Offered Fertility Preservation Research Articles

Impact of cancer on cryopreserved sperm quality and fertility: A cohort study.

BackgroundSperm quality at cancer diagnosis is often compromised by the disease and any given gonadotoxic treatment will further diminish fertility.ObjectivesHere, we aim to analyze the cryopreserved sperm quality according to the cancer types as well as the fertility outcomes.MethodsOur study included all cancer patients who cryopreserved sperm over 20 years at Erasme Hospital Brussels (from 1999 to 2019). First sperm samples from 111 hematologic, 104 testicular, 19 prostate, 28 gastrointestinal, and 16 neurological cancer patients were compared.ResultsOligozoo‐asthenozoospermia was observed in 30% of the samples, including 19.33% with severe oligozoospermia (<5 million/ml). Our results showed a significant reduction in sperm concentration among testicular cancer (p < 0.01). No significant differences in progressive motility, sperm volume, and number of frozen straws were observed. Significant correlations were found between sperm concentration and cancer type (p <0.01) as well as patients' age (p <0.01). Twenty‐eight cancer survivors returned for using their cryopreserved sperm (9.33%), fertilization rate was 60.5% and implantation rate was 29.6%. There was no correlation between sperm concentration and fertility outcomes.ConclusionOur results confirm the negative impact of cancer on sperm quality without affecting assisted reproductive technology (ART) success rate, which is utterly important as a male reproductive health perspective. All cancer patients should be counselled and offered fertility preservation options as a gold standard.

O-262 Impact of the cancer treatment received on the quality of the human (pre)pubertal testicular tissue prior to testicular tissue freezing (TTF)

Abstract Study question What is the impact of the cancer treatment received prior to TTF and the disease on spermatogonia quantity in testicular tissue from (pre)pubertal boys? Summary answer A decrease in spermatogonia number was observed in testicular tissue after cancer treatment when cyclophosphamide equivalente dose (CED) is above 4000 mg/m2. What is known already The improved survival rates associated with the development of sperm and testicular tissue freezing (TTF) renders difficult not to offer fertility preservation to children or adolescents before cancer. Several studies exploring cancer patients have examined the number of spermatogonia per seminiferous tubular cross-section (S/T) or tubular fertility index (TFI, percentage of tubular cross-sections containing spermatogonia) in testicular biopsies. All studies, demonstrated that the S/T and TFI always decreased after the introduction of chemotherapy and more specifically in case of highly gonadotoxic risk such as alkylating agents. Study design, size, duration Testicular tissue samples from 79 (pre)pubertal boys diagnosed with cancer (ranging from 6 month to 16 years of age) were cryopreserved between May 2009 and June 2014. Medical diagnosis and previous chemotherapy exposure were recorded. We examined histological sections of (pre)pubertal testicular tissue to elucidate whether chemotherapy, doses or primary diagnosis affects the quality of testicular tissue. Participants/materials, setting, methods (Pre)pubertal boys with cancer diagnosis who benefitted from TTF prior to conditioning treatment for hematopoietic stem cell transplantation. All the patients included had previously received chemotherapy with moderate risk for future fertility. We have selected patients for whom data on chemotherapy received were complete. The quantity of spermatogonia and quality of testicular tissue were assessed by both morphological and immunohistochemical analysis. Main results and the role of chance The main finding was a significant reduction in spermatogonial cell counts in boys treated with alkylating agents. The mean S/T values in boys exposed to alkylating agents was significantly lower than in a group exposed to non-alkylating agents (p = 0.018). In contrast, no difference was observed for patients treated with carboplatin as the only alkylating agent compared to the group of patients exposed to non-alkylating agents. We observed an increase of S/T with age in the group of patients who did not receive alkylating agents and a decrease of S/T with age when patients received alkylating agents included in the CED formula (r = 0.6166, p = 0.0434; r= -0.3759, p = 0.0036, respectively). The TFI and S/T were decreased in the group of patients who received vincristine (p = 0.0049; p &amp;lt; 0.0001, respectively), but the CED was also significantly increased (p &amp;lt; 0.0001). Multivariate analysis, adjusted for CED, showed the persistence of a decrease in TFI correlated with vincristine administration (-0.5 [-0.96; 0.09], p = 0.02). Limitations, reasons for caution This is a descriptive study of testicular tissues obtained from patients who were at risk of infertility. Spermatognia functionanlity could not be tested by transplantation due limited sample size. Wider implications of the findings This study summarizes spermatogonia quantity and quality of testicular tissue of (pre)pubertal boys after potentially sterilizing treatments. We confirmed a negative correlation between the cumulative exposure to alkylating agents and the spermatogonial quantity. For patients in whom fertility preservation is indicated, TTF should be performed before initiation of alkylating agents. Trial registration number N/A

O-275 Is there a case for ovarian tissue cryopreservation in young girls and Turner syndrome patients?

