Fertility Preservation In Oncology Patients Research Articles

Exploring the complexities of posthumous reproduction in fertility preservation for oncology patients with poor prognosis.

The field of fertility preservation (FP) for oncology patients has evolved significantly in recent years, offering new possibilities for individuals with life-threatening illnesses. We commend Jones et al. for their comprehensive ethical review of offering FP to patients with poor prognoses, acknowledging the potential benefits that it may bring. "Poor prognosis" in this context implies a high likelihood of death due to cancer progression. We highlight the importance of considering posthumous reproduction, involving the use of cryopreserved gametes or embryos to conceive a child after one or both partners have passed away, a topic briefly mentioned by Jones et al. Posthumous reproduction raises complex ethical, logistical, and legal questions. Distinctions between cryopreserved sperm and oocytes are discussed, with each scenario presenting unique challenges. The article also examines the complexities faced by same-sex couples in posthumous reproduction, addressing issues related to donor selection, legal parentage, and rights. Legal and regulatory aspects play a crucial role, including obtaining clear and legally valid consent, defining parental rights, navigating surrogacy laws, and addressing inheritance and estate planning. Ethical dilemmas require healthcare professionals to ensure informed decision-making, consider psychological impacts, and offer information on alternative family-building options.

Controlled Ovarian Stimulation Initiated at Different Phases of the Menstrual Cycle for Fertility Preservation in Oncological Patients: a Retrospective Study.

The purpose of this study is to compare conventional start in early follicular phase (EFP) with late follicular phase (LFP) and luteal phase (LP) in controlled ovarian stimulation (COS) for fertility preservation (FP) to assess differences in clinical outcomes. Retrospective study of the first cycles of COS for FP in oncological patients between 2012 and 2020 in a tertiary hospital. Two-hundred forty-eight cycles were classified into 3 groups: 176 cycles in EFP, 8 cycles in LFP, and 52 cycles in LP. Comparing LFP to EFP, there were no differences in number of oocytes (10.0 [6.3-16.0] vs 12.0 [8.0-18.0]; p = 0.253) or number of metaphase II (MII) obtained (7.0 [2.3-13.3] vs 9.0 [6.0-13.0]; p = 0.229). Total number of days needed was higher in LFP (14.5 [12.5-16.0] vs 3.0 vs 10.0 [8.3-11.0 p = 0.000) but without significant differences in number of days of usage of gonadotropins (11.5 [8.3-12.8] vs 10.0 [8.3-11.0] p = 0.308). No differences were found between LP and EFP in number of oocytes (14.5 [9.0-20.0] p = 0.151) or MII (11.5 [7.0-16.0] p = 0.084). Number of days of gonadotropins (11.0 [10.0-12.0] p = 0.00) and total dosing (3000.0 [2475.0-3600.0] p = 0.013) were significantly higher in LP. FORT and FOI were similar in all groups. COS with a random start in fertility preservation has similar outcomes to EFP start. Therefore, we can initiate COS at any phase of the menstrual cycle with optimal results. However, LP may need more days of stimulation.

Cryopreservation of Gametes, Embryos and Ovarian Tissue as a Method for Fertility Preservation in Oncological Patients

Cryopreservation of Gametes, Embryos and Ovarian Tissue as a Method for Fertility Preservation in Oncological Patients

Fertility Preservation in Oncological Patients

Background: Lately, attention is given to fertility preservation in reproductive-age patients undergoing oncological treatment. This should become a routine part of today’s assisted reproductive technologies. Methods: Available oncofertility preservation methods, next to their clinical, ethical and legal implications are discussed, within the context of the right to health and its broader aspects as delineated in the 1946 Constitution of the World Health Organization. Results: Possible egg and sperm freezing. as well as ovarian tissue cryopreservation, should always be explained and suggested to fertility-age patients before starting oncological treatment. Sperm, oocyte, and embryo cryopreservation should become standard practice. Conclusions: All ethical, cultural, and moral aspects of fertility preservation in cancer patients are multifaceted and need to rely on principles that are based on widely-accepted guidelines and evidence-based practices. Adequate policy, legislation, and regulations should be agreed upon and implemented.

