1
|
Wang YL, Zhai QJ, Wang ZH, Yang X, Wang JL, Zhu HL. A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation. Arch Gynecol Obstet 2024:10.1007/s00404-024-07484-4. [PMID: 38575798 DOI: 10.1007/s00404-024-07484-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
PURPOSES To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. METHODS We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People's Hospital from April 2017 to January 2023 were analyzed and summarized. RESULTS A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81 years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12 ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24 IU/L in examination before OTC. FSH was greater than 10.0 IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84 g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43 g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58 min, and the average blood loss was 32.1 ± 41.6 mL. The maximum blood loss was 200 mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20 days and began HSCT within 30 days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3 years after HSCT and resumed regular menstruation 6 months after OTT. CONCLUSIONS Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.
Collapse
Affiliation(s)
- Yi-Ling Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Qing-Jie Zhai
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Zhao-Hua Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Jian-Liu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
| |
Collapse
|
2
|
Ruan X, Xu C, Huang H, Xu B, Du J, Cheng J, Jin F, Gu M, Kong W, Yin C, Wu Y, Tian Q, Cao Y, Wu R, Xu L, Jin J, Li Y, Dai Y, Ju R, Ma F, Wang G, Wei W, Huang X, Qin M, Lin Y, Sun Y, Liu R, Zhang W, Li X, Zou L, Hao M, Ye X, Wang F, Wang Y, Hu Z, Huang Y, Zhu T, Yang C, Wang J, Yang X, Ni R, Wang L, Luo G, Min A, Zhang S, Li P, Cheng L, Li L, Jin Q, Shi D, Li Y, Ren F, Cheng Y, Niu J, Tian Y, Mueck AO. Practice guideline on ovarian tissue cryopreservation and transplantation in the prevention and treatment of iatrogenic premature ovarian insufficiency. Maturitas 2024; 182:107922. [PMID: 38325136 DOI: 10.1016/j.maturitas.2024.107922] [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: 09/28/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
Premature ovarian insufficiency (POI) refers to the decline of ovarian function before the age of 40. POI causes a reduction in or loss of female fertility, accompanied by different degrees of menopausal symptoms, which increases the risk of chronic diseases related to early menopause and seriously affects patients' quality of life and health. It is conservatively estimated that at least one million prepubertal girls and women of reproductive age in China are at risk of iatrogenic POI caused by radiotherapy and chemotherapy every year. With the development of medical technology and the breakthrough of scientific and technological advances, preventing and treating iatrogenic POI have become possible. International and national guidelines consider cryopreserved ovarian tissue transplantation to be the most promising method of preserving the ovarian function and fertility of prepubertal girls and women of reproductive age who cannot delay radiotherapy and chemotherapy. In order to guide the clinical application of ovarian tissue cryopreservation and transplantation technology in China, the Guideline Working Group finally included 14 scientific questions and 18 recommendations through a questionnaire survey, field investigation, and consultation of a large number of Chinese and English literature databases in order to provide a reference for colleagues in clinical practice.
Collapse
Affiliation(s)
- Xiangyan Ruan
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China; Department for Women's Health, University Women's Hospital and Research Center for Women's Health, University of Tuebingen, Tuebingen, Germany.
| | - Che Xu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China; Fuxing Hospital, Capital Medical University, Beijing, China
| | - Hefeng Huang
- Ministry of Education Key Laboratory of Reproductive Genetics, Shool of Medicine, Zhejiang University, Hangzhou, China
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Du
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jiaojiao Cheng
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Fengyu Jin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Muqing Gu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Weimin Kong
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chenghong Yin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yurui Wu
- Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Qinjie Tian
- Peking Union Medical College Hospital, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing, China
| | - Yunxia Cao
- The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Ruifang Wu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Liangzhi Xu
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jing Jin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanglu Li
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yinmei Dai
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Rui Ju
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Fei Ma
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Wang
- Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Wei Wei
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | | | - Maoquan Qin
- National Center for Children's Health, Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yuan Lin
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian, China
| | - Yuan Sun
- Beijing Jingdu Children's Hospital, Beijing, China
| | - Rong Liu
- Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaodong Li
- The First Hospital of Hebei Medical University, Hebei, China
| | - Lin Zou
- Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Min Hao
- Second Hospital of Shanxi Medical University, Shanxi, China
| | - Xiyang Ye
- Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Fuling Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yue Wang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhuoying Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanhong Huang
- Xi'an International Medical Center Hospital, Xi'an, China
| | - Tianyuan Zhu
- Gansu Provincial Maternal and Child-care Hospital/Gansu Province Central Hospital, Lanzhou, China
| | - Caihong Yang
- The General Hospital of Ningxia Medical University, Ningxia, China
| | - Jinping Wang
- Zibo Maternal And Child Health Hospital, Zibo, China
| | - Xiaomin Yang
- Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Rong Ni
- The Central Hospital of Enshi Tu Jia and Miao Autonomous Prefecture, Enshi, China
| | - Liqun Wang
- Jiangxi Maternal and Child Health Hospital, Jiangxi, China
| | - Guangxia Luo
- The First People's Hospital of Huaihua (Hunan University of Medicine General Hospital), Huaihua, China
| | - Aiping Min
- People's Hospital of Leshan City, Leshan, China
| | - Siyou Zhang
- The First People's Hospital of Foshan, Foshan, China
| | - Peiling Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linghui Cheng
- The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Lianfang Li
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Huairou Maternal and Child Health Care Hospital, Huairou, China
| | - Quanfang Jin
- Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Dongmei Shi
- Maternal and Child Health Hospital of Yinchuan, Yinchuan, China
| | - Yan Li
- Luoyang Anhe Hospital, Luoyang, China
| | | | | | - Jumin Niu
- Shenyang Women's and Children's Hospital, Shenyang, China
| | - Ying Tian
- XiangXi Ninger Obstetrics and Gynecology Hospital, Xiangxi, China
| | - Alfred O Mueck
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China; Department for Women's Health, University Women's Hospital and Research Center for Women's Health, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
3
|
Gillipelli SR, Pio L, Losty PD, Abdelhafeez AH. Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review. J Pediatr Surg 2024:S0022-3468(24)00097-6. [PMID: 38519388 DOI: 10.1016/j.jpedsurg.2024.02.015] [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: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND AIMS As survival rates in childhood cancer progress significantly, health outcomes in adulthood are pivotal to quality of life (QoL). Female patients undergoing chemotherapy and radiation for childhood cancer may experience adverse effects such as gonadotoxicity-related ovarian insufficiency. Ovarian tissue cryopreservation (OTC) is well studied in adults, but has only recently started to be explored in an effort to preserve fertility in young patients with childhood cancer. This systematic review aims to critically highlight contemporary outcomes of cryopreservation in female pediatric cancer patients. METHODS A systematic search was conducted in PubMed, Embase, and Web of Science databases to identify English-language full text articles and abstracts published between 2004 and 2022 describing cryopreservation among female children (0-21 years old) with cancer. Abstracts and full-text articles were screened for inclusion. Subsequently, data from eligible studies was extracted and analyzed. Descriptive statistics were utilized to estimate overall outcomes of cryopreservation. RESULTS Of 104 abstracts and 34 full-text articles, 12 studies were included. Data was collected from 7 world countries and involved some 612 pediatric and adolescent patients with malignant disease. Most common cancers included hematological malignant disease (81%), CNS nervous system malignant tumors (56%), and sarcomas (39%). Of the 6 studies with full reporting, OTC was undertaken in 501 patients, and 5.9% (30/501) of these patients underwent ovarian tissue transplantation (OTT). After OTT, 27 patients desired pregnancy and 33% (9/27) became pregnant. Six of these 9 patients (67%) had live births. CONCLUSIONS Preliminary analysis showed that OTC has been successfully performed but not yet studied thoroughly in pediatric cancer patients in a longitudinal manner. This study has further shown that cryopreservation outcomes are mainly reported among adult patients living in high income countries, demonstrating a crucial need for long-term outcome studies focused on pediatric and prepuberal OTC, subsequent OTT, and potential pregnancy. This work is considered critical to aid standardize recommendations of fertility preservation in childhood cancer patients and to better inform the efficacy of these procedures to benefit patients in world nations of all fiscal income levels. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | - Luca Pio
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
| | - Paul D Losty
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
4
|
Missontsa MM, Bernaudin F, Fortin A, Dhédin N, Pondarré C, Yakouben K, Neven B, Castelle M, Cavazzana M, Lezeau H, Peycelon M, Paye-Jaouen A, Sroussi J, Diesch-Furlanetto T, Barraud-Lange V, Sarnacki S, Fahd M, Marchand I, Delcour C, Vexiau D, Arlet JB, Kamdem A, Arnaud C, Dalle JH, Poirot C. Ovarian tissue cryopreservation for fertility preservation before hematopoietic stem cell transplantation in patients with sickle cell disease: safety, ovarian function follow-up, and results of ovarian tissue transplantation. J Assist Reprod Genet 2024:10.1007/s10815-024-03054-4. [PMID: 38358434 DOI: 10.1007/s10815-024-03054-4] [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: 11/23/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE To describe the experience of performing ovarian tissue cryopreservation (OTC) before hematopoietic stem cell transplantation (HSCT), among girls/women with severe sickle cell disease (SCD)(SS or S/β0-thalassemia) who are, besides the usual surgical risk, at risk of SCD-related complications during the fertility preservation procedure for improving their counseling and management. METHODS This retrospective study included 75 patients (girls/women) with SCD who have had OTC before myeloablative conditioning regimen (MAC) for HSCT. Characteristics of patients and data on OTC, ovarian status follow-up, and results of ovarian tissue transplantation (OTT) were collected in medical records. RESULTS At OTC, the median (IQR 25-75; range) age of the patients was 9.6 (6.9-14.1; 3.6-28.3) years, 56/75 were prepubertal, and no SCD or surgery-related complications occurred. The median follow-up post-HSCT was > 9 years. At the last follow-up, among prepubertal patients at HSCT, 26/56 were ≥ 15 years old and presented with a premature ovarian insufficiency (POI), except 2, including the patient who had received an OTT to induce puberty. Eight were 13-15 years old and presented for POI. The remaining 22 patients were under 13. Among the 19 patients who were menarche at HSCT, 2 died 6 months post-HSCT and we do not have ovarian function follow-up for the other 2 patients. All the remaining patients (n = 15) had POI. Five patients had OTT. All had a return of ovarian function. One patient gave birth to a healthy baby. CONCLUSION OTC is a safe fertility preservation technique and could be offered before MAC independent of the patient's age.
