Cryopreservation Of Mature Oocytes Research Articles

O-086 Risk of serious adverse event after fertility preservation procedures: a comparison of cancer and non-cancer patients

Abstract Study question Do cancer patients have a higher risk of serious adverse event associated to fertility preservation procedures compared to non-cancer patients ? Summary answer No increased risk of adverse event after fertility preservation procedures was identified in cancer patients compared to non-cancer patients undergoing fertility preservation for other indications. What is known already Current recommendations encourage a prompt and exhaustive discussion on the different techniques of fertility preservation that can be performed in cancer patients of reproductive age prior to cancer treatments. Although cryopreservation of mature oocytes and/or embryos is the technique of reference in the absence of contraindication, ovarian stimulation and subsequent oocyte retrieval are associated to complications. Cancer patients might present an additional risk given tumoral hypervascularity and proinflammatory environment, as well as possible immune or coagulation disorders. However, whether cancer patients have an increased risk of serious adverse event associated to fertility preservation procedures compared to non-cancer patients remains unknown. Study design, size, duration A bicentric, retrospective study between January 1st, 2014 and December 31st, 2021. Participants/materials, setting, methods All women undergoing fertility preservation procedures by oocyte and/or embryo cryopreservation after controlled ovarian stimulation or in vitro maturation.The main endpoint was the occurrence of a serious adverse event (hospitalization for ovarian hyperstimulation syndrome, hemorrhage, infection, thromboembolic event, ovarian torsion, acute urine retention or death) in cancer patients compared to non-cancer patients undergoing fertility procedures. Main results and the role of chance A total of 4476 cycles (n = 3180 patients) were included, of which 3761 after controlled ovarian stimulation and 715 in vitro maturation cycles. Among the 4476 cycles, 1678 were performed in an oncological context (n = 1546 cancer patients) and 2798 were fertility preservation cycles for an indication other than cancer (n = 1634 patients). A total of 29 serious adverse events associated to fertility preservation procedures were registered, of which 17 intraperitoneal hemorrhages, 8 cases of ovarian hyperstimulation syndrome, 3 cases of infection and 1 case of acute urine retention. The risk of serious adverse event associated to fertility preservation procedures was not significantly different between cancer patients and non-cancer patients (0.36% vs. 0.82%, respectively, P = 0.06). Young age (P = 0.002), a higher number of oocytes retrieved (P = 0.006) and a higher number of oocytes vitrified (P = 0.002) were significantly associated to the risk of presenting a serious adverse event after fertility preservation. Limitations, reasons for caution Although rates of serious adverse events in our study are similar to that reported in previous literature and that the declaration and registration of any serious adverse event is mandatory according to French legislation, it is possible that not all serious adverse events were declared and registered. Wider implications of the findings Given the trend of delaying parenthood and the improved survival rates after cancer treatments, these findings are of particular importance, emphasizing the safety of performing fertility preservation procedures for cancer patients of reproductive age who might have a pregnancy desire after cancer treatment. Trial registration number not applicable

Controlled ovarian stimulation in cancer patients under 18 years old; a case series

BackgroundFertility preservation for adolescent pubescent girls is a concern of the healthcare system and parents. Oocyte cryopreservation is regarded as a standard medical intervention for patients with a minimum age of 18 years. Evidence suggests that mature oocyte cryopreservation is possible for adolescent pubescent girls, although, ovarian stimulation for these patients remains a challenge.Cases presentationThis case series is the first report regarding ovarian stimulation with oocyte cryopreservation in younger than 18 years cancerous girls, who refer to ROYAN institute, Tehran, Iran, prior to the start of the treatment of cancer (November 2015 to February 2021). The oocyte cryopreservation was carried out in the 7 patients (five patients with Hodgkin lymphoma, one patient with Ewing sarcoma, and one patient with osteogenic tumor), the embryo cryopreservation in one patient with dysgerminoma, and the oocyte and embryo cryopreservation in one patient with germ cell tumor. No oocytes were retrieved after ovarian stimulation in the patient with medulloblastoma. For one of the patients with Hodgkin lymphoma, half of the tissues of one ovary were cryopreserved prior to ovarian stimulation.ConclusionsOocyte cryopreservation is a feasible option of fertility preservation in the adolescent’s patients with cancer. However, only if reported acceptable fertilization rates, as well as the successful cases of live birth from oocyte cryopreservation at the ages under 18, this option of preserving fertility can be applied to this age range.