Influence of breast cancer prognostic factors on oocyte in vitro maturation outcomes performed for urgent fertility preservation.

Do breast cancer (BC) characteristics influence IVM of oocytes outcomes in patients undergoing fertility preservation (FP)? Scarff-Bloom-Richardson (SBR) III grade, triple-negative BC and HER2 overexpression are independent predictors of fewer oocytes or poor IVM outcomes in young women seeking FP. SBR grade, triple-negative status and overexpression of HER2, as well as a high Ki67 proliferation index are all established prognostic factors for BC, influencing patients' therapeutic management. Yet there are also concerns about the potential impact of cancer status on ovarian reserve and function. Previous studies analysing the results of ovarian stimulation in BC patients have shown conflicting findings. Nevertheless, there is no data on the potential impact of BC status and prognostic factors on IVM outcome in women undergoing urgent FP. We studied 321 BC patients, 18 to 41 years of age, who were also candidates for oocyte cryopreservation following IVM. The number of oocytes recovered, maturation rate and total number of cryopreserved oocytes were assessed. Ovarian reserve markers (antral follicle count [AFC] and serum anti-Müllerian hormone [AMH] levels) and IVM outcomes were compared according to BC characteristics (Ki67 proliferation index >20%, progesterone and/or oestrogen receptors expression, HER2 status and SBR grade). Logistic regression analysis was then performed to determine the variables that could be independently associated with poor IVM outcomes, such as oocyte retrieval rate <50%, oocyte maturation rate <60% and total number of frozen oocytes <5. Overall, the mean age of the population was 32.3 ± 4.1 years. Mean AFC and serum AMH levels were 22.8 ± 13.9 follicles and 3.8 ± 3.1 ng/ml, respectively. AMH levels were significantly lower in case of triple-negative BC when compared with ER/PR/HER2 status positive cancer (3.1 ± 2.6 ng/ml vs 4.0 ± 3.3 ng/ml, P = 0.02). The mean number of recovered oocytes was 10.2 ± 9.1. After a mean maturation rate of 58.0 ± 26.1%, 5.8 ± 5.3 mature oocytes were cryopreserved per cycle. The number of retrieved and cryopreserved oocytes after IVM were significantly lower in patients presenting with an SBR III tumour when compared with an SBR I or II tumour (9.6 ± 8.7 vs 11.7 ± 9.8, P = 0.02 and 5.4 ± 5.4 vs 6.6 ± 5.8, P = 0.02, respectively). Multivariate statistical analysis showed that HER2 positive status was associated with a mean maturation rate <60% (odds ratio: 0.54; 95% CI (0.30-0.97)). Ki67 and hormonal status were not correlated with poor IVM outcomes. A weakness is the retrospective nature of the study. Moreover, as with many studies focusing on FP in oncology patients, the lack of data after reutilization of IVM oocytes prevents drawing reliable conclusions on the fate of these frozen gametes. BC prognostic factors might influence IVM outcomes. Moreover, HER2 is likely to be involved in the ovarian function and oocyte maturation process. Further investigations are needed to better understand the mechanisms at play and their possible impact on the competence of IVM oocytes. No specific funding was used and there are no conflicts of interest. N/A.

Telehealth for infertile patients during SARS-CoV-2 pandemic: far, and yet close.

In Italy during the first pandemic wave of SARS-CoV-2 the activity of fertility centers was stopped, with the exception of fertility preservation in oncological patients. We adopted telehealth and we evaluated whether it could help in the management of infertile couples at a fertility center. A longitudinal study performed at a public fertility center. Telehealth was offered to 72 couples referred to our center for a first consultation from March 17th to May 31st, 2020. Percentage of patients who performed the first assisted reproduction technology (ART) cycle or intrauterine insemination (IUI) within 6 months from the first visit and drop-out rate were analyzed during COVID-19 pandemic and compared to historical controls (couples admitted to our center in 2017-2019). Eighty-five (61/72) percent of the couples accepted telehealth. Time to first treatment after online consultation in telehealth group (4.5±1.8 months) was significantly shorter (P=0.033) respect to time to first treatment after face-to-face visit of historical controls (7.5±6.9 months). After telehealth consultation, we observed a significant reduction (P=0.002) of drop-out rate from 39% in historical controls to 17% of telehealth group. Telehealth significantly diminished the drop-out rate also during the COVID-19 pandemic respect to 73% after traditional face-to-face visits (P=0.0005), with a time to first treatment of 3.7±2.1 months in couples who refused telehealth. Telehealth could be a useful tool to facilitate the path of patients in a fertility center.

