant differences were found among the groups considering basal FSH levels, duration of stimulation, number of developed follicles, and number of total retrieved oocytes. Regarding BRCA2 mutation, no effect on fertility was shown in this study. Conclusions The study showed that BRCA1 patients had a higher risk of premature ovarian insufficiency (POI) confirmed by a diminished ovarian reserve and a lower number of mature oocytes suitable for cryopreservation.
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