Ovarian Tissue Freezing in Cancer Patients - Transplantation and IVM

Ovarian tissue cryopreservation (OTC) and subsequent grafting (OTG) is an innovative fertility preservation option, particularly for those patients who cannot delay treatment or are pre-pubertal. Unlike mature oocyte cryopreservation, OTC provides potential multiple opportunities for conception given the large supply of oocytes at immature stage. OTG is increasingly recognised as being successful in re-establishing fertility for women who have had gonadotoxic treatment, with over 200 live births documented worldwide from either spontaneous or assisted conception. However, establishing accurate clinical pregnancy rates and livebirth rates associated with IVF treatment after grafting is somewhat difficult as most studies publish pregnancy rates per patient rather than per transfer. Accurate information is important to assist patients with expectation management of numbers of cycles required to conceive and with outcomes, given this type of treatment is more labour-intensive than straightforward IVF. For patients with haematological cancers and with ovarian cancer there is a risk of tumour cell transmission and therefore strategies are required to allow use of the tissue and/or the gametes without conferring this risk. In-vitro-maturation offers the potential for healthy pregnancy and livebirth without the risk of grafting, and development of this technology will allow a robust and realistic fertility treatment strategy. However, how to successfully effect the initial phase of follicle development from primordial phase, termed the in-vitro-growth phase, is still eluding researchers. Mastery of this will allow substantial expansion of the follicle pool.

Female with peritonitis and abdominal distention.

A G0 35-year-old female with a body mass index (BMI) of 21 and history of antibiotic allergies presented to the emergency department with diffuse abdominal pain. Two days prior, she had a transvaginal ultrasound-guided oocyte retrieval for mature oocyte cryopreservation and 36 hours before the procedure received a human chorionic gonadotropin (hCG) “trigger shot.” She was tachycardic, but otherwise hemodynamically stable. On abdominal examination, she had a distended abdomen with diffuse tenderness to percussion and rebound tenderness. A point-of-care ultrasound demonstrated free fluid and a computed tomography (CT) of the abdomen/pelvis with intravenous contrast was obtained after consultation with surgery and obstetrics (Figures 1-3). CT revealed bilateral enlarged ovaries with follicles, the largest at 17 × 15 × 10 cm, with ascites and bilateral pleural effusions. No free air or active hemorrhage was identified. She underwent paracentesis of 2.5 L with administration of albumin and anticoagulation. Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology, described as cystic enlargement of the ovaries and fluid shifts from the intravascular space to the third space.1, 2 It can occur in 1%–5% of cycles with risk factors of low BMI, polycystic ovarian syndrome, allergy history, high doses of hCG, and large number of follicles.2, 3 Peritonitis can occur because of the release of inflammatory mediators or rupture of follicular cysts.3 Severe OHSS is characterized by ascites, pleural effusions, and hemoconcentration. In addition to OHSS, complications of oocyte retrieval, albeit rare, must also be considered as intraperitoneal hemorrhage, bowel perforation, or infection.4

Gonadal Hormone Production after Hematopoietic Cell Transplant (HCT) in Patients with Sickle Cell Disease (SCD): A Stellar Study