Collapse
Affiliation(s)
- Mitawa Millin Missontsa
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, APHP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Clinique Ngaliema Fertility Center, 42 Avenue Pumbu, Gombe, Kinshasa, Congo
| | - Françoise Bernaudin
- Pediatric Department Sickle Cell Referral Center, Intercommunal Hospital of Créteil, 94000, Creteil, France
| | - Anne Fortin
- Department of Obstetrics Gynecology, APHP, Pitié-Salpêtrière-Charles Foix University Hospital, 75013, Paris, France
| | - Nathalie Dhédin
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, APHP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Corinne Pondarré
- Pediatric Department Sickle Cell Referral Center, Intercommunal Hospital of Créteil, 94000, Creteil, France
- University Paris XII, Inserm U 955, 94000, Creteil, France
| | - Karima Yakouben
- Department of Pediatric Immunology and Hematology, APHP, University Paris Cité, Robert Debré Hospital, 75019, Paris, France
| | - Bénédicte Neven
- Department of Immuno-Hematology and Pediatric Rheumatology, APHP Center, University Paris Cité, Necker-Enfants Malades Hospital, 75015, Paris, France
- University Paris Cité, 75010, Paris, France
| | - Martin Castelle
- Department of Immuno-Hematology and Pediatric Rheumatology, APHP Center, University Paris Cité, Necker-Enfants Malades Hospital, 75015, Paris, France
| | - Marina Cavazzana
- University Paris Cité, 75010, Paris, France
- Department of Biotherapy, Necker-Enfants Malades Hospital, 75015, Paris, France
| | - Harry Lezeau
- Department of Visceral, Urological and Traumatological Surgery, Intercommunal Hospital of Créteil, 9400, Creteil, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Centre de Référence Des Malformations Rares Des Voies Urinaires (MARVU), ERN eUROGEN Accredited Center, APHP North-Université Paris Cité, Robert-Debré University Hospital, Inserm UMR, 1141 NeuroDev, 75019, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Centre de Référence Des Malformations Rares Des Voies Urinaires (MARVU), ERN eUROGEN Accredited Center, APHP North-Université Paris Cité, Robert-Debré University Hospital, Inserm UMR, 1141 NeuroDev, 75019, Paris, France
| | - Jeremy Sroussi
- Department of Obstetrics Gynecology, APHP, University Paris Cité, Lariboisière Hospital, 75010, Paris, France
| | - Tamara Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital of Basel, UKBB, Basel, Switzerland
| | - Virginie Barraud-Lange
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, APHP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Department of Reproductive Biology, APHP Center, University Paris Cité, Cochin Hospital, 75014, Paris, France
| | - Sabine Sarnacki
- University Paris Cité, 75010, Paris, France
- Department of Visceral and Urological Pediatric Surgery, APHP Center, University Paris Cité, Necker Hospital, 75015, Paris, France
| | - Mony Fahd
- Department of Pediatric Immunology and Hematology, APHP, University Paris Cité, Robert Debré Hospital, 75019, Paris, France
| | - Isis Marchand
- Department of Endocrinology, Intercommunal Hospital of Créteil, 94000, Creteil, France
| | - Clémence Delcour
- Department of Obstetrics Gynecology, APHP, University Paris Cité, Robert Debré Hospital, 75019, Paris, France
| | - Dominique Vexiau
- Department of Gynecology, APHP, University Paris Cité, Saint-Louis Hospital, 75010, Paris, France
| | - Jean-Benoît Arlet
- Department of Internal Medicine and French Sickle Cell Disease Referral Center, APHP, University Paris Cité, Georges-Pompidou European Hospital, 75015, Paris, France
| | - Annie Kamdem
- Pediatric Department Sickle Cell Referral Center, Intercommunal Hospital of Créteil, 94000, Creteil, France
| | - Cécile Arnaud
- Pediatric Department Sickle Cell Referral Center, Intercommunal Hospital of Créteil, 94000, Creteil, France
| | - Jean-Hugues Dalle
- Department of Pediatric Immunology and Hematology, APHP, University Paris Cité, Robert Debré Hospital, 75019, Paris, France
- University Paris Cité, 75010, Paris, France
| | - Catherine Poirot
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, APHP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
- Médecine Sorbonne University, 75005, Paris, France.
| |
Collapse
|
5
|
Finkelstein T, Zhang Y, Vollenhoven B, Rolnik DL, Horta F. Successful pregnancy rates amongst patients undergoing ovarian tissue cryopreservation for non-malignant indications: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 292:30-39. [PMID: 37952490 DOI: 10.1016/j.ejogrb.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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/15/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Ovarian tissue cryopreservation (OTC) is a fertility preservation method that has been clinically applied for almost 30 years. Studies specifically evaluating patients presenting with non-malignant indications for OTC and their subsequent pregnancy rates are limited. OBJECTIVE To summarise the evidence on the rates of successful pregnancy amongst women who have undergone OTC for non-malignant indications. METHODS A systematic review with meta-analysis (PROSPERO registration CRD42022307925) was conducted to investigate the pregnancy outcomes of patients who have undergone ovarian tissue cryopreservation for non-malignant indications. Articles published in EMBASE and Ovid MEDLINE before October 2022 were screened for inclusion based on the following criteria: original human studies pertaining to OTC with a defined non-malignant cohort and pregnancy outcomes. The successful pregnancy rates were pooled with a random-effects model of double-arcsine transformed proportions. Sensitivity analysis involved pooling the results of studies with a low risk of bias after being assessed with NIH tools. RESULTS The database search retrieved 3,225 results, of which 16 were included in the meta-analysis. The pooled successful pregnancy rate was 23.52 % (16 studies, 95 % CI 6.48 to 44.79 %). When subgroup analysis of study types was performed, the successful pregnancy rate was higher amongst case series (47.02 %, 9 studies, 95 % CI 6.98 to 89.00 %) than cohort studies (14.64 %, 7 studies, 95 % CI 3.59 to 29.78 %). Sensitivity analysis limited to studies at low risk of bias revealed a similar pooled successful pregnancy rate of 23.35 % (12 studies, 95 % CI 2.50 to 51.96 %). CONCLUSIONS Approximately one quarter of women who underwent OTC for non-malignant indications had a successful pregnancy. These findings are clinically important for fertility preservation counselling by providing greater evidence for more informed care.
Collapse
Affiliation(s)
- T Finkelstein
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.
| | - Y Zhang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - B Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Women's and Newborn, Monash Health, Australia; Monash IVF Melbourne, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Women's and Newborn, Monash Health, Australia
| | - F Horta
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Data Future Institute, Monash University, Clayton, Australia; City Fertility, Australia
| |
Collapse
|
6
|
Kanamori R, Takae S, Ito K, Mukae A, Shimura M, Suzuki N. Significance and Influence of Suturing for Ovarian Tissue Transplantation. Reprod Sci 2024; 31:162-172. [PMID: 37674005 DOI: 10.1007/s43032-023-01320-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: 04/09/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
The purpose of this animal study was to verify the effect of suturing on graft function in ovarian tissue transplantation. Ovaries from 2-week-old rats were transplanted orthotopically into the ovaries of 8-week-old female Wistar rats. The various transplantation methods used were insertion into the ovarian bursa without suturing (group A: control), suturing with a single 6-0 Vicryl stitch (group B: 6-0*1), suturing with a single 10-0 Vicryl stitch (group C: 10-0*1), and suturing with three 10-0 Vicryl stitches (group D: 10-0*3). Two weeks after transplantation, the transplanted ovaries were evaluated histologically and for gene expression. Engraftment rates of the donor ovaries 14 days after transplantation were 62.5%, 100%, 91.7%, and 100% in groups A, B, C, and D, respectively, significantly lower in group A than in the other groups. In terms of gene expression, TNFα levels were significantly higher in group D, and GDF9 and follicle-stimulating hormone receptor (FSHR) levels were significantly lower in group D than in groups A and B. The number of primordial follicles evaluated by HE staining was significantly lower in groups B, C, and D than in group A. Compared to orthotopic transplantation without sutures, direct suturing to the host improved the engraftment rate, although increasing the number of sutures increased inflammatory marker levels and decreased the number of primordial follicles. We believe that it is important to perform ovarian tissue transplantation using optimal suture diameter for good adhesion, but with a minimum number of sutures to preserve ovarian function.
