Fertility Preservation In Cancer Patients Research Articles

A Review: the Essentials of Informed Consent for Cancer Patients Before Autologous Transplantation of Ovarian Tissue

Abstract: Purpose: To highlight the imperative of informed consent in the fertility preservation of cancer patients before ovarian tissue autotransplantation. Methods: Three papers of tumor recurrence after autotransplantation of frozen-thawed ovarian tissue were compared with the main papers before tumor recurrence was reported in the cancer patients. Results: Histology was performed before autotransplantation in cases 1 and 3, but not in case 2. Histology alone is insufficient for the detection of minimal residual disease (MRD). Furthermore, transplanted ovarian tissue is different from that examined for MRD detection, and how much of the resected ovarian tissue was examined for MRD detection is unclear. The possibility that grafted tissue caused tumor recurrence cannot be ruled out in any of the three cases, because autotransplantation in cancer patients, at present, uses ovarian tissue different from that examined for MRD. Conclusions: We recommend informed consent for cancer patients, because: 1) the...

The challenge of fertility preservation in cancer patients: a special focus issue from Future Oncology.

The challenge of fertility preservation in cancer patients: a special focus issue from Future Oncology.

A Study Protocol for the Australasian Oncofertility Registry: Monitoring Referral Patterns and the Uptake, Quality, and Complications of Fertility Preservation Strategies in Australia and New Zealand.

Improvements in cancer diagnosis and treatment in patients of a reproductive age have led to significant improvements in survival rates; however, a patient's fertility can be affected by both cancer and its treatment. As survival rates improve, there is an expectation by clinicians and patients that patient's reproductive potential should be considered and protected as much as possible. However, there is a lack of data about current fertility preservation (FP) uptake as well as accurate data on the acute or permanent reproductive risks of cancer treatment, complications of FP in cancer patients, and the use and success of assisted reproductive technology by cancer survivors. FP remains a major gap in acute cancer management with lifelong implications for cancer survivors. The FUTuRE Fertility research team has established the first binational multisite Australasian Oncofertility Registry, which is collecting a complete oncofertility data set from cancer and fertility centers in Australia and New Zealand. Outcomes from the research study will monitor referral, uptake, and complications of FP, document patient's reproductive potential after treatment, and collect data on the use of assisted reproductive technology following cancer treatment. The data will be linked to other routine health and administrative data sets to allow for other research projects to be carried out. The changes in oncofertility care will be benchmarked against the Australasian Oncofertility Charter. The data will be used to develop evidence-based guidelines and resources, including development of accurate risk projections for patients' risk of infertility, allowing clinicians to make recommendations for FP or assisted reproductive technology. Australian New Zealand Clinical Trials Number-12615000221550.

Vitrification of embryos and oocytes for fertility preservation in cancer patients.

As survival rates and the life expectancy of those with malignancy have increased, more women in their reproductive years are referred for fertility preservation. Chemotherapy and radiotherapy can severely affect ovarian function, and the effect is irreversible. Therefore, it is optimal to attempt fertility preservation before chemotherapy and radiotherapy are initiated. Oocyte and embryo cryopreservation is the most common option for fertility preservation in women. Several reports have proven that embryo and oocyte cryopreservation can achieve a successful pregnancy. This review discusses the impact of chemotherapy and radiotherapy on ovarian function, and the importance of oocyte and embryo cryopreservation for fertility preservation. In addition, the current status of pregnancy outcomes and potential for cryopreserved oocytes to result in live births in cancer patients was reviewed. This may provide useful information for decision-making in cancer patients regarding oocyte and embryo cryopreservation and fertility preservation.

Fertility preservation for cancer patients: Role of nursing attitudes.