Introduction HCT is the only therapy for SCD with curative intent, but the alkylator chemotherapies used in preparative regimens place patients at high risk for gonadal dysfunction. Adequate ovarian and testicular hormone production post-HCT is important for optimal health. Methods We enrolled children and adults with SCD ≥ 1-year post-HCT ("HCT") in the Sickle Cell Transplant Evaluation of Long-term and Late Effects Registry (STELLAR) and a control group of patients with SCD not treated with HCT ("non-HCT"). We obtained annual surveys of gonadal health using a web-based platform. Surveys were completed by proxies for individuals <18 years and were self-report for individuals ≥18 years. Markers of ovarian reserve or testicular function were measured, including follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) in females and FSH and testosterone in males. The most recent survey was used for analysis when multiple surveys were available. The upper limit of normal (ULN) for age of pubertal onset was defined as 13 years in females and 14 in males, and the ULN for menarche was 15 years. Only females >13 years and males >14 years (ULN for activation of the hypothalamic pituitary gonadal axis) were included in the FSH analysis. Descriptive statistics were reported as median (Interquartile range [IQR]: 3rd quartile - 1st quartile), mean (min, max) or count (%). Statistical procedures involved a chi-squared test. The effect size was calculated using standard mean difference (SMD). Results Surveys were completed by 48 SCD HCT patients (30 females, 18 males) and 12 SCD control patients (8 females, 4 males). Median age (IQR) at survey completion was 14.8 years (11.8) for female HCT, 16.0 (10.4) for male HCT, 14.5 (11.6) for female non-HCT, and 21.0 (22.8) for male non-HCT. Median age (IQR) at HCT was 8.8 years (6.1) for females and 9.1 years (5.2) for males. Most patients underwent HCT in 2010-2020 (86.7% of females, 78.8% of males). Donor was predominantly matched related (90.0% of females, 94.4% of males) with bone marrow stem cell source (90.0% of females, 94.4% of males). Most patients received myeloablative conditioning (86.7% of females, 94.4% of males). Only female HCT patients (n=8, 32%) reported being told they might need hormones to enter puberty. In females who were ≥15 years, menarche was reported in 11 (78.6%) HCT and all of the non-HCT patients. Current menstruation was reported in 9 (64.3%) HCT and 3 (75.0%) of non-HCT patients, and 10 (71.4%) HCT and 1 (25%) non-HCT females reported ever having taken hormones, including birth control. P-values and SMD can be seen in Table 1. Hormone levels were measured in 68 HCT patients (41 female, 27 male). Most patients underwent HCT from 2010-2020 (82.9% of females; 74.1% of males) using matched related donor (90.2% of females, 92.6% of males) bone marrow (87.8% of females, 85.2% of males) following myeloablative conditioning (87.8% of females, 88.9% of males). For females, the median age at the time of AMH testing was 16.5 years (IQR 9.1) with a mean of 6.8 years (IQR 4.8) post-HCT. Based on the age and assay normal values, AMH levels were normal in 3 (7.3%), low but detectable in 7 (17.1%), and undetectable in 31 (75.6%) of patients. FSH was measured in 12 females who were >13 years and not on hormone therapy (Table 2). The median age at FSH testing was 18.0 years (IQR 5.1), with a mean of 8.7 years (IQR 3.5) post-HCT. FSH levels were normal in 7 (58.3%) and above the ULN in 5 (41.7%), 3 of which were menopausal (>30mIU/mL). Testosterone values were obtained in 15 males who were >14 years with a median age 18.9 years (IQR 5.9) and a mean of 6.9 years (IQR 5.1) post-HCT. The mean testosterone level was 365.8 ng/dl (range 152-592), 13 (86.7%) of which were in the normal range and 2 (13.3%) being low. FSH values in males >14 years were high in 4 (26.7%). Conclusions Nearly all females had diminished ovarian reserve post-HCT, with >75% having undetectable AMH levels. In addition, close to half of the females had elevated FSH levels, some in the menopausal range. However, females with normal FSH and normal or low AMH can consider post-HCT mature oocyte cryopreservation. Most males had normal testosterone levels, but >25% had elevated FSH levels which could be a signal of impaired spermatogenesis. These findings highlight the importance of studying the impact of HCT on gonadal function and the consideration of these outcomes when developing protocols for curative therapy in SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Dynamic in vitro culture of cryopreserved-thawed human ovarian cortical tissue using a microfluidics platform does not improve early folliculogenesis.

