Fertility Preservation Strategies Research Articles

Advances in fertility preservation of female patients with hematological malignancies

ABSTRACTIntroduction: The most common forms of hematological malignancies that occur in female reproductive years are lymphoma and leukemia.Areas covered: Several aggressive gonadotoxic regimens such as alkylating chemotherapy and total body irradiation are used frequently in treatment of lymphoma and leukemia leading to subsequent iatrogenic premature ovarian failure and fertility loss. In such cases, female fertility preservation options should be offered in advance.Expert commentary: In order to preserve fertility of young women and girls with lymphoma and leukemia, several established, experimental, and debatable options can be offered before starting chemotherapy and radiotherapy. However, each of those female fertility preservation options has both advantages and disadvantages and may not be suitable for all patients. That is why a fertility preservation strategy should be individualized and tailored distinctively for each patient in order to be effective. Artificial human ovary is a novel experimental in vitro technology to produce mature oocytes that could be the safest option to preserve and restore fertility of young women and girls with hematological malignancies especially when other fertility preservation options are not feasible or contraindicated. Further research and studies are needed to improve the results of artificial human ovary and establish it in clinical practice.

Fertility Preservation and Sexual Health After Cancer Therapy.

Recent developments in cancer diagnostics and treatments have considerably improved long-term survival rates. Despite improvements in chemotherapy regimens, more focused radiotherapy and diverse surgical options, cancer treatments often have gonadotoxic side-effects that can manifest as loss of fertility or sexual dysfunction, particularly in young cancer survivors. In this review, we focus on two pertinent quality-of-life issues in female cancer survivors of reproductive age-fertility preservation and sexual function. Fertility preservation encompasses all clinical and laboratory efforts to preserve a woman's chance to achieve future genetic motherhood. These efforts range from well-established protocols such as ovarian stimulation with cryopreservation of embryos or oocytes, to nascent clinical trials involving cryopreservation and re-implantation of ovarian tissue. Therefore, fertility preservation strategies are individualized to the cancer diagnosis, time interval until initiation of treatments must begin, prognosis, pubertal status, and maturity level of patient. Some patients choose not to pursue fertility preservation, and the conversation then centers around other quality of life issues. Not all cancer treatments cause loss of fertility; however, most treatments can directly impact the physical and psychosocial aspects of sexual function. Cancer treatment is also associated with fear, anxiety, and depression, which can further decrease sexual desire, function, and frequency. Sexual dysfunction after cancer treatment is generally ascertained by compassionate inquiry. Strategies to promote sexual function after cancer treatment include pelvic floor exercises, clitoral therapy devices, pharmacologic agents, as well as couples-based psychotherapeutic and psycho-educational interventions. Quality-of-life issues in young cancer survivors are often best addressed by utilizing a multidisciplinary team consisting of physicians, nurses, social workers, psychiatrists, sex educators, counselors, or therapists.

Current Success and Efficiency of Autologous Ovarian Transplantation: A Meta-Analysis.

Ovarian cryopreservation followed by autotransplantation is still considered an experimental strategy for fertility preservation (FP) mainly because the success rates are unknown. To determine cohort epidemiologic characteristics and success rates of autologous ovarian tissue transplantation (OTT) with previously cryopreserved tissue. Literature review from 1999 to October 1, 2016. Additional cases were retrieved from meeting abstracts and own database. We selected studies that reported autologous OTT with previously banked tissue in humans. We did not include any cases involving fresh ovarian tissue transplantation or those performed to treat idiopathic premature ovarian failure/insufficiency. Both authors reviewed and selected studies for eligibility, which resulted in 59 full-text studies assessed for eligibility. Cases were extracted from original reports and reviews by the junior author, and the senior author reviewed and verified the extracted data. Nineteen reports were included for qualitative synthesis. In 10 studies, detailed data were available to determine clinical and live birth + ongoing (LB + OG) pregnancy as well as endocrine restoration rates. Three hundred nine OTTs were performed with cryopreserved tissue, resulting in the birth of 84 children and 8 OG pregnancies. The cumulative clinical and LB + OG rates were 57.5% and 37.7%, respectively, and the endocrine restoration rate was 63.9%. Success rates with cryopreserved OTT have reached promising levels. Given these recent data, ovarian tissue cryopreservation should be considered as a viable option for FP.