P–794 Prevalence of positivity for SARS-CoV–2 RNA in follicular fluid in infertile patients

Abstract Study question Is Sars-Cov–2 present in the follicular fluid of infertile patients? Summary answer In the experience of the Infertility and IVF Unit, University Of Bologna, Italy, RNA of SARS-Cov–2 was not detected in the follicular fluid. What is known already Data on the risk of virus presence in reproductive cells and transmissibility in IVF procedures are very limited. In literature only one study reports the detection of SARS-Cov–2 viral RNA in oocytes of PCR positive women. Research of RNA in follicular fluid could be a marker able to indicate whether to continue IVF treatments in the case of swab-positive patients. Study design, size, duration Prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from March 2020 to January 2021. 451 IVF cycles were performed on 902 patients. In addition 59 cycles of oocyte cryopreservation were also performed to fertility preservation in oncological patients. In all positive swab patients was analyzed the follicular fluid for RNA virus detection. Participants/materials, setting, methods 961 patients underwent telephone triage before going to the IVF Center to identify subjects with suspected or confirmed infection. Body temperature was measured on all patients before entering the IVF Center. All patients were subjected to real-time analysis (RT PCR) of pharyngeal swab samples 48 hours before transvaginal ultrasound-guided oocyte retrieval. In case of positive swab, PCR was performed on follicular fluid. Main results and the role of chance In our population of infertile patients the incidence of SARS COV–2 infection positivity was 0.4% (4/961). No IVF treatments were suspended. The oocytes of the 4 women with positive swab were cryopreserved using closed devices stored in a special dedicated cryogenic container. No viral RNA was detected in the follicular fluid. Limitations, reasons for caution there are no limitations to the study. Wider implications of the findings: The absence of SARS-COV–2 RNA in the follicular fluid is a reassuring result in the storage and future use of oocytes. Trial registration number Not applicable

Utilization and knowledge of oncofertility services: A single institution experience

Objective: The aim of this study was to analyze fertility preservation referral patterns, utilization of fertility preservation services, and provider knowledge of fertility preservation for oncology patients at a large tertiary referral center.

Improving Access for Patients Undergoing Gonadotoxic Therapy: Creation of a Formal Fertility Preservation Program [25A

INTRODUCTION: Prior to 2016, patients undergoing gonadotoxic therapies were not routinely directed towards educational resources regarding fertility preservation options. In 2016, a formalized fertility preservation program was initiated to increase education, referrals, and provide treatment options to this uniquely vulnerable patient population. METHODS: A database was created following initiation of the fertility preservation program (FPP) to track patient demographics such as diagnosis, treatment plan, referring department, consultation turn-around time, uptake of fertility preservation services, and outcomes (post treatment and post fertility preservation, if applicable). For patients undergoing sperm/oocyte/embryo cryopreservation for fertility preservation needs prior to program initiation (2006–2015), a chart review was performed to obtain the same data. We assessed the overall impact of implementation of FPP as compared to other published data from institutions providing formal fertility preservation services. RESULTS: Each year following implementation of FPP, noted statistically significant increase in referrals, consultations, and uptake of fertility preservation services. Similarly, the referring departments and diagnoses on referral expanded beyond oncologic providers and oncologic diagnoses, respectively. We also noted a trend of increased uptake for female patients for fertility preservation as compared to male patients, which is dissimilar from previously published data. CONCLUSION: A formalized program for fertility preservation improves access and uptake of services for patients undergoing gonadotoxic therapies. Our program demonstrated significant beneficial impact on multiple parameters of interest, even within the first two years following implementation. Subsequently, fertility preservation for oncology patients is now considered a covered benefit within this health maintenance organization.

Fertility preservation in oncology patients: A literature review examining current fertility preservation techniques and access to oncofertility services in Australia.