Current strategies for fertility preservation include the cryopreservation of embryos, mature oocytes or ovarian cortical tissue for autologous transplantation. However, not all patients that could benefit from fertility preservation can use the currently available technology. In this regard, obtaining functional mature oocytes from ovarian cortical tissue in vitro would represent a major breakthrough in fertility preservation as well as in human medically assisted reproduction. In this study, we have used a microfluidics platform to culture cryopreserved-thawed human cortical tissue for a period of 8 days and evaluated the effect of two different flow rates in follicular activation and growth. The results showed that this dynamic system supported follicular development up to the secondary stage within 8 days, albeit with low efficiency. Surprisingly, the stromal cells in the ovarian cortical tissue were highly sensitive to flow and showed high levels of apoptosis when cultured under high flow rate. Moreover, after 8 days in culture, the stromal compartment showed increase levels of collagen deposition, in particular in static culture. Although microfluidics dynamic platforms have great potential to simulate tissue-level physiology, this system still needs optimization to meet the requirements for an efficient in vitro early follicular growth.

P-484 Oocytes quality assessment in breast cancer: implications for fertility preservation

Abstract Study question Does the breast cancer (BC) influence the oocyte quality and ovarian response to controlled ovarian hyperstimulation (COH) for fertility preservation (FP) in female oncology patients? Summary answer The diagnosis of breast cancer does not seem to be associated with an impairment of ovarian reserve, but with a worsening of oocyte quality. What is known already Fertility preservation in female oncology patients should be integrated as part of management of cancer patient to improve their quality of life. Every day in Italy about 30 new cases of cancer are diagnosed in patients with age under 40 years and BC is the most common malignancy in women undergoing fertility preservation. Currently mature oocyte cryopreservation is a standard technique for fertility. The studies on the outcome of ovarian response after ovarian stimulation in specific cancer patients are limited. Only few reports have suggested a deleterious impact of the oncological disease on quality of follicular growth and ovarian function. Study design, size, duration This is a retrospective single-center case-control study carried out in the IVF (in vitro fertilization) Unit at the Sandro Pertini Hospital in Rome between 2016 and 2021. The aim of this study is to investigate the effect of BC on number, above all on quality of oocyte and on dysmorphic oocyte ratio, in oncology patients compared to women age- and date-matched controls undergoing COH for IVF for male or tubal factor infertility. Participants/materials, setting, methods A total of 294 women were enrolled in the study: 105 women affected by breast cancer in the case group and 189 healthy women in the control group. Boths groups were comparable in terms of age, body mass index (BMI) and antimulleran hormone (AMH) value, E2 level at triggering day, total FSH cumulative dose, stage, histotype, BRCA status and hormone receptors. The primary outcome was number and quality of retrievd oocyte from ovarian pick-up (OPU). Main results and the role of chance There were no significant differences in terms of basal fertility indices between the 2 groups: median AMH levels were 2.3 ng/mL in BC patients and 2.8 ng/mL in control group (p = 0.103). The median length of stimulation was 11 days in both groups. The median of total immature oocytes (oocytes MI + germinal vesicle) was 2 in cancer patients and 0 in control group (p &amp;lt; 0.0001). Finally, the median of total dysmorphic oocytes were 1 in cancer group vs 0 (p &amp;lt; 0.0001). The multivariable analysis identified the cancer as risk factors of presence of dysmorphic oocytes (OR (95%CI):3.92 (1.84-8.35). Moreover either in the case and control group age, BMI, AMH, duration of stimulation, E2 level at triggering day, total FSH cumulative dose and, only for BC patients, stage, histotype, BRCA status and hormone receptors were not statistical significantly associated with the presence of dysmophic oocytes. Finally, our data confirmed that the cancer is the only risk factors not only for the presence of dysmorphic oocytes, but also respect to the number of dysmorphic oocytes and to the percentage of dysmorphic oocytes respect to the total number of retrieved oocytes for patient. Two patients have had a spontaneous pregnancy. Limitations, reasons for caution The limitations concern the paucity of specific cancer group especially BRCA mutated BC patients and the different triggers for induction of final maturation. We still have not a follow up data to evaluate the competence of vitrified MII oocytes for oncology patients and we cannot report information on spontaneous births. Wider implications of the findings The BC diagnosis is a four times greater risk factor in retrieving dysmorphic oocytes, but the stage of BC does not influence the number of retrieved dysmorphic oocytes. Further studies are necessary to evaluate the etiopathogenetic mechanisms underlying oocyte abnormalities in specific group of female oncology patients. Trial registration number 0104898/2020