Collapse
Affiliation(s)
- Ryo Kanamori
- 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
| | - Kaoru Ito
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Azusa Mukae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Miyuki Shimura
- 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.
| |
Collapse
|
7
|
Houeis L, Dolmans MM. Summary of the ISFP congress, Brussels, 10-12 November, 2022. J Assist Reprod Genet 2023; 40:433-442. [PMID: 36765026 PMCID: PMC10033808 DOI: 10.1007/s10815-023-02720-3] [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: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
The 7th International Congress of the ISFP was held in Brussels in November 2022. Hundreds of attendees from all over the world had the rare opportunity to hear the most distinguished leaders discuss and debate the latest advances in the field. Participants were also able to attend workshops under the guidance of skilled practitioners. Numerous topics were considered, including a recap on fertility preservation approaches in cancer and benign pathologies and a section on male factor infertility. Other aspects covered were in vitro maturation and poor responders, the impact of chemotherapy on the ovary, and future perspectives. Participants had the chance to listen to a symposium on fertility preservation techniques, and finally, a keynote lecture on fertility preservation in gynecological cancers brought this prominent and highly influential event to a close.
Collapse
Affiliation(s)
- Lara Houeis
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
- Department of Gynecology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| |
Collapse
|
8
|
Liu F, Li M. BNIP3-mediated autophagy via the mTOR/ULK1 pathway induces primordial follicle loss after ovarian tissue transplantation. J Assist Reprod Genet 2023; 40:491-508. [PMID: 36869237 PMCID: PMC10033815 DOI: 10.1007/s10815-023-02765-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
PURPOSE To explore the underlying mechanism of primordial follicle loss in the early period following ovarian tissue transplantation (OTT). METHODS BNIP3 was selected through bioinformatic protocols, as the hub gene related to autophagy during OTT. BNIP3 and autophagy in mice ovarian grafts and in hypoxia-mimicking KGN cells were detected using immunohistochemistry, transmission electron microscopy (TEM), western blotting, qPCR, and fluorescence staining. The regulatory role played by BNIP3 overexpression and the silencing of KGN cells in autophagy via the mTOR/ULK1 pathway was investigated. RESULTS Ultrastructure examination showed that autophagic vacuoles increased after mice ovarian auto-transplantation. The BNIP3 and autophagy-related proteins (Beclin-1, LC3B, and SQSTM1/p62) in mice ovarian granulosa cells of primordial follicle from ovarian grafts were altered compared with the control. Administration of an autophagy inhibitor in mice decreased the depletion of primordial follicles. In vitro experiments indicated that BNIP3 and autophagy activity were upregulated in KGN cells treated with cobalt chloride (CoCl2). The overexpression of BNIP3 activated autophagy, whereas the silencing of BNIP3 suppressed it and reversed the autophagy induced by CoCl2 in KGN cells. Western blotting analysis showed the inhibition of mTOR and activation of ULK1 in KGN cells treated with CoCl2 and in the overexpression of BNIP3, and the opposite results following BNIP3 silencing. The activation of mTOR reversed the autophagy induced by BNIP3 overexpression. CONCLUSIONS BNIP3-induced autophagy is crucial in primordial follicle loss during OTT procedure, and BNIP3 is a potential therapeutic target for primordial follicle loss after OTT.
Collapse
Affiliation(s)
- Fengxia Liu
- Guangxi Medical University, Nanning, 530021 China
| | - Mujun Li
- Guangxi Medical University, Nanning, 530021 China
- Department of the Reproductive Medicine Research Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 China
| |
Collapse
|
9
|
Zhou E, Xiang D, Yu B, Yao H, Sun C, Wang Y. Ovarian tissue transplantation ameliorates osteoporosis and dyslipidaemia in ovariectomised mice. J Ovarian Res 2022; 15:139. [PMID: 36578058 PMCID: PMC9798584 DOI: 10.1186/s13048-022-01083-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Ovarian insufficiency frequently renders postmenopausal women susceptible to osteoporosis and dyslipidaemia. Postmenopausal transplant women are at a higher risk developing osteoporosis and dyslipidaemia due to the concomitant application of glucocorticoids and immunosuppressants after solid organ transplantation. Thus, this study aimed to explore the feasibility of ovarian tissue transplantation (OTT) as an alternative to Hormone replacement therapy (HRT) for postmenopausal women with solid organ transplant needs. RESULTS Sixty mice were randomly divided into four groups: sham operation, ovariectomised (OVX group), ovariectomy plus oestrogen (E2 group), and ovariectomy plus OTT (OTT group). The inhibin levels in the OTT group were increased and the follicle stimulating hormone and luteinizing hormone were suppressed to normal levels, which could not be achieved in the E2 group. The femoral bone mineral density in the OTT group was significantly increased than the E2 group (P < 0.05), and the probability of fracture was reduced by 1.4-2.6 times. Additionally, the high-density lipoprotein cholesterol levels were higher in the OTT group than in the E2 group and the triglyceride levels were lower in the OTT group than in the E2 group (P < 0.05). CONCLUSION OTT not only achieves certain endocrine effects by participating in the regulation of the hypothalamic-pituitary-ovarian feedback control loop, but also ameliorates osteoporosis and dyslipidaemia, which may be an alternative to traditional HRT for postmenopausal women with solid organ transplant needs.
Collapse
Affiliation(s)
- Encheng Zhou
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| | - Du Xiang
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| | - Bin Yu
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| | - Hanlin Yao
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| | - Chao Sun
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| | - Yanfeng Wang
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071 Wuhan, China
| |
Collapse
|
10
|
van der Perk MEM, van der Kooi ALLF, Bos AME, Broer SL, Veening MA, van Leeuwen J, van Santen HM, van Dorp W, van den Heuvel-Eibrink MM. Oncofertility Perspectives for Girls with Cancer. J Pediatr Adolesc Gynecol 2022; 35:523-526. [PMID: 35358705 DOI: 10.1016/j.jpag.2022.03.005] [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: 12/03/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Infertility is a serious early, as well as late, effect of childhood cancer treatment. If addressed in a timely manner at diagnosis, fertility preservation measures can be taken, preferably before the start of cancer treatment. However, pediatric oncologists might remain reluctant to offer counseling on fertility-preservation methods, although infrastructure to freeze ovarian tissue has become available and is currently considered standard care for pre- and postpubertal girls at high risk of gonadal damage. More importantly, risk factors have been identified for cancer treatment-related impairment of gonadal function, and the first successful pregnancies have been reported after autotransplanted ovarian tissue, which has been harvested from children. Additionally, great progress has been made in the field of ex vivo maturation of oocytes in frozen ovarian tissue, which provides opportunities for those at risk of ovarian micrometastasis. Hence, it is time to counsel girls at risk and make every effort to cryopreserve their ovarian tissue, now more than ever before.
Collapse
Affiliation(s)
| | | | - Annelies M E Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone L Broer
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jeanette van Leeuwen
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wendy van Dorp
- Department of Obstetrics and Gynecology, IJsselland Ziekenhuis, Rotterdam, the Netherlands
| | | |
Collapse
|
11
|
Naredi N, Talwar P, Karunakaran S. Failed ovarian cortex transplant but successful ovulation induction in a cancer survivor with premature ovarian failure: A paradox. Med J Armed Forces India 2022; 78:S326-S329. [PMID: 36147435 PMCID: PMC9485763 DOI: 10.1016/j.mjafi.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
Better diagnostic and treatment modalities for malignancies occurring in childhood and young age have increased the overall survival of the affected young girls and boys, but this has come at a cost of developing premature ovarian failure in girls and azoospermia in boys because of the gonadotoxicity of chemotherapy and radiotherapy. Thus, young girls and women of reproductive age who are at risk of ovarian failure due to cancer treatment must be mandatorily offered fertility preservation in any form such as cryopreservation of mature metaphase II oocytes after ovarian stimulation with gonadotropins and oocyte recovery and cryopreservation of embryos if the young female has a partner. However, these modalities may require the postponement of chemotherapy. Thus, in such instances, cryopreservation of ovarian tissue remains the only option. Herein, we report a case of a nulligravid young female patient who had stage IV Hodgkin's lymphoma and had to be taken up for immediate fertility preservation owing to the advanced stage of the disease. Therefore, cryopreservation of ovarian tissue was performed. The uniqueness of the case is that after remission of the disease was achieved with chemotherapy, transplantation of the ovarian tissue was carried out which was not successful, but the desire for motherhood prompted to carry out an ovulation induction in the remnant native ovary with a severely compromised ovarian reserve, and she conceived.
Collapse
Affiliation(s)
- Nikita Naredi
- Senior Adviser (Obst & Gyane) & ART Specialist, Assisted Reproductive Technology Centre, Command Hospital (Southern Command), Pune, India
| | - Pankaj Talwar
- Head Medical Services (Fertility and IVF), CK Birla Hospital, Gurugram, Haryana, India
| | - Sandeep Karunakaran
- Clinical Head and Senior Consultant (Obst & Gynae), Oasis Fertility, Banjara Hills, Hyderabad, India
| |
Collapse
|
12
|
Meng L, Sugishita Y, Nishimura S, Uekawa A, Suzuki-Takahashi Y, Suzuki N. Investigation of the optimal culture time for warmed bovine ovarian tissues before transplantation. Biol Reprod 2022; 107:1319-1330. [PMID: 35980811 DOI: 10.1093/biolre/ioac161] [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: 12/12/2021] [Revised: 04/25/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Ovarian tissue cryopreservation by vitrification is an effective technique, but there are still many unresolved issues related to the procedure. The aim of this study was to investigate the optimal culture time of post-warmed ovarian tissues and their viability before ovarian tissue transplantation. The bovine ovarian tissues were used to evaluate the effect of post-warming culture periods (0, 0.25, 0.5, 1, 2, 5 and 24 hours) in the levels of residual cryoprotectant, LDH release, ROS generation, gene and protein abundance, and follicle viability and its mitochondrial membrane potential. Residual cryoprotectant (CPA) concentration decreased significantly after 1 hour of culture. The warmed ovarian tissues that underwent between 0 to 2 hours of culture time showed similar LDH and ROS levels compared to fresh non-frozen tissues. The AMH transcript abundance did not differ in any of the groups. No increase in the relative transcript abundance and protein level of Caspase 3 and Cleaved-Caspase 3, respectively, in the first 2 hours of culture after warming. On the other hand, an increased protein level of double stranded DNA breaks (gamma-H2AX) was observed in post-warmed tissues disregarding the length of culture time, and a temporary reduction in pan-AKT was detected in post-warming tissues between 0 to 0.25 hours of culture time. Prolonged culture time lowered the percentage of viable follicles in warmed tissues, but it did not seem to affect the follicular mitochondrial membrane potential. In conclusion, 1 to 2 hours of culture time would be optimal for vitrified-warmed tissues before transplantation.
