Fertility Preservation Methods Research Articles

Egg Quality during the Pubertal Transition-Is Youth All It's Cracked Up to Be?

Although it is well accepted that egg quality decreases with advanced maternal age, we do not know how it is affected at the earliest ages during the pubertal transition—likely because this young population is not typically reproducing. However, in the setting of fertility preservation, more childhood cancer patients are surviving their diagnosis due to medical advances, forcing patients and their families to consider their future fertility at a very young age. Ex vivo in vitro maturation, in which cumulus oocyte complexes harvested from ovarian tissue are cultured to obtain mature gametes, is gaining traction as a fertility preservation method that is coupled to ovarian tissue cryopreservation. This method is particularly suitable for prepubertal and young adolescent girls, although live births have not yet been reported in gametes derived from females during the pubertal transition. Importantly, the period immediately following menarche in primate species (non-human primate and human) is characterized by relative subfecundity or sterility, and data from agricultural species and humans suggest that this may in part be due to increased chromosomal abnormalities in the egg. Together these data provide a compelling rationale for pushing the age boundary of when egg quality is considered, for performing further basic research to understand egg quality during this period, and for appropriately counseling patients.

Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives.

STUDY QUESTIONWhat progress has been made in fertility preservation (FP) over the last decade?SUMMARY ANSWERFP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended.WHAT IS KNOWN ALREADYFP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility.STUDY DESIGN, SIZE, DURATIONAn international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June 2015.PARTICIPANTS/MATERIALS, SETTING, METHODSTwenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included.MAIN RESULTS AND THE ROLE OF CHANCESeveral oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in post-pubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended.LIMITATIONS, REASONS FOR CAUTIONGiven the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was three or below.WIDER IMPLICATIONS OF THE FINDINGSFurther high quality studies are needed to study the long-term outcomes of FP techniques.STUDY FUNDING/COMPETING INTEREST(S)None.TRIAL REGISTRATION NUMBERN/A.

Update on fertility preservation from the Barcelona International Society for Fertility Preservation–ESHRE–ASRM 2015 expert meeting: indications, results and future perspectives

What progress has been made in fertility preservation (FP) over the last decade? FP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended. FP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility. An international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June2015. Twenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included. Several oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in postpubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended. Given the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was 3 or below. Further high quality studies are needed to study the long-term outcomes of FP techniques. None. N/A.

Current situation on fertility preservation in cancer patients in Spain: Level of knowledge, information, and professional involvement

Abstract Introduction The estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation. Material Questionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation. Results Fifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment. Conclusions There are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest.

In vitro maturation of human immature oocytes for fertility preservation and research material

AimIn recent years, the importance of fertility preservation (FP) has increased. In vitro maturation (IVM), an important technique in FP, has started to be used in the clinic, but controversies persist regarding this technique. Here, a survey of IVM for FP is provided.MethodsBased on a literature review, the applications of FP, methods of FP, IVM of oocytes that had been collected in vivo and ex vivo, maturation of oocytes after IVM for FP, cryopreservation of oocytes for FP, explanation of the procedures to patients, and recent research on FP using IVM were investigated.ResultsAlthough IVM for FP remains controversial, the application of FP is expected to expand. Depending on the age and disease status of the patient, various methods of oocyte collection and ovarian stimulation, as well as various needle types and aspiration pressures, have been reported. The maturation rate of IVM in FP ranges widely and requires optimization in the future. In regard to cryopreservation for matured oocytes, the vitrification method is currently recommended.ConclusionRegarding FP for patients with cancer, the treatment of cancer is prioritized; thus, the time and use of medicines are often constrained. As several key points regarding IVM remain unclear, well‐designed and specific counseling for patients is necessary.