Proteomic profile of mouse oocytes after vitrification: A quantitative analysis based on 4D label-free technique

Mature oocyte cryopreservation represents an important trend for future fertility preservation, however, the relatively low efficiency has hampered its clinical application. Proteomic profiling is a method of choice for the exploration of the molecular mechanism underlying cryoinjuries. Here, a systematic comparison of protein expression between fresh and vitrified oocytes was performed based on the 4D label-free technique, an informative method with high sensitivity. Our results indicated that the oocyte survival rate was significantly reduced after vitrification. Proteomic results showed that 32 proteins were up-regulated, while 77 proteins were down-regulated in vitrified oocytes compared with the fresh counterparts. Gene Ontology (GO) functional analysis revealed that differentially expressed proteins (DEPs) were involved in metabolism, mitochondrial function, cytoskeleton and other cell functions. Moreover, proteins that participated in signaling transduction mechanisms were the largest category based on Clusters of Orthologous Groups of protein/EuKaryotic Orthologous Groups (COG/KOG) functional classification. In addition, over-expressed DEPs were enriched for “nucleus”, “protein binding”, “membrane”, “cytoplasm” as well as mitochondrial function. Furthermore, we discovered that the DEPs were clustered in pyruvate metabolism, citric acid (TCA) cycle and glucose metabolism by Protein-Protein Interaction (PPI) network evaluation. In conclusion, our data demonstrate that vitrification induces multi-level damages in oocytes, the dynamic proteomic profiling will provide systematic insights into uncovering the mechanism underlying cryoinjuries.

Potential use of immature oocyte to improve fertility preservation outcome: A narrative review

ABSTRACTFertility preservation through gamete vitrification has become one of the critical strategies to secure a childbearing potential in patients who are diagnosed with cancer or risks of infertility. Preserving the gametes would prevent the deleterious effects of cancer drugs or radiotherapy exposure on the quality of the gametes. Furthermore, in vitro fertilisation of vitrified mature human oocytes has lately demonstrated promising results that are reflected in the increased survival rate of thawed oocytes and the resultant clinical pregnancy rate. However, limitations in the cryopreservation of mature oocytes of cancer patients persist. Ovarian stimulation protocols which comprise administering gonadotrophin-releasing hormones could aggravate cancer or delay essential cancer therapy. Considering such circumstances, vitrification of immature oocytes would become a rational option. While the vitrification procedure of mature oocytes has been established, the vitrification of immature oocytes remains controversial due to a low post-thaw in vitro maturation and fertilisation rate. Apparent cryoinjuries to the immature oocytes post thawing or warming have been observed in both human and animal model oocytes. An alternative strategy was therefore proposed to improve the effectiveness of utilising immature oocytes for fertility preservation by conducting the in vitro oocyte maturation process first before vitrification. This method has prevailed, especially in oncofertility patients. Although the success rate of the clinical outcomes remains low, this approach, in conjugation with proper counselling, might provide oncofertility patients with an opportunity to preserve their reproductive potential.

Fertility and breast cancer: A literature review of counseling, preservation options and outcomes.

Fertility preservation is an important issue in breast cancer patients undergoing oncological treatment. Fertility counseling is a crucial need given the physical and psychological stress experienced by patients. Cryopreservation of mature oocytes is currently the standard fertility-preserving procedure. Other options such as ovarian tissue preservation or gonadal protection during chemotherapy are still experimental, but have proven effectiveness. Prompt referral to a fertility unit is highly recommended in order to ensure quality of care. In this article, we focus on the different strategies to preserve fertility in breast cancer patients, assessing also the safety of pregnancy and breastfeeding after cancer. A systemic literature review was performed for research articles published in English in PubMed, or as abstracts from the European Society for Medical Oncology (ESMO), San Antonio Breast Cancer Symposium (SABCS) and American Society of Clinical Oncology (ASCO) annual meetings, using the search terms "breast cancer" and "fertility".

Fertility preservation strategies for patients with lymphoma: a real-world practice survey among Fondazione Italiana Linfomi centers.