Collapse
Affiliation(s)
- Lingbo Meng
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yodo Sugishita
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Frontier Medicine, Institute of Medical Science, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Sandy Nishimura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Atsushi Uekawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuki Suzuki-Takahashi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Frontier Medicine, Institute of Medical Science, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
13
|
Dietl AK, Dittrich R, Hoffmann I, Denschlag D, Hanjalic-Beck A, Müller A, Beckmann MW, Lotz L. Does it make sense to refreeze ovarian tissue after unexpected occurrence of endometriosis when transplanting the tissue? J Ovarian Res 2022; 15:53. [PMID: 35513873 PMCID: PMC9074247 DOI: 10.1186/s13048-022-00972-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ovarian insufficiency is a major concern for long-term cancer survivors. Ovarian tissue cryopreservation for fertility preservation is an emerging technique that has proven successful over the past decade through transplantation of frozen-thawed ovarian tissue. Compared to other established techniques, such as oocyte freezing, ovarian tissue cryopreservation preserves actual organ function and thus the production of sex hormones. Endometriosis in perimenopausal women is rare, however it can be surprising diagnosis in the planned transplantation of cryopreserved ovarian tissue and the already thawed tissue may not be transplanted, so that it has to be refrozen. Results Ovarian function returned in the patient two months after transplantation, as shown by estrogen production. Ten months after the ovarian tissue transplantation mild stimulation with FSH was initiated in accordance with a low-dose protocol. When ultrasonography revealed a follicle 17 mm in size in the ovarian graft, hCG was added and after follicular puncture one oocyte was obtained. The oocyte could be fertilized by IVF and transferred to the uterus. On day 14 after embryo-transfer, a positive hCG-Level was detected and after an uncomplicated pregnancy a healthy child was delivered. Conclusions We report the first pregnancy and live birth achieved using transplantation of thawed and refrozen ovarian tissue in a woman treated by chemotherapy and subsequent endometriosis surgery. Refreezing of cryopreserved ovarian tissue is not a hindrance to successful transplantation of ovarian tissue. Against the background of increasing numbers of candidates for transplantation of ovarian tissue is expected that the combination chemotherapy followed by endometriosis will increase.
Collapse
Affiliation(s)
- Anna K Dietl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Aida Hanjalic-Beck
- Center for Gynecologic Endocrinology and Reproductive Medicine, Freiburg, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Municipal-Hospital, Karlsruhe, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| |
Collapse
|
14
|
Terren C, Bindels J, Nisolle M, Noël A, Munaut C. Evaluation of an alternative heterotopic transplantation model for ovarian tissue to test pharmaceuticals improvements for fertility restoration. Reprod Biol Endocrinol 2022; 20:35. [PMID: 35183206 PMCID: PMC8857804 DOI: 10.1186/s12958-022-00910-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/13/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ovarian tissue cryopreservation and transplantation (OTCTP) is currently the main option available to preserve fertility in prepubertal patients undergoing aggressive cancer therapy treatments. However, a major limitation of OTCTP is follicle loss after transplantation. The mouse is a model of choice for studying ovarian function and follicle development after ovarian tissue grafting in vivo. In these mouse models, ovarian tissue or ovaries can be transplanted to different sites. Our aim was to evaluate a new alternative to heterotopic transplantation models that could be useful to test pharmaceutical improvement for ovarian grafts after OTCTP. METHODS Slow frozen murine whole ovaries were transplanted into the mouse ears (between the external ear skin layer and the cartilage). Ovarian transplants were recovered after 3, 14 or 21 days. Grafts were analyzed by immunohistochemistry and follicle density analyses were performed. RESULTS An increase of ovarian vascularization (CD31 and Dextran-FITC positive staining), as well as cellular proliferation (Ki67 staining) were observed 3 weeks after transplantation in comparison to 3 days. Fibrosis density, evaluated after Van Gieson staining, decreased 3 weeks after transplantation. Furthermore, transplantation of cryopreserved ovaries into ovariectomized mice favored follicle activation compared to transplantation into non-ovariectomized mice. CONCLUSION The present study indicates that surgical tissue insertion in the highly vascularized murine ear is an effective model for ovarian grafting. This model could be helpful in research to test pharmaceutical strategies to improve the function and survival of cryopreserved and transplanted ovarian tissue.
Collapse
Affiliation(s)
- Carmen Terren
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, Tour de Pathologie , Site Sart-Tilman, Building 23/4, Avenue Hippocrate, 13, 4000, Liege, Belgium
| | - Jules Bindels
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, Tour de Pathologie , Site Sart-Tilman, Building 23/4, Avenue Hippocrate, 13, 4000, Liege, Belgium
| | - Michelle Nisolle
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, Tour de Pathologie , Site Sart-Tilman, Building 23/4, Avenue Hippocrate, 13, 4000, Liege, Belgium
- Department of Obstetrics and Gynecology, Hôpital de La Citadelle, University of Liège, B-4000, Liège, Belgium
| | - Agnès Noël
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, Tour de Pathologie , Site Sart-Tilman, Building 23/4, Avenue Hippocrate, 13, 4000, Liege, Belgium
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, Tour de Pathologie , Site Sart-Tilman, Building 23/4, Avenue Hippocrate, 13, 4000, Liege, Belgium.
| |
Collapse
|
15
|
Damous LL, Shiroma ME, Carvalho AETSD, Soares-Jr JM, Krieger JE, Baracat EC. Gene expression profile in experimental frozen-thawed ovarian grafts treated with scaffold-base delivery of adipose tissue-derived stem cells. Clinics (Sao Paulo) 2022; 77:100066. [PMID: 35777300 PMCID: PMC9253596 DOI: 10.1016/j.clinsp.2022.100066] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Gelfoam scaffold is a feasible and safe non-invasive technique for Adipose tissue-derived Stem Cell (ASC)-delivery in the treatment of frozen-thawed ovarian autografts. This study seeks to analyze the genes expression profile of rat frozen-thawed ovarian autografts treated with scaffold-based delivery of adipose tissue-derived stem cells. METHODS Eighteen adult Wistar rats were distributed into three groups: Control (frozen-thawed only); Group 1 (G1) and Group 2 (G2) (frozen-thawed ovaries treated with culture medium or ASC, respectively). Both treatments were performed immediately after autologous retroperitoneal transplant with scaffold-based delivery. The ovarian grafts were retrieved 30 days after transplantation. Quantitative gene expression (qPCR) for apoptosis, angiogenesis, and inflammatory cytokines (84 genes in each pathway) were evaluated by RT-PCR. Graft morphology (HE), apoptosis (cleaved-caspase-3), neoangiogenesis (VEGF), and cellular proliferation (Ki-67) were assessed. RESULTS In grafts treated with ASC, the apoptosis pathway showed the highest number of genes over-regulated - 49 genes - compared to inflammation cytokines and angiogenesis pathway - 36 and 23 genes respectively, compared to grafts treated with culture medium. Serpinb5 family was highlighted in the angiogenesis pathway and Cxcl6 in the inflammation cytokines pathway. In the apoptosis pathway, the most over-regulated gene was Capsase14. ASC treatment promoted the reduction of cleaved caspase-3 in the theca internal layer and increased cell proliferation by Ki-67 in the granulosa layer without altering VEGF. A mild inflammatory infiltrate was observed in both groups. CONCLUSION ASC therapy in rat frozen-thawed ovarian autografts promoted an abundance of genes involved with apoptosis and inflammatory cytokines without compromising the ovary graft morphology and viability for short time. Further studies are necessary to evaluate the repercussion of apoptosis and inflammation on the graft in the long term.
