Fertility Preservation Practice Research Articles

Principles and Practice of Fertility Preservation edited by Jacques Donnez and S Samuel Kim

Principles and Practice of Fertility Preservation edited by Jacques Donnez and S Samuel Kim

Strategies to support human oocyte development in vitro

Many young cancer patients are now being given the option to store ovarian cortical biopsies before undergoing potentially damaging chemo- or radiotherapy. This tissue mainly contains large numbers of immature primordial follicles. Currently the only option to restore fertility using this tissue is by transplantation which may not be a viable option for all patients. Greater options to realise the potential of this tissue to restore fertility could be achieved by the development of in vitro systems that support oocyte development. The ability to develop human oocytes from the most immature stages of follicles (primordial) through to maturation and fertilisation in vitro would revolutionise fertility preservation practice. This has been achieved in mouse where in vitro grown (IVG) oocytes from primordial follicles have resulted in the production of live offspring. However, developing IVG systems to support complete development of human oocytes has been more difficult because of differences in scale of timing and size. Our lab has been working on a multi-step culture system to support growth and development of bo-vine and human oocytes from primordial through to fully grown, using fresh and cryopreserved ovarian cortical tissue. This review outlines the approaches being taken to obtain complete in vitro development of human oocytes and strategies for assessing the health and viability of IVG oocytes.

A cross Canada survey of sperm banking practices in pediatric oncology centers

Childhood cancer survivors have identified fertility preservation as a major concern. Sperm banking is an established fertility preservation option in pubertal males. We sought to describe current practices in Canadian pediatric oncology programs, and to identify perceived barriers to sperm banking for male adolescents. A questionnaire was developed to (1) describe current sperm banking practices and facilities; (2) report on the utilization of sperm banking; and (3) identify barriers to sperm banking and possible solutions to improve current practices. A healthcare professional with an interest in fertility preservation within each institution was approached to participate in the study. Fifteen of 16 institutions participated, 2 have fertility preservation teams. Only one has written guidelines or adolescent focused educational material. Over 2 years, 50/262 (19%) adolescents in 12 institutions successfully banked a specimen. In 11 of these, additional information was available: of 85/172 (49%) adolescents offered the option to bank, 38/85 (45%) subsequently attempted. Reported barriers to sperm banking included the pressure to start therapy and restricted banking hours. Formal education of healthcare providers in fertility preservation practices, provision of financial support for families, and an adolescent focused approach were identified as important initiatives to improve sperm banking. There is a disparity in current sperm banking practices in Canada and at present, <25% of eligible male adolescents attempt to bank sperm. The development of a fertility preservation team, adolescent-specific guidelines, adolescent friendly sperm banking units, financial support, and improving knowledge translation among professionals and patients may improve the rates of banking.

Final results of the survey for preservation of adolescent reproduction (SPARE) study: semen preservation knowledge, attitudes, practices and barriers

OBJECTIVE: The SPARE survey was designed to obtain robust data on current fertility preservation (FP) knowledge and utilization amongst adolescent oncology health care providers. We describe a subset of the final data that specifically addresses semen preservation knowledge, attitudes, practices, and barriers. DESIGN: A questionnaire based, cross-sectional study assessing adolescent pediatric health care provider attitudes and practices regarding fertility preservation. MATERIALS AND METHODS: The SPARE survey was created by our group and consists of 22 questions (61 total items) assessing FP attitudes and practice patterns for adolescent cancer patients. It includes 19 items specifically dealing with semen preservation knowledge, attitudes, practices, and barriers. The survey was constructed and collected through the use of SurveyMonkey™ and launched via a pediatric oncologist email list serve. Data was analyzed using Microsoft Excel software. RESULTS: Data from 209 respondents including 181 pediatric oncologists has been obtained. 85% of respondents offered sperm banking to pubertal patients most commonly within 1 week of diagnosis. The youngest age at which patients are offered sperm banking was 13 years (median). Estimated cost for the first year of cryo-preserving sperm ranged from $100 to $500,000, with a mean and median of $4547 and $500 respectively. In the event of patient's death, 46% recommend that banked sperm be thawed and destroyed, 37% recommend it be given to parents, and 23% recommend donating the sperm to a research facility. The most likely reason for physicians to not recommend sperm banking was a patient having a poor survival prognosis or an aggressive disease requiring immediate initiation of treatment, with the second most likely reason being lack of parental consent; physician discomfort in discussing sperm banking was not reported as a risk factor. The most commonly reported reason that pubertal male patients or parents refused sperm banking prior to treatment was a desire to initiate treatment as soon as possible and they did not want to be concerned with possible infertility. CONCLUSIONS: Pediatric oncologists are strongly motivated to preserve fertility in male pediatric cancer patients through semen preservation but barriers exist. Additional utilization of semen preservation techniques and promotion of the ASCOR are essential to optimize reproductive health of young cancer patients.

A survey of fertility preservation practices by Canadian oncologists for female cancer patients

Over the last 20 years, the field of reproductive medicine has expanded greatly by providing many options for female cancer patients to preserve their fertility. However, it is unknown whether female patients who would benefit from fertility preservation techniques are provided accurate information, and/or are being referred by their oncologists to appropriate services. It is unknown if these services are available and/or offered across all of Canada. The purpose of the study is to determine practice policies, referral patterns, and fertility preservation knowledge among Canadian oncologists who treat female cancer patients at risk for infertility.

Discussion of fertility preservation with newly diagnosed patients: oncologists’ views

Although physician discussion with patients regarding fertility preservation (FP) options prior to cancer treatment can provide important information for survivors concerning their future fertility, little is known about the extent to which physicians discuss FP with patients. This qualitative study sought to identify current physician FP communication practices and determine factors that may impact communication efforts regarding FP. Qualitative data were collected using semi structured interviews with 16 physicians practicing at a major cancer center in the South. All providers were board certified in medical oncology, radiation oncology or surgical oncology. The main factors that emerged from qualitative analysis included distinct variations in quality of discussion about FP, knowledge of FP resources, attitudes, practice behaviors and perceptions of patient characteristics. While most physicians discussed potential fertility loss as a side effect of cancer treatment, few provided information to patients about preserving fertility. Patient characteristics such as gender and cancer site may impact the discussion, as well as system factors such as costs of procedures and access to FP resources. Education and training for physicians about FP options for cancer patients, particularly females, may promote discussion of FP. In addition, system barriers related to availability and affordability of FP resources must also be addressed. Physicians should consider providing patients with timely, understandable information related to their FP options, prior to the administration of treatment. Such discussions may lead to improved quality of life for individuals as they transition from patients to survivors.