Improvement in the prognosis of lymphomas in recent decades has allowed focus on reducing long-term toxicity of treatment, including infertility. The aim of this study was to assess the fertility preservation knowledge and practices among hematologic centers affiliated with Fondazione Italiana Linfomi (FIL) in Italy. A survey questionnaire was provided to 152 FIL centers between December 2019 and December 2020. Responses from 58 centers (38%) were received. All respondents reported informing patients about treatment-related gonadotoxicity. A minority of patients (10% female, 20% male) refused fertility preservation due to personal reasons. The most common fertility preservation options offered to female patients were mature oocyte cryopreservation (43.1%), ovarian tissue cryopreservation (6.9%), and mature oocyte or ovarian tissue cryopreservation (39.7%). Six centers (10.3%) did not perform any procedures. All centers offered sperm cryopreservation for male patients. Challenges regarding the time intervals between lymphoma diagnosis and fertility consultation (up to 20 days) as well as between consultation and fertility preservation procedure (up to 40 days) were revealed. This survey provides insight into fertility preservation practices among Italian hematologic centers and points out an urgent need to improve close cooperation between hematologists and fertility preservation specialists in order to avoid unacceptable delays in lymphoma treatment.

P–462 First live birth after fertility preservation using vitrified oocytes in a woman with mosaic Turner syndrome

Abstract Study question Is oocyte vitrification an option for preserving the fertility of women diagnosed with Turner syndrome (TS)? Summary answer We report the first live birth achieved using cryopreserved oocytes in a woman diagnosed with mosaic Turner syndrome. What is known already Women with TS are at extremely high risk for premature ovarian insufficiency (POI) and infertility. Although the desire of becoming parents may be fulfilled through egg donation or adoption, fertility preservation using ovarian tissue cryopreservation or oocyte vitrification has been offered to adolescents with TS before complete exhaustion of their follicular stockpile. However, women with TS exhibit higher rates of pregnancy loss and obstetric complications, and the feasibility of fertility preservation in TS is hampered by the reduced follicular pool and by concerns about the X chromosomal content of oocytes and follicular cells. Study design, size, duration Case report in a university hospital. Participants/materials, setting, methods A 25-year-old woman with Turner syndrome mosaicism (45,X0[14]/46,XX[86]) was referred for fertility preservation (FP) counseling. Serum antimüllerian hormone (AMH) level was normal (6.4 µg/L). In view of parenthood postponement and because of the unpredictable rate of follicle loss, the woman underwent two cycles of ovarian stimulation using recombinant follicle stimulating hormone (rFSH), 200–250 IU/day for 8 resp. 12 days, in a GnRH antagonist protocol. Main results and the role of chance In total, 29 metaphase II oocytes (MII) were vitrified. Five years later, the patient returned to the clinic with a desire for pregnancy. Because of evidence of considerable AMH decline (–56% in an interval of four years), the patient was advised to utilize her cryopreserved oocytes for in-vitro fertilization with preimplantation genetic testing for aneuploidy screening (PGT-A). All 29 MII oocytes were thawed; 26 oocytes survived (89.7%) and were inseminated using intracytoplasmic sperm injection (ICSI). Thirteen oocytes were fertilized normally. Three good quality blastocysts ensued and were vitrified after trophectoderm biopsy for PGT-A using array-CGH. Two blastocysts were found euploid. One was thawed and transferred into the uterus using a HRT priming protocol. An uneventful pregnancy occurred. The patient delivered a healthy baby girl weighing 3490 g at 40 weeks of gestation. Limitations, reasons for caution Cryopreservation of oocytes and/or ovarian tissue in selected postmenarchal girls or young women with Turner syndrome is an investigational FP approach that may result in genetic parenthood. The feasibility of FP in TS individuals is limited to those with evidence of ovarian function, before POI occurs. Wider implications of the findings: Cryopreservation of mature oocytes after ovarian stimulation is a realistic option for FP in selected postmenarchal individuals with mosaic TS. Whether PGT-A may reduce the risk of pregnancy loss in TS has to be confirmed by further studies. Trial registration number Not applicable

Standardization of fertility preservation discussion amongst pediatric oncology and bone marrow transplant patients.