Collapse
Affiliation(s)
- Luciana Lamarão Damous
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcos Eiji Shiroma
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Elisa Teófilo Saturi de Carvalho
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração (Incor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Maria Soares-Jr
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Eduardo Krieger
- Laboratório de Genética e Cardiologia Molecular, Instituto do Coração (Incor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund C Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
16
|
Meng L, Kawamura K, Yoshioka N, Tamura M, Furuyama S, Nakajima M, Suzuki-Takahashi Y, Iwahata H, Takae S, Sugishita Y, Horage-Okutsu Y, Suzuki N. Learning curve of surgeons performing laparoscopic ovarian tissue transplantation in women with premature ovarian insufficiency: A statistical process control analysis. J Minim Invasive Gynecol 2021:S1553-4650(21)01332-7. [PMID: 34958952 DOI: 10.1016/j.jmig.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To analyze patient safety in laparoscopic ovarian tissue transplantation surgery by tracking the rate of postoperative complications and the learning curves of the surgeons by statistical process control (SPC) analysis. DESIGN A retrospective study. SETTING A university-affiliated hospital. PATIENTS One hundred patients with premature ovarian insufficiency (POI) who underwent ovarian tissue cryopreservation by vitrification and then autologous transplantation of frozen-thawed ovarian tissues with in vitro activation (IVA). INTERVENTION Ovarian tissue cryopreservation, in vitro activation and transplantation. MEASUREMENTS AND MAIN RESULTS We assessed the surgery complications, differences in total surgery time, transplantation time, and transplantation time per ovarian sheet in operations performed by 3 experienced laparoscopic surgeons. Surgeon A performed 80 operations; surgeon B, 29 operations; and surgeon C, 20 operations. Complications occurred in 1.55% of the procedures. While all three surgeons' performance never fell below the unacceptable failure limit, only surgeon A became competent after 66 cases. CONCLUSION The laparoscopic ovarian tissue transplantation surgery was generally safe as the postoperative complications were infrequent (1.55%). Although the performance of all 3 surgeons was acceptable, only surgeon A attained the level of competency after 66 cases. The transplantation method may not be the key factor for reducing surgery time in this surgery. An efficient OTT team is more important in reducing the surgery time than the surgeon's surgical technique alone.
Collapse
|
17
|
Isachenko V, Isachenko E, Mallmann P, Rahimi G. High cryo-resistance of SARS-CoV-2 virus: Increased risk of re-contamination at transplantation of cryopreserved ovarian tissue after COVID-19 pandemic. Cryobiology 2021; 103:1-6. [PMID: 34571024 DOI: 10.1016/j.cryobiol.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
Cryopreservation and re-transplantation of ovarian tissue after anticancer treatment is important medical technology. Today, during a pandemic, the risk of contamination of transplanted cells with SARS-CoV-2 virus is extremely high. Data about cryo-resistance (virulence and/or infectivity) of SARS-CoV-2 are limited. Analysis and systematization of literature data allow us to draw the following conclusions: 1) The cytoplasmic membrane of somatic cell, like envelope of corona viruses, consists of lipid bilayer and this membrane, like envelope of corona virus, contains membrane proteins. Thus, we can consider the cytoplasmic membrane of an ordinary somatic cell as a model of the envelope membrane of SARS-CoV-2. It is expected that the response of the virus to cryopreservation is similar to that of a somatic cell. SARS-CoV-2 is more poor-water and more protein-rich than somatic cell, and this virus is much more cryo-resistant. 2) The exposure of somatic cells at low positive temperatures increases a viability of these cells. The safety of the virus is also in direct proportion to the decrease in temperature: the positive effect of low temperatures on SARS-CoV-2 virus has been experimentally proven. 3) Resistance of SARS-CoV-2 to cryoprotectant-free cryopreservation is extremely high. The high viability rate of SARS-CoV-2 after freezing-drying confirms its high cryo-resistance. 4) The risk of SARS-CoV-2 infection after transplantation of cryopreserved ovarian tissues that have been contaminated with this virus, increases significantly. Our own experimental data on the increase in the viability of cancer cells after cryopreservation allow us to formulate a hypothesis about increasing of viability (virulence and/or infectivity) of SARS-CoV-2 virus after cryopreservation.
Collapse
|
18
|
Cacciottola L, Donnez J, Dolmans MM. Ovarian tissue damage after grafting: systematic review of strategies to improve follicle outcomes. Reprod Biomed Online 2021; 43:351-369. [PMID: 34384692 DOI: 10.1016/j.rbmo.2021.06.019] [Citation(s) in RCA: 3] [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: 03/15/2021] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 12/17/2022]
Abstract
Frozen-thawed human ovarian tissue endures large-scale follicle loss in the early post-grafting period, characterized by hypoxia lasting around 7 days. Tissue revascularization occurs progressively through new vessel invasion from the host and neoangiogenesis from the graft. Such reoxygenation kinetics lead to further potential damage caused by oxidative stress. The aim of the present manuscript is to provide a systematic review of proangiogenic growth factors, hormones and various antioxidants administered in the event of ovarian tissue transplantation to protect the follicle pool from depletion by boosting revascularization or decreasing oxidative stress. Although almost all investigated studies revealed an advantage in terms of revascularization and reduction in oxidative stress, far fewer demonstrated a positive impact on follicle survival. As the cascade of events driven by ischaemia after transplantation is a complex process involving numerous players, it appears that acting on specific molecular mechanisms, such as concentrations of proangiogenic growth factors, is not enough to significantly mitigate tissue damage. Strategies exploiting the activated tissue response to ischaemia for tissue healing and remodelling purposes, such as the use of antiapoptotic drugs and adult stem cells, are also discussed in the present review, since they yielded promising results in terms of follicle pool protection.
Collapse
Affiliation(s)
- Luciana Cacciottola
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques Donnez
- Prof. Emeritus, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Department of Gynecology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| |
Collapse
|
19
|
Manavella DD, Herraiz S, Soares M, Buigues A, Pellicer A, Donnez J, Díaz-García C, Dolmans MM. Disease-inducing potential of two leukemic cell lines in a xenografting model. J Assist Reprod Genet 2021; 38:1589-1600. [PMID: 33786735 PMCID: PMC8266930 DOI: 10.1007/s10815-021-02169-2] [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: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Cryopreserved ovarian tissue transplant restores ovarian function in young cancer patients after gonadotoxic treatment. However, leukemia is associated with increased risk of malignant cell transmission. We aimed to assess the tumor-inducing potential of two different leukemic cell lines when xenografted to immunodeficient mice. METHODS Fifty-four female immunodeficient mice were grafted with either 100, 200, 500, 1000, and 10,000 chronic myeloid leukemia in blast crisis (BV-173) cells or relapsed acute lymphoblastic leukemia (RCH-ACV) cells, embedded inside a fibrin scaffold along with 50,000 human ovarian stromal cells. Two mice per cell line received the fibrin matrix without leukemic cells as negative controls. Clinical signs of disease were monitored for 20 weeks. Grafts, liver tissue, and masses were collected for macroscopic analysis and gene expression of BCR-ABL1 and E2A-PBX fusion transcripts present in BV-173 and RCH-ACV respectively. RESULTS BV-173 cells: Mice grafted with 100, 200, or 500 cells showed no sign of disease after and were negative for BCR-ABL1 expression. Three of the 5 animals grafted with 1000 cells and all mice with 10,000 cells developed disease and showed BCR-ABL1-positive expression. RCH-ACV cells: Two out of 4 mice grafted with 100 cells developed disease and were E2A-PBX1-positive. All the animals grafted with higher cell doses showed signs of disease and all but one were E2A-PBX1-positive. CONCLUSION The present work proves that the disease-inducing potential of BV-173 and RCH-ACV leukemic cells xenografted to SCID mouse peritoneum differs between cell lines, depending on cell number, type, status, and cytogenetic disease profile when ovarian tissue is harvested.
Collapse
MESH Headings
- Animals
- Cell Line, Tumor
- Cryopreservation
- Disease Models, Animal
- Female
- Fertility Preservation/methods
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Neoplastic/genetics
- Heterografts
- Homeodomain Proteins/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Mice
- Oncogene Proteins, Fusion/genetics
- Ovarian Follicle/transplantation
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Translocation, Genetic/genetics
- Transplantation, Heterologous
- Transplants/growth & development
- Transplants/metabolism
Collapse
Affiliation(s)
- D D Manavella
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
- Neolife-Medicina y Cirugía Reproductiva, Brasilia 760, 1434, Asunción, Paraguay
| | - Sonia Herraiz
- IVI Foundation-Instituto de Investigación Sanitaria Hospital La Fe (IIS La Fe), Valencia, Spain.
| | - M Soares
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - A Buigues
- IVI Foundation-Instituto de Investigación Sanitaria Hospital La Fe (IIS La Fe), Valencia, Spain
| | - A Pellicer
- IVI Foundation-Instituto de Investigación Sanitaria Hospital La Fe (IIS La Fe), Valencia, Spain
| | - J Donnez
- Society for Research into Infertility, Brussels, Belgium
| | - C Díaz-García
- IVI Foundation-Instituto de Investigación Sanitaria Hospital La Fe (IIS La Fe), Valencia, Spain
- IVI London, IVIRMA Global, London, W1G 9RQ, UK
- Department of Reproductive Health, UCL, London, WC1E 6AU, UK
| | - M M Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
- Gynecology Department, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium
| |
Collapse
|
20
|
Vatel M, Torre A, Paillusson B, Scheffler F, Bergere M, Benkhalifa M, Le Martelot MT, Leperlier F, Mirallié S, Selleret L, Prades-Borio M, Neuraz A, Barraud-Lange V, Boissel N, Fortin A, Poirot C. Efficacy of assisted reproductive technology after ovarian tissue transplantation in a cohort of 11 patients with or without associated infertility factors. J Assist Reprod Genet 2021; 38:503-511. [PMID: 33389379 DOI: 10.1007/s10815-020-02033-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/02/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE IVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor reproductive outcomes. The aim of this study was to evaluate the efficacy of ovarian tissue transplantation (OTT) followed by assisted reproductive technology (ART) in women with or without associated infertility factors. METHODS This is a prospective cohort study with retrospective data collection including eleven women, four of whom having an infertility factor (IF), who had undergone OTT in one university center between 2005 and 2017, followed by ART in six in vitro fertilization (IVF) centers. RESULTS In total, 25 of the 85 cycles initiated (29%) were canceled, resulting in 60 oocyte retrievals. Ninety-five oocytes were retrieved: 36 were abnormal or immature, 29/39 fertilized (74%) after ICSI and 13/20 (65%) after IVF. Thirty-five embryos were transferred in seven patients (5/7 patients without IF and 2/4 patients with IF). After ART, one patient with IF experienced two pregnancies, one resulting in a live birth. For all patients, pregnancy rates and live birth rates were 7.4% and 3.7% per embryo transfer, respectively. Nine pregnancies and four live births occurred after spontaneous conception in five patients without IF, none in the infertility group. CONCLUSION This study confirms that IVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor outcomes. However, the chances of natural conception are high in women without IF. Patients with IF, without the possibility of spontaneous pregnancy, should be informed of poor reproductive outcomes after OTT followed by ART. TRIAL REGISTRATION NUMBER NCT02184806.