In Australia, between the years 2010 and 2014, over 4500 adolescents and young adults (15-25years old) were diagnosed with cancer. Treatment regimens are often gonadotoxic and are well known to induce ovarian and testicular failure. Oncofertility is an emerging discipline in obstetrics and gynaecology which seeks to preserve and restore the reproductive future of cancer patients. To perform a systematic literature review to assess the current fertility preservation techniques available to patients and examine access and uptake of fertility preservation in Australia. Electronic databases, including Medline, Cochrane Review, SCOPUS and CINHAL, were searched for peer-reviewed publications and national guidelines examining oncofertility practices from 2008 to July 2018. Three hundred and seventy-five articles were initially screened, with 158 articles for full text review and an additional five clinical guidelines were identified. There is a paucity of Australian data on oncofertility with <50% of data included for analysis reflecting the Australian experience. The majority of primary research included retrospective papers with small cohort numbers. Key areas addressed included live birth outcomes, uptake of services and patient and physician perspectives on fertility preservation. Few articles sought to examine the positive and negative side effects of fertility preservation in oncology, social challenges of oncofertility and access to services worldwide. Oncofertility is an emerging discipline which seeks to provide safe, efficient and effective fertility preservation options for young adults and adolescents diagnosed with cancer. A multi-disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia.

Psychosocial benefits of fertility preservation for young cancer patients.

The risk of ovarian failure after radiotherapy and/or chemotherapy is a concern among oncologic women. There is no doubt regarding the psycho-emotional benefits of fertility preservation (FP) after a cancer diagnosis because concerns about biological conception are a source of anxiety and can even affect the patient's cancer recovery. The aim of this study was to evaluate oncology patients' feelings, concerns, and life quality impacts related to FP. This qualitative cross-sectional study was based on a questionnaire administered to a selected group of women diagnosed with cancer who underwent FP. Thirty-four eligible women (23-39years old) completed this questionnaire. Two of the participants already had a child, and most of them (61.8%) stated a desire to have children at the time of FP. Their feelings primarily involved safety (44.1%) and hope (23.5%). Time and/or financial issues (82.4%) were the main challenge for FP. All of the women noted the importance of FP, with many stating that it is warranted to allow the possibility of a biological pregnancy due to the risk of infertility. Finally, questions about the impact on their lives if they had not undergone FP indicated emotional impairment, low quality of life, relationship problems, and uncertainty about maternity. FP for oncology patients is a positive strategy. The women in this study felt that FP was a worthwhile process and that the security of having undergone FP brought them peace during oncological treatment and contributed to their quality of life.

Advanced practice nurses: Improving access to fertility preservation for oncology patients

Les traitements contre le cancer comme la chimiotherapie, la radiotherapie et l’intervention chirurgicale peuvent presenter des risques pour la fertilite future des enfants et des jeunes adultes. L’oncofertilite est un domaine en pleine evolution qui comporte un acces elargi a la preservation de la fertilite et a ses services. Cet article vise a : a) mettre en evidence les risques pour la fertilite associes au traitement du cancer et a ses impacts psychosociaux; b) decrire les options de preservation de la fertilite; c) discuter des problemes uniques poses par la preservation de la fertilite dans les populations distinctes atteintes de cancer; d) determiner le role primordial de l’infirmiere en pratique avancee en matiere de counseling et d’education.

Advanced practice nurses: Improving access to fertility preservation for oncology patients.

Cancer therapies such as chemotherapy, radiation therapy and surgery may place the future fertility of both children and young adults at risk. Oncofertility is a rapidly evolving area that involves increasing access to fertility preservation (FP) information and services. This manuscript aims to: a) highlight the fertility risks associated with cancer therapy and its psychosocial impact, b) describe FP options, c) discuss the unique challenges of FP in distinct cancer populations, and d) illustrate the pivotal role of APNs in oncofertility counselling and education.