What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all made important contributions to our understanding of the FP decision-making process, none of them examine solely and specifically these processes for women of reproductive age with a diagnosis of any cancer, leaving a gap in the knowledge base. Given the expectation that care is patient-centred, our review aims to address this gap which may be of help to those managing patients struggling to make difficult decisions in the often brief period before potentially sterilizing cancer treatment is started. Underpinning this narrative review was the question 'What factors hinder the decision-making process for women with any cancer and contemplating FP treatment?' Our objectives were to (i) assess and summarize this existing literature, (ii) identify the factors that hinder this decision-making process, (iii) explore to what extent these factors may differ for women choosing different methods of FP and (iv) make recommendations for service delivery and future research. A systematic search of the medical and social science literature from the 1 January 2005 up to the end of January 2016 was carried out using three electronic databases (Web of Science (PubMed), Ovid SP Medline and CINAHL via Ebsco). Included in the review were quantitative, qualitative and mixed-method studies. Reference lists of relevant papers were also hand searched. From the 983 papers identified, 46 papers were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and thematic analysis was used to analyse the data. From the analysis, 6 key themes with 15 sub-themes emerged: (i) fertility information provision (lack of information, timing of the information, patient-provider communication); (ii) fear concerning the perceived risks associated with pursuing FP (delaying cancer treatment, aggravating a hormone positive cancer and consequences of a future pregnancy); (iii) non-referral from oncology (personal situation, having a hormone positive cancer, FP not a priority and transition between service issues); (iv) the dilemma (in survival mode, whether to prioritize one treatment over another); (v) personal situation (parity, relationship status) and (iv) costs (financial concerns). This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women's fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these 'risks' were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Healthcare professionals in both oncology and fertility services may also benefit from the implementation of training programmes and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poorer prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research.

Current situation and prospect of fertility preservation in male cancer patients

With the rapid development of tumor subjects and the advance of medical technology, tumor mortality is declining in spite of the increase in tumor incidence. The male survivors pay more and more attention to their prognosis to improve the quality of their life. In the meantime, whether they could produce their own offspring become the main concern of tumor patients with good prognosis. However, until now, male tumor patients, their relatives, different social sectors and even some of our health workers, haven't noticed the importance of fertility preservation and long-term fertility desires of male patients with tumor which will lead to declined or even irreversible sterility induced by the lack of fertility preservation before anti-tumor therapy. It's an important way to do fertility counseling, learn the risk of their treatment plans and choose the appropriate technique of fertility preservation which will improve prognosis quality of life of male tumor patients. This article will review the effects of tumor and the treatment on male fertility, their subjective needs and concerns, main methods for fertility preservation and the domestic and foreign research present situation. Key words: Neoplasms; Fertility; Editorial

Recent advances in the field of ovarian tissue cryopreservation and opportunities for research.

The purpose of this study was to summarize the latest advances and successes in the field of ovarian tissue cryopreservation while identifying gaps in current knowledge that suggest opportunities for future research. A systematic review was performed according to PRISMA guidelines for all relevant full-text articles in PubMed published in English that reviewed or studied historical or current advancements in ovarian tissue cryopreservation and auto-transplantation techniques. Ovarian tissue auto-transplantation in post-pubertal women is capable of restoring fertility with over 80 live births currently reported with a corresponding pregnancy rate of 23 to 37%. The recently reported successes of live births from transplants, both in orthotopic and heterotopic locations, as well as the emerging methods of in vitro maturation (IVM), in vitro culture of primordial follicles, and possibility of in vitro activation (IVA) suggest new fertility options for many women and girls. Vitrification, as an ovarian tissue cryopreservation technique, has also demonstrated successful live births and may be a more cost-effective method to freezing with less tissue injury. Further, transplantation via the artificial ovary with an extracellular tissue matrix (ECTM) scaffolding as well as the effects of sphingosine-1-phosphate (SIP) and fibrin modified with heparin-binding peptide (HBP), heparin, and a vascular endothelial growth factor (VEGF) have demonstrated important advancements in fertility preservation. As a fertility preservation method, ovarian tissue cryopreservation and auto-transplantation are currently considered experimental, but future research may pave the way for these modalities to become a standard of care for women facing the prospect of sterility from ovarian damage.