Collapse
Affiliation(s)
- M Vatel
- Department of Reproductive Medicine, Clinique de la Muette, 75116, Paris, France
| | - A Torre
- Division of Child Health, Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - B Paillusson
- Department of Reproductive Medicine, Poissy Saint-Germain-en-Laye Hospital, 78300, Poissy, France
| | - F Scheffler
- Department of Reproductive Medicine, Amiens Hospital, 80054, Amiens, France
| | - M Bergere
- Department of Reproductive Biology, Poissy Saint-Germain-en-Laye Hospital, 78300, Poissy, France
| | - M Benkhalifa
- Medicine and Reproductive Biology, University Hospital and School of Medicine, Picardy Jules Verne University, 80054, Amiens, France.,Peritox-INERIS, UMR-I 01, Joint Research Centre, Picardy Jules Verne University, 80054, Amiens, France
| | - M-T Le Martelot
- Department of Reproductive Medicine, Brest Hospital, 29200, Brest, France
| | - F Leperlier
- Department of Reproductive Medicine and Biology, Nantes Hospital, 44000, Nantes, France
| | - S Mirallié
- Department of Reproductive Medicine and Biology, Nantes Hospital, 44000, Nantes, France
| | - L Selleret
- Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris (AP-HP), Tenon Hospital, 75020, Paris, France
| | - M Prades-Borio
- Department of Reproductive Biology, Assistance Publique des Hôpitaux de Paris (AP-HP), Tenon Hospital, 75020, Paris, France
| | - A Neuraz
- Department of Gynecology and Obstetrics, Les Bluets Hospital, 75012, Paris, France
| | - V Barraud-Lange
- Department of Reproductive Biology, Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Hospital, 75014, Paris, France
| | - N Boissel
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Paris University, EA3518, 75006, Paris, France
| | - A Fortin
- Department of Obstetrics and Gynecology, Assistance Publique des Hôpitaux de Paris (AP-HP), Pitié-Salpétrière Hospital, 75013, Paris, France
| | - C Poirot
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France. .,Médecine Sorbonne University, 75005, Paris, France.
| |
Collapse
|
21
|
Cacciottola L, Courtoy GE, Nguyen TYT, Hossay C, Donnez J, Dolmans MM. Adipose tissue-derived stem cells protect the primordial follicle pool from both direct follicle death and abnormal activation after ovarian tissue transplantation. J Assist Reprod Genet 2021; 38:151-61. [PMID: 33184773 DOI: 10.1007/s10815-020-02005-z] [Citation(s) in RCA: 4] [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: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate whether adipose tissue-derived stem cells (ASCs) protect the primordial follicle pool, not only by decreasing direct follicle loss but also by modulating follicle activation pathways. METHODS Twenty nude mice were grafted with frozen-thawed human ovarian tissue from 5 patients. Ten mice underwent standard ovarian tissue transplantation (OT group), while the remaining ten were transplanted with ASCs and ovarian tissue (2-step/ASCs+OT group). Ovarian grafts were retrieved on days 3 (n = 5) and 10 (n = 5). Analyses included histology (follicle count and classification), immunohistochemistry (c-caspase-3 for apoptosis and LC3B for autophagy), and immunofluorescence (FOXO1 for PI3K/Akt activation and YAP for Hippo pathway disruption). Subcellular localization was determined in primordial follicles on high-resolution images using structured illumination microscopy. RESULTS The ASCs+OT group showed significantly higher follicle density than the OT group (p = 0.01). Significantly increased follicle atresia (p < 0.001) and apoptosis (p = 0.001) were observed only in the OT group. In primordial follicles, there was a significant shift in FOXO1 to a cytoplasmic localization in the OT group on days 3 (p = 0.01) and 10 (p = 0.03), indicating follicle activation, while the ASCs+OT group and non-grafted controls maintained nuclear localization, indicating quiescence. Hippo pathway disruption was encountered in primordial follicles irrespective of transplantation, with nuclear YAP localized in their granulosa cells. CONCLUSION We demonstrate that ASCs exert positive effects on the ovarian reserve, not only by protecting primordial follicles from direct death but also by maintaining their quiescence through modulation of the PI3K/Akt pathway.
Collapse
|
22
|
Lotz L, Barbosa PR, Knorr C, Hofbeck L, Hoffmann I, Beckmann MW, Antoniadis S, Dittrich R. The safety and satisfaction of ovarian tissue cryopreservation in prepubertal and adolescent girls. Reprod Biomed Online 2020; 40:547-554. [PMID: 32199797 DOI: 10.1016/j.rbmo.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 01/18/2023]
Abstract
RESEARCH QUESTION Is ovarian tissue cryopreservation (OTC) for fertility preservation in prepubertal and adolescent girls safe, and who would benefit most from the procedure? DESIGN Survey and retrospective study including patients who had OTC under the age of 18 years in a single centre for fertility preservation. Serum anti-Müllerian hormone levels were measured as a marker for detection of diminished ovarian reserve. RESULTS Fifty-three from 102 women participated in the survey (12 deceased, 19 declined, 17 unreachable, 1 palliative). The average age at OTC was 14.8 ± 2.3 (range: 6-17) years and at survey 21.9 ± 4.3 (range: 16-33) years. Ovarian tissue retrieval (laparoscopy: n = 45, laparotomy: n = 8) was without complications in 52 cases. In 23 (53.5%) of the 43 women who were post-menarchal at OTC, transient amenorrhoea occurred. At survey, 15 women reported a regular menstrual cycle, 25 used oral contraceptives, 9 women reported hormone replacement therapy due to primary ovary insufficiency and 4 had amenorrhoea. Two patients reported the birth of a healthy child after IVF, while 51 patients are still childless, mostly due to their young age (mean: 21.2 years). To date, one patient has had transplantation of the ovarian tissue (17 years at cryopreservation). Forty-nine of the interviewees would again decide on OTC, while three argued against it on the basis of the previous financial cost; one woman was unsure. CONCLUSIONS Children with cancer may be at risk for gonadal insufficiency. OTC is practically the only technique that can be offered to young girls. The procedure is safe and well accepted.
Collapse
Affiliation(s)
- Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
| | - Patricia Reis Barbosa
- Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St Hedwig, Hospital Barmherzige Brüder Regensburg, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Christian Knorr
- Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St Hedwig, Hospital Barmherzige Brüder Regensburg, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Louisa Hofbeck
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Sophia Antoniadis
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany
| |
Collapse
|
23
|
Masciangelo R, Hossay C, Chiti MC, Manavella DD, Amorim CA, Donnez J, Dolmans MM. Role of the PI3K and Hippo pathways in follicle activation after grafting of human ovarian tissue. J Assist Reprod Genet 2019; 37:101-108. [PMID: 31732846 DOI: 10.1007/s10815-019-01628-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/05/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Our aim was to elucidate the mechanisms involved in follicle activation of the ovarian reserve after human ovarian tissue transplantation, with specific focus on the role of the effectors of the PI3K (mTOR and FOXO1) and Hippo (YAP) signaling pathways and whether they are somehow altered. METHODS Frozen-thawed ovarian tissue was collected from six women (age 25-35 years) undergoing surgery for non-ovarian pathologies and divided into 4 fragments in each case: one for non-grafted controls and three for grafting to immunodeficient mice for 3, 7 and 21 days. The tissue was processed for hematoxylin and eosin staining, immunohistochemistry and immunofluorescence at different timepoints before and after grafting. Activation of the PI3K and Hippo signaling pathways was investigated by analysis of mTOR phosphorylation, FOXO1 cytoplasmic localization and YAP nuclear localization. RESULTS No change in mTOR levels was observed in primordial follicles post-transplantation, but a significant upturn was recorded in growing follicles compared with primordial follicles, irrespective of grafting time. A higher percentage of primordial follicles was also found with FOXO1 in the cytoplasm after 3 days of transplantation than in non-grafted controls. Finally, a greater proportion of primordial follicles was detected with YAP in the nucleus at all timepoints after grafting. CONCLUSIONS This study supports the hypothesis that follicle activation may occur as an early event after transplantation, with follicle growth and death both contributing to the burnout phenomenon. This is the first time that the effectors of the PI3K and Hippo pathways have been investigated in grafted human ovarian tissue and their role in burnout documented.
Collapse
Affiliation(s)
- Rossella Masciangelo
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Camille Hossay
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Maria Costanza Chiti
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Diego Daniel Manavella
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Christiani Andrade Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium
| | - Jacques Donnez
- Société de Recherche pour l'Infertilité, Avenue Grandchamp 143, 1150, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte. B1.52.02, 1200, Brussels, Belgium.