110 Background: Nurses play a pivotal role in ensuring adherence to quality guidelines. The 2006 American Society of Clinical Oncology - Quality Oncology Practice Initiative guidelines state that infertility risks should be discussed prior to initiation of fertility-reducing therapies for patients in their reproductive years. Despite this guideline on fertility preservation (FP), national compliance is only 6% (Tallent, 2013). Research is lacking in the understanding of nurses’ attitudes and behaviors towards FP and no tools exist from which to examine this problem. The purpose of this study is to gain increased understanding of potential barriers for nurses to recommend FP as an option for newly diagnosed patients. Methods: This instrument development study was developed by content experts and field tested with staff nurses. Next, an online survey method was used to examine factors associated with nursing recommendation for FP of newly diagnosed cancer patients. An anonymous online survey was sent to oncology nurses at UT Southwestern and members of the Oncology Nursing Society (Dallas Fort Worth Chapter). The endpoint of the study is a sound survey to assess nursing behaviors toward FP in diagnosed cancer patients. Standardized descriptive measures of central tendency were used to describe baseline characteristics for the sample. Factor analysis was completed using SAS v9.3 with orthogonal rotation. Scree plot was examined for factors and loading > 0.30 were retained. Results: Analysis of the first 67 returned surveys (Phase 1) supports a 15-item (5-factor) survey tool. Preliminary results suggested the need for education, referral availability, and system refinement. Phase 2 surveys of additional 200 was initiated in August 2015, with an expected close of enrollment date of December 2015. Conclusions: Cancer patients of childbearing age worry how treatment will affect their ability to have a child. This survey may be beneficial in identifying nursing attitudes regarding FP. All members of the care team should be sensitive to this concern and should recommend appropriate action. This study will identify nursing barriers to patient education, and will support system-wide implementation of a comprehensive FP program.

Current State of Fertility Preservation in Cancer Patients—What is Established and What is Still Controversial?

Fertility Preservation is an essential part of cancer care when treating young females and men. While semen cryopreservation is a straightforward approach for postpubertal men and there is the option of experimental testicular tissue freezing for prepubertal boys, the options for females are more tumultuous. The last 17 years brought us established approaches such the embryo and oocyte cryopreservation and the ovarian cryopreservation is ready to join the list. However, there still is no proven medical fertility preservation method and the controversy around the utility of GnRHa continues.

The past, present and future of fertility preservation in cancer patients.

Fertility preservation strategies have been developed for men and women whose fertility is compromised for medical reasons, especially in case of cancer therapy. At present, many reliable options for preserving fertility are available. However, a part of these fertility preservation methods, despite being promising, are still considered experimental. Nevertheless, there are still situations where no methods can be offered. Remarkable scientific progress is currently underway to improve available techniques and to develop new technologies to solve problems with current fertility strategies. These new options may drastically change reproductive options for young patients facing germ cell loss and hence sterility. Therefore, oncofertility counseling by a specialist is recommended for all young cancer patients having to undergo treatment that may reduce fertility potential.

Oocyte versus embryo cryopreservation for fertility preservation in cancer patients: guaranteeing a women's autonomy.

The increasing incidence of cancer, combined with higher survival rates in reproductive-aged women is generating growing scientific interest in the application of fertility preservation (FP) technologies for oncological patients [1, 2]. However, less than 5 % of these patients actually preserve their future fertility prior to treatment [3]. Upon examination of the extensive literature, a perception emerges that oocyte cryopreservation is not clearly indicated over embryo cryopreservation for FP. This misconception potentially generates confusion, reluctance, and doubts in the minds of ethics.

Random-start IVF treatment: An emergent fertility preservation technique between cytotoxic treatment courses and stem-cell transplantation in acute myelocytic leukemia

Abstract Objective To report the ability to undergo two successive emergency IVF cycles between the cytotoxic treatments for a patient with AML waiting for stem-cell transplantation. Design Case report. Setting Fertility unit of a tertiary university medical center. Patient(s) A 28-year old woman diagnosed with AML and went through cytotoxic treatment. Intervention(s) Two emergency IVF cycles and OPU with embryo cryopreservation within 45 days between the cytotoxic treatment courses. Main outcome measure(s) Number of oocytes and/or embryos cryopreserved after two random start COSs. Result(s) 18 eggs were retrieved totally and a combined standard IVF/ICSI technique was used to fertilize them. 12 eggs fertilized and divided and all of them cryopreserved at day-2 stage. Conclusions Although it is still experimental, emergency IVF treatment considered as a novel approach for fertility preservation in cancer patients not only before the start of chemotherapy but even between the treatment courses if the patient’s physical and psychological conditions are stable and acceptable.

Random-start GnRH antagonist for emergency fertility preservation: a self-controlled trial.