PD13-10 BARRIERS IN ACCESS TO MALE ONCOFERTILITY CARE AMONG MEN RECEIVING TARGETED CANCER THERAPY

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I1 Apr 2017PD13-10 BARRIERS IN ACCESS TO MALE ONCOFERTILITY CARE AMONG MEN RECEIVING TARGETED CANCER THERAPY Joris Ramstein, Puneet Kamal, Katy Tsai, and James Smith Joris RamsteinJoris Ramstein More articles by this author , Puneet KamalPuneet Kamal More articles by this author , Katy TsaiKaty Tsai More articles by this author , and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.698AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of Tyrosine Kinase Inhibitors (TKI) in men with certain malignancies has in many cases improved the course of illness from rapidly fatal to a chronic disease requiring long-term treatment. However, very little has been published on TKI effects on male fertility despite the potential for significant risk to fertility. Many major organizations have guidelines advocating fertility preservation (FP) for all patients at risk of impaired fertility from cancer treatment, yet it is unclear how often men receiving TKI are counseled on the fertility risks of their oncologic treatments and the need for FP. We sought to identify potential barriers to accessing oncofertility care, assess baseline understanding of treatment-related infertility, and characterize reproductive expectations of men receiving TKI treatment. METHODS A retrospective cohort of men receiving TKI at UCSF completed a single detailed questionnaire. Cancer history, consultation with treating physician about the possible effects on fertility, obstacles to fertility preservation methods and satisfaction with treatment decisions were addressed. RESULTS Fifty-one patients receiving TKI participated in the study. The mean age was 46 years (range 21-72). Thirty-one (61%) had chronic myelogenous leukemia and 26 (51%) had received prior treatment for cancer (11 surgery, 12 chemotherapy, 3 radiation). While 18 (36%) said they would like to have children in the future and 24 (46%) had some degree of concern that their cancer treatment might affect their fertility, 26 (51%) were not given any information about the fertility risks of TKI by their medical team, 30 (59%) were not able to discuss possible ways to protect their fertility, and 39 (76%) did not have the opportunity to discuss protecting their testicles from cancer treatments. Furthermore, 32 (63%) felt they had encountered some barrier to fertility care prior to receiving their cancer treatment, including 11 (22%) who were not provided a referral to a fertility specialist, and 14 (27%) who did not understand that the cancer treatment might affect their fertility. CONCLUSIONS Nearly half of the patients surveyed worried about the reproductive risks of TKI, and most felt they had not received enough information about these risks. Furthermore, the majority of men experienced barriers to oncofertility care. These findings highlight the need for medical providers to take a proactive approach to discuss potential fertility risks in men on TKI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e274-e275 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joris Ramstein More articles by this author Puneet Kamal More articles by this author Katy Tsai More articles by this author James Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence and Risk Factors of Ovarian Metastases in Breast Cancer Patients < 41 Years of Age in the Netherlands: A Nationwide Retrospective Cohort Study.

PurposeBreast cancer is one of the primary indications for cryopreservation and subsequent autotransplantation of ovarian tissue. The safety of this fertility preservation method remains questionable, as the presence of disseminated breast tumor cells cannot yet be excluded in the ovarian autografts. We explored the prevalence of ovarian metastases among young breast cancer patients and determined risk factors for the development of ovarian metastases.MethodsUsing the nationwide database of the Dutch Pathology Registry (PALGA), we identified a cohort of 2648 women with primary invasive breast cancer at age < 41 years in the period 2000–2010 in the Netherlands who subsequently underwent an oophorectomy. From this source population, all cases who had histologically confirmed ovarian metastases were included. For each case of whom clinical data were available, one control without ovarian metastases who matched the time interval between breast cancer diagnosis and oophorectomy was selected. Data were collected on patient characteristics, diagnosis, treatment and follow-up.ResultsOvarian metastases were found in 63 out of 2648 patients who met the inclusion criteria. The risk of developing ovarian metastases increased with time passed since breast cancer diagnosis. Multivariate logistic regression analyses showed significant association between tumor stage and the development of ovarian metastases (p = 0.024).ConclusionsThe prevalence of ovarian metastases was 2.4% among young breast cancer patients. Early ovary removal may reduce the risk of developing ovarian metastases. In breast cancer patients with tumors > 5 cm and/or inflammatory carcinoma, we recommend a cautious approach to ovarian tissue autotransplantation.