- Département de Gynécologie, Cliniques Universitaires St. Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| |
Collapse
|
24
|
Liebenthron J, Montag M, Reinsberg J, Köster M, Isachenko V, van der Ven K, van der Ven H, Krüssel JS, von Wolff M. Overnight ovarian tissue transportation for centralized cryobanking: a feasible option. Reprod Biomed Online 2019; 38:740-749. [PMID: 30733076 DOI: 10.1016/j.rbmo.2019.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 06/18/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
RESEARCH QUESTION Is overnight transportation of ovarian tissue before cryopreservation in a centralized cryobank from the FertiPROTEKT network feasible? DESIGN Data from 1810 women with cryopreserved ovarian tissue after overnight transportation from December 2000 to December 2017 were analysed with a focus on transportation, tissue activity parameters and pregnancy, and delivery rates after transplantation. RESULTS A total of 92.4% of tissue samples arrived at ideal temperatures of 2-8°C, 0.4% were transported at temperatures lower than ideal and 6.4% were transported at temperatures that were too high, generally due to mishandling of the inlayed cool packs of the transportation boxes. In 62 women, 78 tissue transplantations were carried out. A subgroup of 30 women who underwent a single orthotopic transplantation with fulfilled criteria of a complete follow-up after transplantation until the end of study, a premature ovarian insufficiency after gonadotoxic therapy as well as the absence of pelvic radiation, was further analysed. In this group, transplantations into a peritoneal pocket accounted for 90%. Transplants were still active at 1 year and above after transplantation in 93.3%. Pregnancy and delivery rates were 46.7% and 43.3%, respectively, with one ongoing pregnancy at the end of the study. CONCLUSIONS Overnight transportation for central cryobanking is a feasible concept that results in high reproducible success rates through standardized professional tissue freezing and storage.
Collapse
Affiliation(s)
- Jana Liebenthron
- UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD, University Women's Hospital Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany.
| | - Markus Montag
- Ilabcomm GmbH, Eisenachstr. 34, Augustin 53757 St., Germany
| | - Jochen Reinsberg
- Department of Gynecological Endocrinology and Reproductive Medicine, University Clinic Bonn, Sigmund-Freud-Str. 25, Bonn 53125, Germany
| | - Maria Köster
- KWZ Germany GmbH, Joseph-Schumpeter-Allee 1, Bonn 53227, Germany
| | - Vladimir Isachenko
- Department of Gynecological Endocrinology and Reproductive Medicine, University Clinic Cologne, Kerpener Straße 34, Cologne 50931, Germany
| | - Katrin van der Ven
- MVZ für Frauenheilkunde und IvF-Medizin Bonn GbR, Godesberger Allee 64, Bonn 53175, Germany
| | - Hans van der Ven
- MVZ für Frauenheilkunde und IvF-Medizin Bonn GbR, Godesberger Allee 64, Bonn 53175, Germany
| | - Jan-Steffen Krüssel
- UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD, University Women's Hospital Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany
| | - Michael von Wolff
- University Women's Hospital Bern, Division of Gynecological Endocrinology and Reproductive Medicine, Effingerstrasse 102, Bern 3010, Switzerland
| |
Collapse
|
25
|
Fransolet M, Noël L, Henry L, Labied S, Blacher S, Nisolle M, Munaut C. Evaluation of Z-VAD-FMK as an anti-apoptotic drug to prevent granulosa cell apoptosis and follicular death after human ovarian tissue transplantation. J Assist Reprod Genet 2019; 36:349-59. [PMID: 30390176 DOI: 10.1007/s10815-018-1353-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the efficiency of ovarian tissue treatment with Z-VAD-FMK, a broad-spectrum caspase inhibitor, to prevent follicle loss induced by ischemia/reperfusion injury after transplantation. METHODS In vitro, granulosa cells were exposed to hypoxic conditions, reproducing early ischemia after ovarian tissue transplantation, and treated with Z-VAD-FMK (50 μM). In vivo, cryopreserved human ovarian fragments (n = 39) were embedded in a collagen matrix containing or not Z-VAD-FMK (50 μM) and xenotransplanted on SCID mice ovaries for 3 days or 3 weeks. RESULTS In vitro, Z-VAD-FMK maintained the metabolic activity of granulosa cells, reduced HGL5 cell death, and decreased PARP cleavage. In vivo, no improvement of follicular pool and global tissue preservation was observed with Z-VAD-FMK in ovarian tissue recovered 3-days post-grafting. Conversely, after 3 weeks of transplantation, the primary follicular density was higher in fragments treated with Z-VAD-FMK. This improvement was associated with a decreased percentage of apoptosis in the tissue. CONCLUSIONS In situ administration of Z-VAD-FMK slightly improves primary follicular preservation and reduces global apoptosis after 3 weeks of transplantation. Data presented herein will help to guide further researches towards a combined approach targeting multiple cell death pathways, angiogenesis stimulation, and follicular recruitment inhibition.
Collapse
|
26
|
Kim S, Lee Y, Lee S, Kim T. Ovarian tissue cryopreservation and transplantation in patients with cancer. Obstet Gynecol Sci 2018; 61:431-42. [PMID: 30018897 DOI: 10.5468/ogs.2018.61.4.431] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 09/07/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 12/31/2022] Open
Abstract
Chemotherapy and radiotherapy improved survival rates of patients with cancer. However, they can cause ovarian failure and infertility in women of reproductive age. Infertility following cancer treatment is considered a major quality of life issue. Ovarian tissue cryopreservation and transplantation is an important option for fertility preservation in adult patients with cancer who need immediate chemotherapy or do not want to undergo ovarian stimulation. Ovarian tissue freezing is the only option for preserving the fertility of prepubertal patients with cancer. In a recent review, it was reported that frozen-thawed ovarian transplantation has lead to about 90 live births and the conception rate was about 30%. Endocrine function recovery was observed in 92.9% between 3.5 and 6.5 months after transplantation. Based on our review, ovarian tissue cryopreservation and transplantation may be carefully considered before cancer treatment in order to preserve fertility and endocrine function in young cancer survivors.
Collapse
|
27
|
Takae S, Tsukada K, Maeda I, Okamoto N, Sato Y, Kondo H, Shinya K, Motani Y, Suzuki N. Preliminary human application of optical coherence tomography for quantification and localization of primordial follicles aimed at effective ovarian tissue transplantation. J Assist Reprod Genet 2018; 35:627-636. [PMID: 29607457 PMCID: PMC5949120 DOI: 10.1007/s10815-018-1166-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/20/2017] [Accepted: 03/15/2018] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the possible clinical application of optical coherence tomography for assessing ovarian reserve in individual specimens of human ovarian tissue for fertility preservation. Methods Ovarian tissue examination by optical coherence tomography was performed before ovarian tissue cryopreservation. Three of the four subjects had hematological disease or cancer, and they faced a threat to their fertility due to impending chemotherapy. One patient underwent ovarian tissue extraction for in vitro activation of dormant follicles as fertility treatment. Results The current full-field optical coherence tomography technique can detect primordial follicles in non-fixed and non-embedded human ovarian tissue. These images are well correlated with histological evaluation and the ovarian reserve test, including follicle counts. Conclusion It was demonstrated that optical coherence tomography could assess localization of primordial follicles and ovarian reserve in specimens of non-fixed human ovarian cortex, although optimization for examination of human ovarian tissue is needed for clinical application. Additionally, this technique holds the possibility of assessing the ovarian reserve of patients with unevaluable ovarian reserve. Trial registration number UMIN000023141
Collapse
Affiliation(s)
- Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Kosuke Tsukada
- Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Naoki Okamoto
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yorino Sato
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Haruhiro Kondo
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Kiemi Shinya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yuki Motani
- Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan.
| |
Collapse
|
28
|
Lee DM, Thomas CM, Xu F, Yeoman RR, Xu J, Stouffer RL, Wolf DP, Zelinski MB. Subcutaneous ovarian tissue transplantation in nonhuman primates: duration of endocrine function and normalcy of subsequent offspring as demonstrated by reproductive competence, oocyte production, and telomere length. J Assist Reprod Genet 2017; 34:1427-34. [PMID: 28942525 DOI: 10.1007/s10815-017-1019-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/03/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The main purposes of the study were to investigate the endocrine function of ovarian tissue transplanted to heterotopic subcutaneous sites and the reproductive competence and telomere length of a nonhuman primate originating from transplanted tissue. METHODS Ovarian cortex pieces were transplanted into the original rhesus macaques in the arm subcutaneously, in the abdomen next to muscles, or in the kidney. Serum estradiol (E2) and progesterone (P4) concentrations were measured weekly for up to 8 years following tissue transplantation. A monkey derived from an oocyte in transplanted ovarian tissue entered time-mated breeding and underwent controlled ovarian stimulation. Pregnancy and offspring were evaluated. Telomere lengths and oocytes obtained following controlled ovarian stimulation were assessed. RESULTS Monkeys with transplants in the arm and abdomen had cyclic E2 of 100 pg/ml, while an animal with arm transplants had E2 of 50 pg/ml. One monkey with transplants in the abdomen and kidney had ovulatory cycles for 3 years. A monkey derived from an oocyte in transplanted tissue conceived and had a normal gestation until intrapartum fetal demise. She conceived again and delivered a healthy offspring at term. Controlled ovarian stimulations of this monkey yielded mature oocytes comparable to controls. Her telomere length was long relative to controls. CONCLUSIONS Heterotopic ovarian tissue transplants yielded long-term endocrine function in macaques. A monkey derived from an oocyte in transplanted tissue was reproductively competent. Her telomere length did not show epigenetically induced premature cellular aging. Ovarian tissue transplantation to heterotopic sites for fertility preservation should move forward cautiously, yet optimistically.