A short report on current fertility preservation strategies for boys.

Advances in cancer treatment have led to improved long-term survival after childhood cancer, but often at a price of impaired future fertility. Fertility preservation (FP) in male children and early adolescents poses unique challenges as efficacy is unproven. To describe characteristics of testicular tissue cryopreservation (TTCP) specimens taken from paediatric and adolescent patients, stratified by age, and prior chemotherapy, if any, and to demonstrate evidence for germ cells. Retrospective review of gonadal biopsies and clinical records of patients consented into the Royal Children's Hospital FP programme between 1987 and 2015. Tissue was sliced into blocks, with one section sent for histopathology prior to cryopreservation. In boys ≥12years where spermatogenesis could be expected, a portion of tissue was disaggregated completely to look for mature sperm and if found, additional tissue was dissected and the resulting suspension frozen. Testicular tissue cryopreservation specimens in 44 males (0.3-16.8years) provided an average of 7.8 slices per patient. All the specimens were taken at the same time as another necessary surgical procedure, under one general anaesthesic. There was only one complication of scrotal wound dehiscence. Seven of the forty-four (15.9%) patients had chemotherapy prior to testicular biopsy, while the rest were chemotherapy naïve. Five of these were prepubertal, and two were pubertal patients. Eleven subjects had tissue dissected with mature sperm found in eight. Of these eight patients where sperm were found, all were pubertal with testicular size of more than 10mL and showing histological evidence of spermatogenesis. No histologic specimen demonstrated any malignant cells. Testicular tissue cryopreservation can be performed in young patients without delay, preferably prior to cancer treatment. As testicular tissue contains germ cells from which haploid spermatozoa are ultimately derived, future technologies may allow their utilization for fertility in humans. This may be the only hope for biological offspring in some patients undergoing fertility compromising treatment. Retrieval of mature sperm from some pubertal patients, however, offers realistic hope to these patients of future fertility.

Controversies about fertility and pregnancy issues in young breast cancer patients: current state of the art.

For trying to help physicians in counseling their young patients with breast cancer interested in fertility preservation and future reproductive plans, this manuscript aims to perform an overview of the main available data on 10 controversies in this field. Thanks to the improvement in patients' prognosis, a growing attention towards fertility and pregnancy issues has been given over the past years and is currently provided to young breast cancer patients. However, several grey zones persist in many domains of this field and some physicians are still uncomfortable to deal with these issues. Despite the great number of breast cancer patients experiencing fertility and pregnancy concerns at the time of diagnosis, the pursuit of fertility preserving strategies is realized only for a small proportion of them. The lack of adequate oncofertility counseling at the time of anticancer treatment decisions and the high costs of fertility preserving procedures can be considered the main explanations for these findings. The several ongoing registries and prospective studies investigating fertility and pregnancy issues in young breast cancer patients are crucial to acquire more robust data and try to address and solve the still unmet controversies in this field.

Anticancer treatments and female fertility: clinical concerns and role of oncologists in oncofertility practice

ABSTRACTIntroduction: Anticancer treatments such as aggressive chemotherapy and radiotherapy have deleterious gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women.Areas covered: In order to preserve fertility of young women and girls with cancer, several established, experimental, and debatable options can be offered in the emerging field of oncofertility. This article reviews the effects of anticancer treatments on female fertility and discusses the current challenges and future directions of fertility preservation options that can be offered to the female patients with cancer.Expert commentary: Although promising, several medical, economic, social and legal barriers face oncofertility practice around the globe especially in underserved areas. To overcome such barriers, more effective solutions should be provided to spread awareness and enhance communication between patients, oncologists and gynecologists. Early referral by oncologists before initiation of chemotherapy and radiotherapy is an important key factor for success in female fertility preservation strategies.