Fertility preservation for patients with breast cancer: The Korean Society for Fertility Preservation clinical guidelines.

With advances in the methods of cancer treatment used in modern medicine, the number of breast cancer survivors has been consistently rising. As the number of women who wish to become pregnant after being diagnosed with breast cancer increases, it is necessary to consider fertility preservation in these patients. However, medical doctors may be unaware of the importance of fertility preservation among cancer patients because most patients do not share their concerns about fertility with their doctors. Considering the time spent choosing and undergoing treatment, an early referral to a reproductive specialist is the best way to prevent a delay in cancer treatment. Since it is not easy to make decisions on matters related to cancer diagnosis and fertility, patients should be provided with enough time for decision-making, and to allow for this, an early referral will provide patients with sufficient time to choose an appropriate method of fertility preservation. The currently available options of fertility preservation for patients with breast cancer include cryopreservation of embryos, oocytes, and ovarian tissue and gonadotropin-releasing hormone agonist treatment before and during chemotherapy. An appropriate method of fertility preservation must be selected through consultations between individual patients and health professionals and analyses of the pros and cons of different options.

Fertility preservation methods in women subjected to gonadotoxic treatment or gonadoreducing surgery

All patients in whom gonadotoxic treatment or gonadal resection is recommended and also present future reproductive intentions should be referred to a specialist in infertility and endocrinology to be detailed fertility preservation options. The gold standard in these cases is the cryopreservation of embryos, being superior to the freezing of oocytes or other techniques. For the cases where freezing embryos it is not possible, cryopreservation of mature oocytes is reasonable. Maturation of oocytes in vitro is an experimental method, with implantation and pregnancy rates lower than if using oocytes matured in vivo. Ovarian tissue cryopreservation is an investigational technique not recommended in patients with ovarian cancer or at increased risk for this pathology, with still uncertain eficacy, but more and more increasingly used. If cryopreservation of embryos or oocytes is not feasible, alternative methods are needed to protect fertility. For cases which are to undergo pelvic radiotherapy, but not to chemotherapy, ovarian transposition outside the field of radiation may be an option. The use of GnRH agonists in women following chemotherapy is not recommended, having unproven benefits and theoretical risks. Alternative methods (ovarian tissue transplantation, donation of oocytes or embryos, the use of surrogate mothers, adoption) are the last choices for cases where the other methods are not available.

Fertility Preservation in Female Cancer Patients: A Retrospective Study from Iran

Introduction: Improvements in cancer treatments have improved survival, thus it is important to improve the quality of life of cancer survivors. Use of fertility preservation methods has developed considerably in recent years. Therefore, in order to save future fertility, consultation with cancer patients is important. Patients and Methods: This was a retrospective cohort study among female patients with different cancer disorders who were referred to IVF center, Taleghani Hospital, in Iran between April 2014 and September 2014 for fertility preservation. Results: Eighteen patients were referred, with a mean age of 27 years, 9 patients (50%) before gonadotoxic treatment and 9 patients (50%) after previous gonadotoxic treatment. The mean value of anti-mullerian hormone was 1.6 ng/ml, and the mean antral follicle count per ovary was 4. For 14 patients (77.8%), embryo cryopreservation and for 4 others (22.2%) oocyte cryopreservation was carried out. Patients with a history of gonadotoxic therapy needed more gonadotropins for stimulation (4328 IU versus 2233 IU, P<0.05). Patients with lower antral follicle count had lower oocytes (p<0.05) and patients with lower anti mullerian hormone had lower antral follicle count per ovary (p<0.05). Conclusion: Due to the high dose of gonadotropins for stimulation and its effect on anti mullerian hormone and antral follicle count, in patients with a history of gonadotoxic therapy, it is recommended that patients be referred for fertility preservation before gonadotoxic treatment.