10051 Background: As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options. Methods: Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014-2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or radiation treatment. We implemented a standard fertility preservation note and patient handouts, then surveyed our department to identify diagnoses that place patients at risk for infertility and barriers to formalized fertility consultations. We then provided educational sessions to address these barriers with pre- and post-evaluation to measure efficacy. Our longitudinal assessment, encompassing multiple points of intervention, was compared to results from previous chart review (2010-2013). Results: Of 474 patients diagnosed between 2014-2020, 175 (90 females, 85 males) warranted a fertility discussion per inclusion criteria. 61 (67.8%) females received a fertility discussion and of those 8 (8.9%) completed oocyte or gonadal tissue preservation, all between 2017-2020. 52 (61.2%) males received a fertility discussion and 20 (23.5%) completed sperm cryopreservation, with even distribution pattern between 2014-2020. Following implementation of an electronic fertility consult process and standardized fertility preservation documentation, there was an increase in documented fertility discussions from 30% in 2014 to 63.6% in 2020. Internal department survey responses identified a lack of comfort with knowing fertility preservation options available and diagnoses that should prompt this conversation. Education sessions with pre- and post-provider assessment demonstrated more comfort discussing fertility preservation (average score increase from 3.44 to 4.33) and knowledge regarding diagnoses at higher risk of infertility (average score increase from 3.67 to 4.33). Conclusions: Integration of a standardized fertility preservation process and addressing barriers identified within our division have led to a 33.6% increase in fertility discussions over the last 6 years. While the data shows a promising increase in oocyte and ovarian tissue preservation, sperm banking completion rates remained unchanged. Further steps include incorporation of an automated fertility consultation order into electronic chemotherapy orders, hospital-wide identification of other high-risk patient populations, and continued education of patient, families, and the health care team.

Fertility preservation in men and women: Where are we in 2021? Are we rising to the challenge?

Demand for fertility preservation in women for oncologic, nononcologic, and personal reasons has increased dramatically. Meeting that demand is a major challenge, and we are rising to the challenge. Mature oocyte cryopreservation after ovarian stimulation and ovarian tissue cryopreservation are both methods endorsed by the American Society for Reproductive Medicine (formerly The American Fertility Society), and numerous papers confirmed their efficacy. In girls and women with leukemia or cancers who are at a high risk of ovarian metastasis and who may not be eligible for ovarian tissue transplantation, restoration of fertility can only be achieved by invitro methods. Male fertility preservation has also become a pressing issue and is extensively reviewed in the present journal issue.

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report

ObjectiveTo report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy.DesignReport of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy.SettingPrivate fertility clinic with university affiliation.Patient(s)A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy.Intervention(s)Fertility preservation through oocyte cryopreservation.Main Outcome Measure(s)This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk.Result(s)Cryopreservation of 22 mature oocytes.Conclusion(s)Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area.

Effect of a dual trigger on oocyte maturation in young women with decreased ovarian reserve for the purpose of elective oocyte cryopreservation.

ObjectiveThe aim of this study was to determine whether co-administration of a gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) for final oocyte maturation improved mature oocyte cryopreservation outcomes in young women with decreased ovarian reserve (DOR) compared with hCG alone.MethodsBetween January 2016 and August 2019, controlled ovarian stimulation (COS) cycles in women (aged ≤35 years, anti-Müllerian hormone [AMH] <1.2 ng/mL) who underwent elective oocyte cryopreservation for fertility preservation were retrospectively analyzed.ResultsA total of 76 COS cycles were triggered with a GnRH agonist and hCG (the dual group) or hCG alone (the hCG group). The mean age and serum AMH levels were comparable between the two groups. The duration of stimulation, total dose of follicle-stimulating hormone used, and total number of oocytes retrieved were similar. However, the number of mature oocytes retrieved and the oocyte maturation rate were significantly higher in the dual group than in the hCG group (p=0.010 and p<0.001). After controlling for confounders, the dual-trigger method remained a significant factor related to the number of mature oocytes retrieved (p=0.016).ConclusionWe showed improved mature oocyte collection and maturation rate with the dual triggering of oocyte maturation in young women with DOR. A dual trigger appears to be more beneficial than hCG alone in terms of mature oocyte cryopreservation for young women with DOR.