Collapse
|
29
|
Zhang Y, Xia X, Yan J, Yan L, Lu C, Zhu X, Wang T, Yin T, Li R, Chang HM, Qiao J. Mesenchymal stem cell-derived angiogenin promotes primodial follicle survival and angiogenesis in transplanted human ovarian tissue. Reprod Biol Endocrinol 2017; 15:18. [PMID: 28274269 PMCID: PMC5343383 DOI: 10.1186/s12958-017-0235-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We have recently reported that human bone marrow-derived mesenchymal stem cells (MSCs) facilitate angiogenesis and prevent follicle loss in xenografted human ovarian tissues. However, the mechanism underlying this effect remains to be elucidated. Thus, determining the paracrine profiles and identifying the key secreted factors in MSCs co-transplanted with ovarian grafts are essential for the future application of MSCs. METHODS In this study, we used cytokine microarrays to identify differentially expressed proteins associated with angiogenesis in frozen-thawed ovarian tissues co-transplanted with MSCs. The function of specific secreted factors in MSCs co-transplanted with human ovarian tissues was studied via targeted blockade with short-hairpin RNAi and the use of monoclonal neutralizing antibodies. RESULTS Our results showed that angiogenin (ANG) was one of the most robustly up-regulated proteins (among 42 protein we screened, 37 proteins were up-regulated). Notably, the targeted depletion of ANG with short-hairpin RNAi (shANG) or the addition of anti-ANG monoclonal neutralizing antibodies (ANG Ab) significantly reversed the MSC-stimulated angiogenesis, increased follicle numbers and protective effect on follicle apoptosis. CONCLUSION Our results indicate that ANG plays a critical role in regulating angiogenesis and follicle survival in xenografted human ovarian tissues. Our findings provide important insights into the molecular mechanism by which MSCs promote angiogenesis and follicle survival in transplanted ovarian tissues, thus providing a theoretical basis for their further application.
Collapse
MESH Headings
- Adult
- Animals
- Antibodies, Neutralizing/pharmacology
- Apoptosis/drug effects
- Cells, Cultured
- Female
- Graft Survival/drug effects
- Humans
- Mesenchymal Stem Cell Transplantation/methods
- Mesenchymal Stem Cells/metabolism
- Mice, SCID
- Neovascularization, Physiologic/drug effects
- Neovascularization, Physiologic/genetics
- Neovascularization, Physiologic/physiology
- Ovarian Follicle/blood supply
- Ovarian Follicle/growth & development
- Ovarian Follicle/transplantation
- Ovariectomy
- RNA Interference
- Ribonuclease, Pancreatic/genetics
- Ribonuclease, Pancreatic/immunology
- Ribonuclease, Pancreatic/metabolism
- Transplantation, Heterologous
Collapse
Affiliation(s)
- Yaoyao Zhang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Xi Xia
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Shenzhen Hospital, No.1120 Lotus Road, FuTian District, Shenzhen, Guangdong, 518000, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Liying Yan
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Cuilin Lu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Xiaohui Zhu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Tianren Wang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 100004, China
| | - Tailang Yin
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Hsun-Ming Chang
- Department of Obstetrics and Gynaecology, Child and Family Research Institute, University of British Columbia, Vancouver, V5Z4H4, Canada
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No.49 North HuaYuan Road, HaiDian District, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China.
| |
Collapse
|
30
|
Chiti MC, Dolmans MM, Donnez J, Amorim CA. Fibrin in Reproductive Tissue Engineering: A Review on Its Application as a Biomaterial for Fertility Preservation. Ann Biomed Eng 2017; 45:1650-63. [PMID: 28271306 DOI: 10.1007/s10439-017-1817-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022]
Abstract
In recent years, reproductive medicine has made good use of tissue engineering and regenerative medicine techniques to develop alternatives to restore fertility in cancer patients. For young female cancer patients who cannot undergo any of the currently applied strategies due to the possible presence of malignant cells in their ovaries, the challenge is creating an in vitro or in vivo artificial ovary using carefully selected biomaterials. Thanks to its numerous qualities, fibrin has been widely used as a scaffold material for fertility preservation applications. The goal of this review is to examine and discuss the applications and advantages of this biopolymer for fertility restoration in cancer patients, and consider the main results achieved so far.
Collapse
|
31
|
Beckmann MW, Dittrich R, Lotz L, Oppelt PG, Findeklee S, Hildebrandt T, Heusinger K, Cupisti S, Müller A. Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience. Arch Gynecol Obstet 2017; 295:1033-1039. [PMID: 28197717 DOI: 10.1007/s00404-017-4311-2] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates. METHODS The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket. RESULTS Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels. CONCLUSIONS The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15-30%, can be expected to rise further in the near future.
Collapse
Affiliation(s)
- Matthia W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Sebastian Findeklee
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Susanne Cupisti
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Klinikum Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
32
|
Abstract
In tissue engineering, decellularized scaffolds have been proved to have remarkable capacity to promote regeneration in various organs such as kidney, heart, lung, and liver. Marrying the field of cryobiology and reproductive medicine resulted in considerable progress and breakthroughs, which led to the emergence of ovarian tissue cryopreservation and transplantation as a promising option for fertility preservation. Here we describe an innovative application of decellularized tissue scaffolds as a regenerative platform for reconstruction of ovarian grafts for auto-transplantation.
Collapse
Affiliation(s)
- Enes Taylan
- Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, NY, USA
| | - Kutluk Oktay
- Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, NY, USA. .,Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.
| |
Collapse
|
33
|
Jensen AK, Macklon KT, Fedder J, Ernst E, Humaidan P, Andersen CY. 86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children. J Assist Reprod Genet 2017; 34:325-36. [PMID: 28028773 DOI: 10.1007/s10815-016-0843-9] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/14/2016] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aims to make an account of the children born following transplantation of frozen-thawed ovarian tissue worldwide with specific focus on the perinatal outcome of the children. Furthermore, perinatal outcome of seven deliveries (nine children) from Denmark is reported. METHODS PubMed was searched for papers of deliveries resulting from ovarian tissue cryopreservation (OTC). Seven women underwent OTC prior to chemotherapy. Four of these women still had low ovarian function and had tried to conceive. They therefore had tissue autotransplanted to augment their fertility. The other three women had developed premature ovarian insufficiency (POI) after the end of treatment. RESULTS Worldwide, approximately 95 children have been born or will be born in the near future from OTC, including these 9 new children. Information on the perinatal outcome was found on 40 children. The mean gestational age was 39 weeks and the mean birth weight was 3168 g of the singleton pregnancies, which is within internationally recognized normal standards. Furthermore, half the singletons resulted from natural conception and all twins resulted from in vitro fertilization treatment. All seven Danish women became pregnant within 1-3 years after transplantation. They gave birth to nine healthy children. CONCLUSION The data is reassuring and further suggests that cryopreservation of ovarian tissue is becoming an established fertility preservation method. The seven Danish women reported in this study were all in their early thirties when OTC was performed. Most other reported cases were in the women's twenties. This suggests that the follicular pool in the thirties is large enough and sufficient to sustain fertility.
Collapse
|
34
|
Voultsos P, Raikos N, Vasileiadis N, Spiliopoulou C, Tarlatzis B. Ethico-legal issues related to ovarian tissue transplantation. Med Sci Law 2016; 56:293-304. [PMID: 27381404 DOI: 10.1177/0025802416657685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.
Collapse
Affiliation(s)
- P Voultsos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Raikos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Vasileiadis
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ch Spiliopoulou
- 2 Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - B Tarlatzis
- 3 Infertility and IVF Center, Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
35
|
Kim EJ, Lee HJ, Lee J, Youm HW, Lee JR, Suh CS, Kim SH. The beneficial effects of polyethylene glycol-superoxide dismutase on ovarian tissue culture and transplantation. J Assist Reprod Genet 2015; 32:1561-9. [PMID: 26238386 DOI: 10.1007/s10815-015-0537-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/07/2015] [Accepted: 07/02/2015] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Reducing the ischemic damage from free radicals that is inflicted on ovarian tissue is critical for successful ovarian tissue transplantation. Polyethylene glycol-superoxide dismutase (PEG-SOD) is mimetic of superoxide dismutase (SOD) and powerful free radical scavenger acts by reducing superoxide anions. The objective of study was to evaluate effects of PEG-SOD on mouse ovarian tissues in in vitro culture and in autotransplantation. METHODS Ovaries were collected and randomly divided into four groups that received different doses of PEG-SOD. To assess effects of PEG-SOD on in vitro cultures, four different doses of PEG-SOD were applied to in vitro culture media during in vitro culturing following ovarian tissue vitrification and warming. To evaluate effects of PEG-SOD on ovarian tissue transplantation, four different doses of PEG-SOD were applied for 2, 7, and 21 days to mice following vitrified-warmed mouse ovarian tissue autotransplantation. RESULTS The percentage of primordial follicles was maintained at the highest dose of PEG-SOD for 2 h in vitro, and there was a significant decrease in the percentage of apoptotic follicles at 2 h, but not at later time points. The highest dose of PEG-SOD also maintained primordial, primary, and secondary follicles 2 days post-transplantation, but only primordial follicles were maintained up to 21 days after transplantation. CONCLUSIONS PEG-SOD is protective mainly toward primordial follicles only for a short interval in vitro, presumably via antioxidant effects. PEG-SOD may be a promising additive for preserving ovarian tissue integrity, at least for primordial follicles, up to 21 days post-transplantation.
Collapse
Affiliation(s)
- Eun Jung Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hee Jun Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea
| | - Jaewang Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hye Won Youm
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea.
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| |
Collapse
|