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.

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. 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. 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 39weeks and the mean birth weight was 3168g 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 1-3years after transplantation. They gave birth to nine healthy children. 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.

Assessment of ovarian reserve and fertility preservation strategies in children treated for cancer.

The survival rate of chemotherapy treatments of malignant cancer or non-malignant conditions are continuously improving. As a result, there is an increased number of patients who received a gonadotoxic treatment during childhood and who later face fertility issues. Depending on the extent of the damage to the ovaries, acute or late complications may occur. Acute ovarian failure is defined by permanent amenorrhea after a high-risk treatment. When the drugs used are less gonadotoxic, ovarian insufficiency might appear later. This literature review will review both the current solutions for management of high-risk patients and the care options for low and medium risk patients. For each patient the risk of premature ovarian insufficiency should be evaluated individually before treatment. Guidelines clearly recommend to preserve fertility of high-risk group before treatment, but questions remain about the future counselling of patients with low or moderate risk. Demand for fertility preservation methods has greatly increased. In this context, studies focusing on the best fertility preservation methods for patients, either before chemotherapy for the high-risk group or during the follow-up for the others, are essential. For the high-risk group, ovarian tissue cryopreservation is the only option for prepubertal girls. For postpubertal girls, oocytes vitrification could also be offered. The risk of premature ovarian failure must be evaluated for each patient treated with gonadotoxic therapies. Fertility preservation must be offered in high-risk patients and appropriate follow-up should be proposed to anticipate later fertility issue in low and medium risk patients.

Second children born after autotransplantation of cryopreserved ovarian tissue in a young patient previously treated with chemotherapy for Askin's diseasethe successful of fertility preservation program

Oncological treatment was associated with a reduced ovarian reserve, the chance of a successful pregnancy is currently around 1/3 for those with ovarian-tissue autotransplantationOvarian tissue cryopreservation is an effective option,gaining ground as a valid method for fertility preservation especially for pre-pubertal patients and patients who have a short time between diagnosis of a disease and gonadotoxic treatment.More than 62 children worldwide have now been born following this procedure. Case report and a retrospectively analyse, of patients whose underwent ovarian tissue cryopreservation at IFER, Argentina between 1999-2015.One of these women, had orthotopic transplantation, after chemotherapy premature ovarian failure (POF) has now conceived again following natural conception. She gave birth to a healthy girl on 7/2015 and is therefore the second woman in the world to have had two children, from separate pregnancies, born as a result of transplanting frozen/thawed ovarian-tissue. 68 patients referred from private oncological units underwent cryopreservation of ovarian tissue before gonadotoxic therapy for malignant disease. 7 patients (10,3%) died during follow-up due to recurrence of disease. 24 post-pubertal patients without the need for grafts of cryopreserved tissue. 4 patients had undergone ovarian tissue transplantation in order to restore their fertility after remission of the disease and one of these women became pregnant twice and has given birth two healthy babies. In 2005 a 28 year old patient was referred for fertility preservation before undergoing aggressive chemotherapy for Askin tumor. Several strips of ovarian cortical tissue were obtained by laparoscopy and cryopreserved . The patient underwent surgical treatment, and chemotherapy (CVEA), ovarian failure was established. In 2009 orthotopic transplantation of frozen-thawed ovarian tissue was carried out by laparoscopy in the right ovary,.Three months after transplantations she resumed regular menses. Four IVF cycles were performed with no pregnancy.9/2012 POF was established. In 2/2013 another laparoscopy was performed with replacement of ovarian tissue this time in the left ovary. In 5/2013 spontaneous menses began. An Intrauterine Insemination resulted in pregnancy. In 2/2014, and after an uneventful pregnancy, a healthy baby boy was born.The patient was breastfeeding her first baby and returned to our fertility clinic in 9/2014 a pregnancy test revealed that she had already conceived naturally,after an uneventful pregnancy a normal healthy girl was born in 7/2015. The present result supports cryopreservation of ovarian tissue as a valid method of fertility preservation to be used in women facing gonadotoxic treatment. However alternative procedures such as oocyte or embryo cryopreservation should be considered as first options especially for older patients.