The aim of this study is to evaluate the feasibility and safety of random-start controlled ovarian hyperstimulation (COH) for emergency fertility preservation, regardless of the phase of the menstrual cycle. A self-controlled pilot clinical trial (NCT01385332) was performed in an acute-care teaching hospital and in two private reproductive centers in Barcelona, Spain. Eleven egg donors participated in the study. Two random-start gonadotropin-releasing hormone (GnRH) antagonist protocols were assessed in which ganirelix was initiated on either day 10 (protocol B) or on day 20 (protocol C) of the menstrual cycle and was continued until estradiol levels were below 60 pg/dL. These protocols were compared with a standard protocol (protocol A). The main outcome of interest was the number of metaphase 2 oocytes retrieved. Results from this study show that the number of mature oocytes retrieved was comparable across the different protocols (14.3±4.6 in the standard protocol versus 13.0±9.1 and 13.2±5.2 in protocols B and C, respectively; values expressed as mean ± standard deviation). The mean number of days needed for a GnRH antagonist to lower estradiol levels, as well as the ongoing pregnancy rates, were also similar when protocols B (stimulation in follicular phase) and C (stimulation on luteal phase) were compared with protocol A (standard stimulation). GnRH antagonists can be effectively used for random-start controlled ovarian hyperstimulation with an ovarian response similar to that of standard protocols, and the antagonists appear suitable for emergency fertility preservation in cancer patients.

Setting Up an Ethical Oncofertility Practice in Developing Countries

Fertility preservation for cancer patients is a relatively new field in medicine which requires interdisciplinary approach. Improving therapies and rising survival rates require to consider patient’s quality of life after cancer is cured which is relevant personal issue regardless of the individual income and the level of development of the country of origin. Fertility preservation offers possible solution but also raises ethical questions. We provide a summary of ethical principles embodied in professional guidelines together with options and restrictions to access fertility preservation in developing countries. We also make a suggestion that oncofertility counselling could be a pillar to address fertility preservation issues in cancer patients. Our proposed decisional support model is patient centred and focuses on patient values, personal philosophy and view of life emphasizing sensitivity to individual patient’s needs and wishes. Some fertility preservation concerns in oncology might be addressed mirroring already available expertise while some others will call for innovative and region specific solutions. Therefore, in addition to our proposal we also provide a list of organisations working in oncofertility field. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21532 Bangladesh Journal of Bioethics 2014 Vol.5 (3): 6-17.

Fertility Preservation for Cancer Patients: “We Need to Foot the Bill ”

Fertility Preservation for Cancer Patients: “We Need to Foot the Bill” A 27-year-young G0 P0 female presented to the office for a consultation on fertility preservation after a referral from her oncologist with her friend as her sole medical supporter. She was distraught by a recent medical diagnosis of cancer, but leaned in as we broached the subject of possibly losing her fertility. We sat for about an hour discussing the likelihood of damage to her reproductive functioning and the options available to attempted to preserve her fertility.

Fertility preservation in cancer patients: attenuation of chemotherapy-induced ovarian damage by oral administration of phytochemical carotenoids in an animal model

Fertility preservation in cancer patients: attenuation of chemotherapy-induced ovarian damage by oral administration of phytochemical carotenoids in an animal model

Ovarian stimulation for emergency fertility preservation in cancer patients: A case series study

•We used Random-Start for the IVF cycle in urgent settings of gynecological cancer.•Oocytes can be obtained at any time before cancer treatment efficiently.•Oocyte maturity rates were comparable with conventional antagonist protocol.•Random-Start protocol is promising in emergency fertility preservation.

Long-term outcome results of the phase III PROMISE-GIM6 study evaluating the role of LHRH analog (LHRHa) during chemotherapy (CT) as a strategy to reduce ovarian failure in early breast cancer (BC) patients.

105 Background: The PROMISE-GIM6 phase III randomized study showed that the use of triptorelin-induced temporary ovarian suppression during CT in premenopausal patients with early-stage BC reduced the occurrence of CT-induced early menopause (Del Mastro L, JAMA 2011). The 2013 ASCO and ESMO guidelines on fertility preservation in cancer patients consider this strategy still experimental due to the absence of data on long-term ovarian function and pregnancy rates, and some concerns exist on the safety of this procedure particularly for hormone-receptor positive BC patients. The present analysis reports long-term outcome results of the study. Methods: From October 2003 to January 2008, 281 premenopausal women with stage I through III BC who were candidates for adjuvant or neoadjuvant CT were randomized to receive CT alone or combined with triptorelin. The primary objective was to compare the incidence of CT-induced early menopause in patients treated with CT alone or combined with triptorelin. The present analysis considers data on recurrences, pregnancies and long-term ovarian function. Results: A total of 133 pts were enrolled in the CT alone arm and 148 in the CT + LHRHa arm; 82% and 79% of pts had hormone receptor positive-disease, respectively. The median follow-up at the time of the analysis was 7.3 years (interquartile range: 6.3-8.2 years). No differences in the 5-year disease-free survival (DFS) between treatment arms were observed (83.7% in CT alone arm vs 80.5% in CT plus LHRHa: HR=1.17; 95% CI 0.72-1.92, p=0.519). After the end of adjuvant treatments, 4 pregnancies (3.0%; incidence rate per 100 person-year=0.4) occurred in the CT-alone group and 8 pregnancies (5.4%; incidence rate per 100 person-year=0.8) occurred in the CT plus triptorelin group (CT + LHRHa arm vs CT alone: OR=1.84; 95% CI 0.54-6.27, p=0.39). Conclusions: The administration of LHRHa with CT was associated with the occurrence of more pregnancies; no differences in DFS were observed. The analysis on long-term ovarian function is still ongoing and will be presented at the meeting. Clinical trial information: NCT00311636.