The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients

BackgroundFertility and pregnancy issues are of key importance for young breast cancer patients. Despite several advances in the field, there are still multiple unmet needs and barriers in discussing and dealing with these concerns. To address the significant challenges related to fertility and pregnancy issues, the PREgnancy and FERtility (PREFER) study was developed as a national comprehensive program aiming to optimize care and improve knowledge around these topics.MethodsThe PREFER study is a prospective cohort study conducted across several Italian institution affiliated with the Gruppo Italiano Mammella (GIM) group evaluating patterns of care and clinical outcomes of young breast cancer patients dealing with fertility and pregnancy issues. It is composed of two distinctive studies: PREFER-FERTILITY and PREFER-PREGNANCY. The PREFER-FERTILITY study is enrolling premenopausal patients aged 18–45 years, diagnosed with non-metastatic breast cancer, who are candidates to (neo)adjuvant chemotherapy and not previously exposed to anticancer therapies. The primary objective is to obtain and centralize data about patients’ preferences and choices towards the available fertility preserving procedures. The success and safety of these strategies and the hormonal changes during chemotherapy and study follow-up are secondary objectives. The PREFER-PREGNANCY study is enrolling survivors achieving a pregnancy after prior history of breast cancer and patients diagnosed with pregnancy-associated breast cancer (PABC). The primary objectives are to obtain and centralize data about the management and clinical outcomes of these women. Patients’ survival outcomes, and the fetal, obstetrical and paediatric care of their children are secondary objectives. For both studies, the initial planned recruitment period is 5 years and patients will remain in active follow-up for up to 15 years. The PREFER-FERTILITY study was first activated in November 2012, and the PREFER-PREGNANCY study in May 2013.DiscussionThe PREFER study is expected to support and improve oncofertility counseling in Italy, to explore the real need of fertility preserving procedures, and to acquire prospectively more robust data on the efficacy and safety of the available strategies for fertility preservation, on the management of breast cancer survivors achieving a pregnancy and of women with PABC (including the possible short- and long-term complications in their children).Trial registration numberClinicalTrials.gov identifier: NCT02895165 (Retrospectively registered in August 2016).

Prospective evaluation of serum anti-Müllerian hormone dynamics in 250 women of reproductive age treated with chemotherapy for breast cancer

AimWomen of reproductive age with breast cancer generally receive gonadotoxic chemotherapy. Fertility issues are of great concern for them. However, little is known on ovarian damage during chemotherapy and its evolution during long-term follow-up. The aim of this study was to provide a detailed description of serum anti-Müllerian hormone (AMH) evolution during chemotherapy and 24-month follow-up. MethodsThis prospective cohort study was conducted in 250 patients, aged 18–39 years, diagnosed with breast cancer and treated with adjuvant/neoadjuvant chemotherapy. Each patient underwent blood AMH measurement at each chemotherapy cycle, and at 6, 12 and 24 months after chemotherapy. Menses occurrence was also recorded. ResultsMean basal AMH level was 4.19 ± 4.84 ng/mL, and was negatively correlated with age. Serum AMH level rapidly decreased in all patients after each chemotherapy cycle to undetectable levels in most of them, and slowly increased in 45% of the patients during the 24-month follow-up. AMH decrease was significantly associated with age and basal AMH level, but not with cyclophosphamide dose and tamoxifen use. The prevalence of chemotherapy-related amenorrhoea was 92.4% at the end of chemotherapy; women with amenorrhoea being significantly older and having lower basal AMH than women who resumed menses. ConclusionsOur study confirms rapid and deep ovarian reserve alteration in young women receiving chemotherapy for breast cancer, and shows moderate AMH recovery in some patients. Although AMH cannot alone predict fertility potential, these new data emphasise the need for post-treatment ovarian insufficiency follow-up, strongly support the use of fertility preservation strategies and may provide new tools for improved counselling.