Abstract The development of new cancer drugs and drug combinations has led to a dramatic increase in the survival rates of prepubertal and postpubertal girls undergoing myeloablative treatment for malignant or non-malignant diseases. This includes girls who will receive high doses of alkylating agents, total body irradiation, or high radiation doses to the craniospinal, abdominal or pelvic area. Chemotherapy is also used as a conditioning regimen before hematopoietic stem cell transplantation for treatment of, for example, beta thalassaemia or homozygous sickle-cell anaemia. The corollary of improved treatment outcomes of childhood diseases is that many survivors are now at risk of multi-faceted, chronic morbidity, impaired quality-of-life and psychosocial problems. Depending on the nature and duration of their treatment some, but not all, young patients facing fertility threatening diagnosis and treatments will have an increased risk of adverse pregnancy outcomes and premature ovarian insufficiency (POI) as their future fertile potential will be defined by the number of follicles remaining in their ovaries following completion of their chemotherapy/radiotherapy. While a fully functioning hypothalamic-pituitary-ovarian axis and uterus are vital to the reproductive potential of adult females, Ovarian tissue cryopreservation (OTC) is now being used to safeguard the future fertility of prepubertal and adolescent girls and young women undergoing treatments that have a high risk of causing POI. OTC is increasingly advocated for young girls receiving an early diagnosis of the most common sex chromosome abnormality- Turner Syndrome (TS) who have a high risk of POI. In theory the ovaries of girls, including TS patients with an adequate ovarian reserve, are well suited to OTC as their ovaries contain high numbers primordial follicles which can be used to preserve future fertility. Ovarian tissue can be removed laparoscopically and early staged follicles cryopreserved in situ within slices of cortex. The operative approaches used for tissue removal from paediatric and adolescent patients are variable and invasive and are dependent on patient age, health and ovarian reserve at the time of tissue recovery. Extensive research has shown that ovarian cryopreservation techniques are robust and that experienced practitioners can achieve high levels of survival of both the ovarian stroma and follicle compartments post thaw. Cryobanked ovarian cortex collected from prepubertal and postpubertal girls has been shown to function normally and support fertility, pregnancy to term and the birth of healthy babies following orthotopic autografting in adulthood. Regardless of patient age at tissue preservation, autografting of frozen-thawed ovarian cortex at either the site of the retained ovary or into the peritoneal cavity results in an immediate and significant follicle loss due to ischaemia and accelerated apoptosis. Those primordial follicles that survive graft revascularization have been shown to have the capacity to grow to preovulatory stages, to reinstate hormonal function and to undergo ovulation and restore natural fertility. Alternatively, follicle growth can be induced in autografted tissue by controlled ovarian stimulation before oocyte harvest for insemination in vitro using assisted reproductive technologies. Graft functional longevity remains variable between patients and may extend from months to years. Alternative methods for fertility restoration such as the complete in vitro growth and maturation of oocytes and the construction of artificial ovaries remain unproven in humans. While OTC can be recommended for young girls at high risk of developing ovarian insufficiency for genetic reasons or following high dose chemotherapy and/or irradiation, to date very few young patients with stored ovarian tissue have used their tissue for fertility restoration. OTC therefore remains experimental and further research is needed to establish the risks, benefits, efficacy, safety and ethical and clinical frameworks for offering fertility preservation to girls during childhood and adolescence and to girls with TS.