Autotransplantation of cryopreserved ovarian tissue – effective method of fertility preservation in cancer patients

Objective: To review the literature and to present the latest advances in the autotransplantation of cryopreserved ovarian tissue.Materials and methods: A literature review was conducted for all relevant articles assessing the fertility preservation, ovarian tissue transplantation, standard freezing and vitrification of ovarian tissue.Results: One of the promising and effective methods for fertility preservation may be the autotransplantation of cryopreserved ovarian tissue. At present, 30 babies have been born after orthotopic autotransplantation of frozen-thawed human ovarian tissue. Restoration of ovarian activity occurs between 3.5 months and 6.5 months. The longevity of autotransplanted ovarian tissue is about 5–7 years. The follicles are similarly preserved after all freezing methods; however, the ovarian stroma is significantly better preserved after vitrification than after slow freezing. An important topic for further research is preparation of the “vascular bed”, optimization of vitrification technique and the development of alternative procedures to avoid the transmission of cancer cells via ovarian tissue autotransplantation – “artificial ovary”.Conclusions: Cryopreservation of ovarian tissue has unique advantages over other strategies. This method: (1) does not delay cancer treatment; (2) is safer for hormone dependent malignancy; (3) can be done independent of menstrual cycles; (4) is the only option for prepubertal girls; (5) can restore not only fertility but endocrine function.

Reproductive options for female cancer patients: balancing hope and realistic expectation.

To review currently available options in fertility preservation in cancer patients, report on emerging techniques, and highlight the importance of time sensitivity and recording of outcomes. Fertility preservation in cancer patients is a rapidly expanding area of medicine. Recent success with experimental techniques such as oocyte cryopreservation and ovarian tissue cryopreservation exemplify the need for follow-up data collection. Results of fertility outcomes in cancer patients should form an integral and important part of the pretreatment counselling process for cancer patients but limited published data from larger cohorts exist. The formation of a growing fertility preservation database would, therefore, allow ease of data analysis and more robust results.

Random-start controlled ovarian hyperstimulation (COH) for fertility preservation in cancer patients: a comparison between luteal and non-luteal start

Random-start COH has been reported as an alternative method for initiating oocyte/embryo cryopreservation cycles for the purpose of fertility preservation, with the benefit of a shortened interval from presentation to retrieval and thus to cancer treatment. We evaluated our experience with random start COH antagonist cycles, compared outcomes in luteal and non-luteal cycle starts, and measured the time from initial consultation to COH start.

Ovarian tissue cryopreservation followed by controlled ovarian stimulation and pick-up of mature oocytes does not impair the number or quality of retrieved oocytes.

BackgroundThe objective of this study was to evaluate the feasibility of fertility preservation in cancer patients by combined bilateral ovarian cortex cryopreservation and embryo freezing.MethodsThis was a cohort-controlled study in a university hospital center. Sixteen patients with a recent cancer diagnosis were included in the study. They all consented to fertility preservation by a combined technique: ovarian tissue cryopreservation (OTC) followed by ovarian stimulation for in vitro fertilization (IVF) and embryo freezing. The control group included 100 women of the same age undergoing IVF for male factor infertility.ResultsThe mean number of metaphase II oocytes was 8.3 per patient (±7.7) and was not statistically different from the control group (8.1 ± 5.6). The mean number of good quality embryos obtained was not statistically different in the 2 groups (4.2 versus 4.4).ConclusionOTC before embryo freezing does not impair the number or quality of cryopreserved embryos, but increases fertility preservation potential.

Editorial introductions

Editorial introductions