A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services

The American Society of Clinical Oncology issued practice guidelines in 2006 to provide critical information about fertility impact to adolescents and young adults (AYA) at the time of cancer diagnosis. Survivors continue to express concerns about their long-term reproductive health after cancer therapy even as treatment options for fertility preservation evolve. An underutilization of fertility preservation methods by cancer patients continues to persist. A review of the literature cites barriers and challenges that limit fertility information and preservation options for AYA cancer patients. A review of medical literature was conducted to examine current practice for patients receiving fertility information and the barriers to patients receiving fertility preservation services. A total of 69 publications were included in this review. The review summarizes (1) patient experiences with receiving fertility information and (2) patient desires, barriers, and challenges to utilizing fertility preservation services. Despite advances in fertility preservation, there are challenges for patients to utilizing fertility preservation services. Barriers include the following: urgency to initiate treatment, inadequate information, clinic time constraints, and perceptions around patients' gender, age, cost, parity, race, relationship, and sociodemographic status influence whether patients receive fertility preservation consultation. Patients report a lack of adequate information to make informed fertility decisions.

Establishment of the ovarian tissue cryopreservation protocol on bovine model

Ovarian tissue cryopreservation is a suitable method for fertility preservation on women receiving treatment that may threaten the ovarian function and subsequent fertility. The whole ovarian or a part of ovarian can be cryopreserved for future use. This study was aimed to establish ovarian tissue cryopreservation protocols on bovine model for human application in Vietnam. In this method, bovine ovarians were collected from a slaughterhouse and kept at 4 oC up to a maximum of 12 hours before doing experiments. The ovarian cortex was cut into pieces of 10x10x1 mm. These pieces were randomly divided into 3 groups: (1) fresh species (control group), (2) species were freezed by slow-freezing method and (3) pieces were freezed by vitrification. After thawing, ovarian cortex pieces were treated with Collagenase Ia for the follicle isolation. The isolated follicles then were stained with Neutral Red. The rate of viable follicles was used as the outcome measure to assess the efficiency of the cryopreservation protocol. In results, the rates of viable follicles were 72.46 ± 6.11 % and 59.09 ± 7.08 % after slow-freezing and vitrification comparing to the control group, respectively. This was the first study which successfully established a protocol of ovarian tissue cryopreservation on bovine model in Vietnam. The protocol should be improved for further application to human treatment in the near future.

Situación de la preservación de fertilidad en pacientes con cáncer en nuestro medio: grado de conocimiento, información e implicación de los profesionales

IntroductionThe estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation. MaterialQuestionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation. ResultsFifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment. ConclusionsThere are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest.

Female fertility preservation strategies: cryopreservation and ovarian tissue in vitro culture, current state of the art and future perspectives.

In the present review, the main strategies of female fertility preservation are covered. Procedures of fertility preservation are necessary for women who suffer from diseases whose treatment requires the use of aggressive therapies, such as chemotherapy and radiotherapy. These kinds of therapy negatively influence the health of gametes and their progenitors. The most commonly used method of female fertility preservation is ovarian tissue cryopreservation, followed by the retransplantation of thawed tissue. Another approach to female fertility preservation that has been actively developed lately is the ovarian tissue in vitro culture. The principal methods, advantages and drawbacks of these two strategies are discussed in this article.