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America.

Thanks to the improved survival outcomes observed in recent years, a growing attention has been given to the quality of life issues faced by young women with breast cancer such as fertility preservation and concerns related to future pregnancies. However, several challenges remain for young women with breast cancer considering undergoing fertility preservation strategies. Further specific issues on this regard should be taken into account in Latin America, where patients and physicians face particular barriers that hinder the routine adoption of this practice. Hence, further efforts are needed to overcome these deficiencies and improve the correct referral of breast cancer patients to fertility preservation strategies. The aim of the present review is to focus on the risk of anticancer treatment-related premature ovarian failure and infertility in young breast cancer patients, to summarize the current knowledge on the available options for fertility preservation, and to discuss the safety issues of pregnancy in breast cancer survivors. Furthermore, this review aims to highlight the specific clinical challenges in this field encountered by healthcare providers and young breast cancer patients from Latin American countries.

PD13-11 COST-EFFECTIVENESS OF FERTILITY PRESERVATION IN TESTIS CANCER PATIENTS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I1 Apr 2017PD13-11 COST-EFFECTIVENESS OF FERTILITY PRESERVATION IN TESTIS CANCER PATIENTS Kirven Gilbert, Ajay Nangia, and Akanksha Mehta Kirven GilbertKirven Gilbert More articles by this author , Ajay NangiaAjay Nangia More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.699AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Paternity is an important concern among young testicular cancer survivors. Despite this, some affected men elect not to cryopreserve sperm prior to undergoing cancer treatment, because of the perceived costs of cryopreservation and the perceived successes of assisted reproductive technology (ART). The goal of this study investigated the cost-effectiveness of sperm cryopreservation compared to fertility management after undergoing cancer therapy among men with testicular cancer. METHODS We performed a systematic search of the Pubmed database for the following variables: risk of azoospermia after orchiectomy, 2 year surveillance, chemotherapy, RPLND, and radiation therapy (RT); rate of natural conception after cancer therapy, rate of conception with the use of IUI, and IVF/ICSI. Costs of cryopreservation were based on costs published commercial sperm cryobank companies. A decision tree was constructed using the TreePlan add-in for Microsoft Excel (TreePlan Software, San Francisco, California). The cost-effectiveness outcome was determined by the overall weighted cost of a given management branch divided by that branch's likelihood of pregnancy. A sensitivity analysis was performed for the price of microTESE between $3,000 to $11,000 and banking for a range of 2 to 10 years. RESULTS Of the total 1,113 articles identified, 55 papers were pertinent to the study question, and included. Patients undergoing chemotherapy or active surveillance had the highest chance of azoospermia over a year after treatment, at 18%. The average cost of banking was $402 one time fee with an additional $343/year. In patients undergoing active surveillance, banking had a lower cost-per-pregnancy when storing for less than 4 years and microTESE was $9,000 or greater. Banking prior to chemotherapy is more cost-effective when banking for 6 or fewer years regardless of microTESE price. Patients receiving RPLND, banking was more cost-effective when banking for 4 or fewer years and the cost of microTESE was $7,000 or greater. Banking was more cost-effective when done for 8 or fewer years regardless of price in patients undergoing RT. CONCLUSIONS A large proportion of men have recovery of spermatogenesis following chemotherapy or RT for testicular cancer (82% and 94%, respectively). Nevertheless, sperm cryopreservation prior to chemotherapy or RT remains the most cost-effective strategy for fertility preservation, across a range of possible costs associated with surgical sperm retrieval and ART. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e275 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kirven Gilbert More articles by this author Ajay Nangia More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

What is new in 2017? Update on fertility preservation in cancer patients.