Emergency IVF versus ovarian tissue cryopreservation: decision making in fertility preservation for female cancer patients

Hundreds of thousands of women in their reproductive years are diagnosed with cancer each year. As the number of female patients who survive cancer increases, the demand for effective and individualized fertility preservation options grows. Currently there are limited clinical options for fertility preservation, and the paucity of publications describing clinical experience and outcomes data has limited accessibility to these options. Decision making for patients diagnosed with cancer requires up-to-date knowledge of the efficacy and safety of available techniques. This article describes a step-by-step approach to evaluation of the cancer patient and presents an accumulation of clinical experience with challenges unique to patients with breast cancer and leukemia. Current data on reproductive outcomes of fertility preservation techniques are examined, demonstrating increasing evidence that these techniques are becoming effective enough to offer routinely to patients facing gonadotoxic cancer therapies, including those still considered to be "experimental."

Sperm and oocyte cryopreservation: comprehensive consent and the protection of patient autonomy

Sperm cryopreservation and increasingly oocyte cryopreservation are common forms of fertility preservation for oncology patients facing gonadotoxic therapy. Both procedures present challenging ethical issues with regard to informed consent, given that the context for these procedures is a disease that carries a significant risk of mortality. We argue that the current consent process does not allow for adequate collection of information about a patient's wishes for the custody of cryopreserved gametes in the case of premature death. After review of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine guidelines we propose that a new, comprehensive consent procedure for sperm and oocyte cryopreservation including a 'roll-down' option is imperative to protect the autonomy of these oncology patients. This 'roll-down' option should allow for the transfer of custody of gametes to a pre-selected alternative recipient(s) if the original recipient no longer intends to use the gametes to create a child. We also demonstrate that objections over non-spousal custody of gametes can be overcome with sound ethical arguments.

Physician Referral for Fertility Preservation in Oncology Patients: A National Study of Practice Behaviors

Cancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States. This study examined oncologists' referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians. Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those with favorable attitudes (P = .043), and those whose patients routinely ask about FP (odds ratio = 2.09; 95% CI, 1.31 to 3.33). Less than half of US physicians are following the guidelines from the American Society of Clinical Oncology, which suggest that all patients of childbearing age should be informed about FP.

Fertility preservation in oncological patients

Fertility preservation in oncological patients

Vitrification: an effective new approach to oocyte banking and preserving fertility in cancer patients

Oocyte cryopreservation is a useful tool for preserving the fertility of cancer patients at risk of losing ovarian function due to undergoing potentially sterilising therapies. Results obtained with different cryopreservation protocols have been disappointing, particularly those obtained with slow cooling procedures. The efficacy of vitrification as an application in clinical practice has recently been demonstrated. The aim of this study is to report results obtained with the Cryotop method of oocyte vitrification in a population of healthy women and to point out its potential usefulness for fertility preservation in oncological patients. The study population consisting of non-oncological patients included 47 oocyte donors and 57 recipients undergoing an oocyte donation cycle of assisted reproductive technology (ART). A total of 693 mature metaphase II oocytes were collected following ovarian stimulation using long protocol down-regulation plus gonadotropin administration. Vitrification was carried out by means of the Cryotop method. Oocytes were donated to a compatible recipient after endometrial preparation. Of the 693 oocytes, 666 (96.1%) survived. A total of 487 (73.1%) were fertilised successfully. One hundred and seventeen embryos were transferred to 57 recipients. Pregnancy rate per transfer and implantation rates were 63.2% and 38.5% respectively. Twenty-eight healthy babies were later born. Oocyte cryo-banking by means of the Cryotop vitrification method represents a viable option for healthy women, producing excellent survival rates and a clinical outcome similar to that obtained with fresh oocytes. This approach could potentially be used in cancer patients who want to safeguard their fertility. Cancer patients could potentially benefit from this approach by storing their oocytes before the onset of the oncological therapy.

Germ cell transplantation

Transplantation of germ cells leads to restoration of spermatogenesis from spermatogonial stem cells. The original description of germ cell transplantation in 1994 has led to new approaches to explore many basic aspects of spermatogonial physiology. Combining germ cell transplantation with culture and cryopreservation of spermatogonia opens new pathways for genetic engineering and conservation of livestock. In addition, autologous transfer of spermatogonia might be used as an approach for fertility preservation in oncological patients. This review summarises the history of germ cell transplantation and presents an outlook on future research on spermatogonial stem cells.