Impact of ABVD chemotherapy on ovarian reserve after fertility preservation in reproductive-aged women with Hodgkin lymphoma.

How is ovarian reserve affected by chemotherapy in patients with Hodgkin lymphoma (HL) who undergo fertility preservation (FP)? A retrospective study was conducted by reviewing medical records of 105 HL patients referred to the FP unit before starting adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Ovarian reserve was evaluated before chemotherapy and at the last follow-up using anti-Müllerian hormone (AMH) and antral follicle count (AFC) measurements. The decrease in AMH was compared with that expected from normograms. AMH was compared between patients who underwent cryopreservation of ovarian tissue and those who underwent cryopreservation of mature oocytes. After ABVD, 15% of patients required hematopoietic stem cell transplantation. At a median follow-up of 33months, the median decrease in AMH was 0.88ng/mL, which was significantly greater than that of the general population of this age group (p< 0.001). Of the 82 women who only had ABVD, 38 underwent FP by cryopreservation of mature oocytes and 44 underwent cryopreservation of the ovarian cortex. There was no significant difference in AMH or AFC at the last follow-up between FP techniques. Although ABVD is considered to be of low gonadotoxic risk, the decrease in AMH was greater than expected for patients' age, and 15% of patients needed more aggressive therapy during follow-up. Type of FP was not associated with decline in ovarian reserve. Reproductive-aged women with HL should have the opportunity for FP counseling before starting treatment.

Bypassing physiological puberty, a novel procedure of oocyte cryopreservation at age 7: a case report and review of the literature

To report the first successful oocyte cryopreservation in a prepubertal girl. Case report and review of the literature. Tertiary medical center. A 7-year-old prepubertal girl with Turner syndrome mosaicism (45,X[37]/47,XXX[15]) who underwent a novel fertility preservation procedure after fertility preservation counseling and informed decision of the parents. Controlled ovarian hyperstimulation with daily administration of 100 IU recombinant human follicle-stimulating and 50 IU recombinant human luteinizing hormone per milliliter, injection of 250 μg human chorionic gonadotropin was given 36 hours before the follicular aspiration procedure, and oocytes retrieved by a transabdominal ultrasound guided approach. Mature oocyte cryopreservation. The first cryopreservation cycle with use of a gonadotropin-releasing hormone agonist trigger failed to yield oocytes. The second cycle with human chorionic gonadotropin trigger was successful. Six oocytes were retrieved, and all were mature metaphase 2. The patient was discharged in good condition with no complications. This novel procedure bypasses the timely physiologic progression of pubertal maturation of the hypothalamic-pituitary-ovarian axis to directly target the ovaries and achieve mature ovarian follicles. This innovative approach offers a new treatment modality for prepubertal girls who need fertility preservation such as in Turner syndrome or in cases that ovarian tissue cryopreservation is contraindicated.

Fertility Preservation in Women with Endometriosis: It is About Time We Talk About it!

Endometriosis is a common benign disease that affects young women and carries a significant risk to the reproductive organs. Studies have shown that endometriosis is associated with diminished ovarian reserve and worse prognosis in assisted reproductive technology treatments. Surgical treatment aims to remove the disease while maintaining reproductive potential with minimal damage to the reproductive organs. The authors reviewed the published literature regarding fertility preservation in endometriosis, focussing on patient selection criteria, available treatment options, and follow-up. The goal of this study was to find evidence to answer the following clinical questions: how should women of reproductive age with endometriosis be managed, and what fertility-sparing options are available? Cryopreservation of embryos and mature oocytes are established techniques for preserving fertility in women during the reproductive period. Fertility preservation is a key consideration in the care of young girls and women with endometriosis, mainly those with ovarian endometriomas and advanced disease. Although no cohort studies have been published on the subject to date, adequate information detailing disease progression, treatment options, and the risks involved should be made available for these women. Available fertility preservation strategies include embryo and oocyte crypreservation, and women should be counselled individually on the risks, benefits, and costs involved with these options. In this scenario, management by a multidisciplinary endometriosis team is a fundamental step for producing successful results.