The prevention of fertility loss due to cancer treatment as well as non-malignant causes has been gaining importance over the last few decades. Clinically applied modalities for fertility preservation in cancer patients include cryopreservation of oocytes and embryos, the application of GnRH agonists, ovarian tissue banking, and cryopreservation of ejaculated or surgically extracted sperm. In addition, several new possibilities to restore fertility are currently being investigated, such as the establishment of in-vitro culture systems for gonadal tissue, the development of artificial gonads, and the application of germline stem cells. This review aims to provide an update on the methods currently applied in clinical practice for fertility preservation, as well as to summarize the progress made in the development of novel strategies for fertility preservation.

Infertility - Prevention and Management.

Infertility and subfertility, menstrual irregularities, and decreased parity may occur in women with autoimmune diseases due to multiple factors, including underlying inflammatory disease, gonadotoxic medications, and psychosocial issues related to living with chronic disease. Awareness of these factors, as well as validation and support of patients confronting reproductive challenges, is important for providing comprehensive care to these women. An understanding of the expanding options for fertility preservation strategies during gonadotoxic medications is essential. Referral to a reproductive endocrinology clinic is indicated in this patient population.

Fertility and breast cancer

Breast cancer is the most common cancer among females worldwide. The mean age of breast cancer patients is > 60 yrs old, and it is seldom found in women < 40 yrs old (6.5%) and in very young women < 35 yrs old (0.6%). In young females, fertility and all its aspects are an additional therapeutic challenge. Before initiating treatment, the oncologist should offer effective contraception to be applied throughout the therapy, bearing in mind that fertility preservation is of utmost importance. When it comes to breast cancer in pregnancy, the attending physician should use a therapy which is safe for both the mother and the foetus. Chemotherapy, radiotherapy, hormonal therapy and immunotherapy can, to a lesser or greater degree, damage the ovarian function resulting in amenorrhea in women < 50 yrs (33–76%). However, owing to fertility preservation strategies, more and more pregnancies are successful, even in breast cancer survivors.

Transgender men's experiences of fertility preservation: a qualitative study.

How do transgender men experience fertility preservation (FP) by cryopreservation of oocytes? The procedures required prior to oocyte cryopreservation, such as hormonal ovarian stimulation and transvaginal ultrasound (TVS), have a negative impact on gender dysphoria as they are closely linked to the men's female assigned sex at birth, which is incompatible with their current status. Transgender persons often have high dissatisfaction with assigned sex-specific body features, such as the genital organs and androgen/oestrogen-responsive features. Thus, undergoing FP that requires genital-specific examinations, aimed at obtaining oocytes to cryopreserve, could be distressing. As no previous studies have investigated transgender men's experiences of FP involving cryopreservation of oocytes, little is known about their experience of the procedures. This is a prospective study among adult transgender men referred for FP between March 2014 and December 2015. Individual in-depth qualitative interviews were conducted shortly after FP treatment. The interviews lasted between 62 and 111 min (mean 81 min) and were digitally recorded and transcribed verbatim. Participants were recruited on their first visit to the assisted reproduction clinic for reproductive counseling. There were 15 men, scheduled for FP, who chose to participate in the study (age 19-35); none had given birth and eight had a partner. Data were analyzed by thematic content analysis. The analysis resulted in three main categories: the journey to FP, reactions to the FP proceedings and strategies for coping. The referral for FP was an important part of the assessment and diagnosis and sometimes lined with frustrating waits and doubts. The reaction to the FP proceedings revealed that the genital examinations and the physical changes associated with discontinuation of testosterone or hormonal stimulation treatment triggered gender incongruence and dysphoria. However, for some, the negative expectations were not met. The participants used several coping strategies in order to manage the procedure, such as focusing on their reasons for undergoing FP, reaching out to friends and family for support and the cognitive approaches of not hating their body or using non-gendered names for their body parts. The results demonstrate the importance of contextual sensitivity during FP procedures. The authors have strived to be reflective about their pre-understanding of the phenomenon. The majority of the participants resided in large urban areas; it is possible that transgender men living in rural areas have different experiences. As the results are based on qualitative data from 15 transgender men, the results cannot readily be generalized to larger populations. However, the results are suggested to be applicable to other transgender men who want to undergo FP by cryopreservation of oocytes. The results show that transgender men's experience of FP places may elicit gender incongruence and gender dysphoria. However, health care personnel can alleviate distress by using a gender-neutral language and the preferred pronoun. Also, reassuringly, the men also have coping strategies of how to handle the situation. This knowledge is important to ensure adequate professional support for patients with gender dysphoria during FP. Swedish Society of Medicine, Stockholm County Council and Karolinska Institutet (to K.A.R.-W.). N/A.

Fertility Preservation in Pediatric and Adolescent Patients Undergoing HSCT: a Cross-Sectional Survey of the EBMT Pediatric WP

Introduction: Fertility preservation is crucial in the setting of hematopoietic stem cell transplantation (HSCT) due to the severe impact of infertility on quality of life in long term survivors. Many chemotherapy agents as well as CNS or pelvic irradiation can affect gonads leading to impairment of pubertal development and/or infertility. In the last years different fertility preservation guidelines especially for cancer patients have been published. Despite these recommendations options for fertility preservation are not well established in children, it's discussed only in about 42% (Terenziani et al. PBC 2014) of all eligible patients. We present here a survey conducted by the Pediatric WP of the EBMT.Aim: to analyze and compare the different fertility preservation practices for children and adolescents across the EBMT centers and to identify hence the unmet needs in the field.Material and Methods: The survey was conducted between September 2014 and December 2015. 177 pediatric centers reporting to the EBMT were asked to fill-out a form with 24 questions related to fertility preservation strategies. Questions focused on institutional availability of a fertility preservation program and its options, number of patients included in the program, payers and suggestions for improvement.Results: 38 (21%) centers from 16 countries replied. In 2013 the number of HSCT per center ranges from 2 to 60. Totally, 834 children were transplanted in the 38 centers, 22% of the reported HSCT in children (3789) in 2013 from the EBMT centers. Of the 834 patients 612 (73%) were prepubertal and 203 (25%) postpubertal. 322/834 (39%) patients received a fertility preservation counselling and 243 (29%) of them had a fertility preservation procedure. Half of the 38 centers reported to have a fertility preservation program with standard operating procedure (SOP) for counselling. Centers with SOP counselled patients significantly more often than those without (Figure 1A). Regarding the number of applied procedures, no significant difference was found between centers with and without a SOP (Figure 1B). Centers with SOP counselled earlier (at the beginning of treatment/diagnosis; 61% versus 29%), and an interdisciplinary counselling team was largely used (60%). This team involved hematologists, gynecologists and /or reproductive medicine specialists. The most frequently cited reasons for missing counselling were lack of time (59%), refusal by parents (35%) and expected poor prognosis (29%). Reasons explaining parents/patients refusal were psychological distress (52%) and overwhelming feeling (50%) in this life-threatening moment. All responding centers considered the topic of fertility preservation as very relevant. Better education, more resources and financial funding emerged as pivotal factors to support and implement such programs.Conclusion: This EBMT survey showed the great interest for fertility preservation in participating centers. The collected data indicated that less than half of pediatric and adolescent patients undergoing HSCT in 2013 received a counselling on fertility preservation and/ or underwent fertility preservation procedures. This emphasizes the need for enhanced education of the transplant team and active multidisciplinary collaboration in the field. Fertility preservation becomes a standard of care; this data represents the basis to further efforts toward fertility preservation standardization in the EBMT community. [Display omitted] DisclosuresBader:Servier: Consultancy, Honoraria; Neovii Biotech: Research Funding; Riemser: Research Funding; Medac: Consultancy, Research Funding; Novartis: Consultancy, Honoraria.

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.

The Effect of a Unilateral Orchiectomy before Gonadotoxic Treatment on the Contralateral Testis in Adult and Prepubertal Rats

PurposePrevious studies have shown that the removal of one testis leads to a compensatory mechanism in the contralateral one, but this was species and age dependent. The aim of this study was to check whether this compensation would still occur after the combination of a unilateral orchiectomy and gonadotoxic treatment, since this resembles the clinical situation of patients who have to undergo highly toxic cancer treatment and therefore choose to cryopreserve a testicular biopsy for fertility restoration purposes.Materials & MethodsSprague Dawley rats underwent either unilateral orchiectomy, gonadotoxic busulfan treatment, the combination of both or served as fertile control. A comparison of the compensatory effects was made between adult and prepubertal treated rats. Mating experiments were performed, testosterone levels were followed-up, testicular weight was recorded and histology was analysed.ResultsAdult treated rats were able to restore fertility spontaneously in all treatment groups. On the other hand, 30% of the rats that underwent a unilateral orchiectomy and gonadotoxic treatment at prepubertal age showed hampered spermatogenesis, low testosterone levels, decreased testicular weights and were not able to reproduce.ConclusionThis study emphasizes the need of fertility preservation strategies in prepubertal patients before gonadotoxic interventions.

Factors associated with ovarian function recovery after chemotherapy for breast cancer: a systematic review and meta-analysis.

Which factors related to patient, treatment or disease are associated with ovarian function recovery after chemotherapy in premenopausal women with breast cancer? Younger age and GnRH agonist (GnRHa) administration during chemotherapy were significantly associated with menses recovery, but this recovery was less likely in patients exposed to taxanes. To date, published meta-analyses have only assessed GnRHa administration as a possible factor for ovarian function recovery, and their results were conflicting. Current guidelines present distinct recommendations regarding the use of GnRHa for fertility preservation (FP) in women with breast cancer. A systematic review and meta-analysis of published studies in the English, Portuguese, French or Spanish languages (1990-2015), ongoing trials or completed trials (1990-2015) and conference proceedings (2000-2015) were performed. We searched the MEDLINE, Embase, LILACS, Scielo, Toxline and DART databases, online trial registries and conference proceedings. Studies were eligible if they included premenopausal women with early breast cancer treated with chemotherapy, reported ovarian function recovery data and identified factor(s) associated with recovery. Two authors independently screened the studies, extracted data and assessed the risk of bias. An odds ratio (OR) was estimated from the number of recovery events. A meta-analysis was conducted using a random-effects model. Fifteen articles were included. Five different factors were analysed: younger age and baseline levels of anti-Müllerian hormone (patient-related factors), co-administration of GnRHa, addition of taxanes to anthracycline-based chemotherapy and addition of endocrine therapy to chemotherapy (treatment-related factors). Menses recovery was the most used marker. Younger age (≤40 years) and exposure to GnRHa were positively associated with menses recovery (OR 6.07 and 2.03, respectively) but exposure to taxanes adversely affected recovery (OR 0.49). Significant heterogeneity among studies was found. A general limitation of the included studies is the use of menses as the main recovery marker. Regarding GnRHa, the substantial heterogeneity and conflicting results limit the interpretation of our results. Studies that use additional markers and have a longer follow-up are needed. The decision for using chemotherapy regimens with taxanes must take into account their potential adverse effects on female fertility. Considering the conflicting results regarding GnRHa agonist use, other fertility preservation strategies should also be considered. No external funding was received. There are no conflicts of interest to declare. This review was registered at PROSPERO (CRD42015013494).

Tissue recovery and in vitro maturation of immature oocytes as a fertility preservation strategy for tandem ovarian, oocyte, and embryo cryopreservation

Tissue recovery and in vitro maturation of immature oocytes as a fertility preservation strategy for tandem ovarian, oocyte, and embryo cryopreservation

Current succes and efficiency of autologous ovarian transplantation with cryopreserved tissue: a meta-analysis

Ovarian cryopreservation is still considered an experimental fertility preservation strategy and the success rates with the transplantation (OT) of previously banked ovarian tissue are unknown. Here we sought to meta-analyze published and unpublished data, including our own to determine success rates of OT.