P-452 Suboptimal quality of integrated female oncofertility care is associated with a lowered quality of life and more decisional conflict and regret in female cancer survivors

Abstract Study question Is quality of female oncofertility care associated with quality of life, decisional conflict, regret, reproductive concerns, and fertility preservation knowledge in female cancer survivors? Summary answer Receiving high-quality integrated female oncofertility care is associated with an improved quality of life, and with less decisional conflict and regret in female cancer survivors. What is known already Female adolescent and young adult cancer patients should be informed about their infertility risks due to cancer treatment. However, adherence to oncofertility guidelines is far from optimal. At this moment, it is not known whether adherence to oncofertility guidelines measured with quality indicators is associated with a better quality of life, less decisional conflict, regret, and reproductive concerns in female cancer survivors Study design, size, duration A multicenter cross-sectional survey study was conducted to measure the association between quality of oncofertility care and patient-reported outcome measures (PROMs). Participants/materials, setting, methods Female AYA cancer survivors (18-40 years) who were diagnosed in 2016 or 2017, and received a (potential) gonadotoxic treatment were eligible to participate. They were recruited from six hospitals across the Netherlands and were asked to fill in a survey. Quality indicators were used to assess quality of care, and validated scales to assess PROMs. Quality indicator and PROM scores were calculated, and associations were analyzed by T-tests and multilevel multivariate analyses Main results and the role of chance In total, 121 out of 344 female cancer survivors participated. Female cancer survivors received a suboptimal quality of care with 8 out of 11 quality indicators scoring &amp;lt;90% adherence. Of all patients, 72,7% was informed about their infertility, 51,2% was offered a referral, with 18,8% all aspects were discussed in counselling, and 35,5% received written and/or digital information. When survivors were informed about infertility risks, and were offered fertility preservation counseling, and received digital/written information (i.e. adherence to three quality indicators), their quality of life was highest, and levels of decisional conflict and regret were lowest. Physical quality of life, decision regret, reproductive concerns, and fertility preservation knowledge scores were significantly influenced by female cancer survivor’s age, relationship status, strength of wish to conceive, and type of cancer. Limitations, reasons for caution Selection bias could have occurred as we have no insight into reasons for non-responding and we have a low response rate. Furthermore, recall bias could have played a role as patients were asked to fill in questions three to four years after their diagnosis, treatment, and consultation. Wider implications of the findings As quality of oncofertility care is suboptimal, strategies should be developed and tailored to the current gaps, and to guideline-specific barriers, to improve quality of care and, importantly, quality of life in female cancer survivors. Trial registration number N/A

QOL-07. The importance of an onco-fertility program for pediatric neuro-oncology patients

INTRODUCTION: In the Netherlands pediatric oncology care is centralized in one hospital since 2018. 600 new patients a year are seen with 100-120 new neuro-oncology (NO) patients. Of the NO patients 20-25% classify as high risk for infertility (HR) such as patients with medulloblastoma, ependymoma, ATRT and germinoma . An onco-fertility program was started navigated by a nurse-practitioner. The program runs with intense collaboration between the different specialties. All new patients are identified according to the international guidelines on fertility care. The fertility-risk is based on the CED score (cyclofosfamide equivalent dose) and radiotherapy dose. Since 2018 awareness was created by teaching sessions among colleagues, nursing staff, and parent association organizations. METHODS: All HR children are informed by the nurse-practitioner and can be referred for counseling to gynaecology for OTC (ovarian tissue cryopreservation) or urology for sperm cryopreservation or testicular biopsy. Monthly the onco-fertility working-group members discuss cases and research in the field. RESULTS: In 2019, 19% NO cases and in 2020 18% of cases were HR for infertility. In both years 36% of these cases had fertility preservation performed. In 2021, 22% cases HR were identified and in 55% preservation was performed. Reasons for not preserving fertility were diverse, varying from poor prognosis, or too ill to be included. CONCLUSION: Awareness of the fertility risk in NO patients who are HR is necessary. These patients need to be informed, and stratified for counseling and offered fertility preservation before start of their treatment. An active onco-fertility program helps to offer the best option for future fertility for these patients

Awareness and practices of Arab oncologists towards oncofertility in young women with cancer.

BackgroundCancer in young women is a major health problem in the Middle Eastern and North African population. We explored the awareness, barriers and practice of Arab oncologists towards oncofertility.MethodsOncologists from Arab countries treating female cancer patients were invited to complete a 30-item web-based questionnaire that explores oncologists’ demographics, available techniques and barriers to oncofertility.Results170 oncologists working in 9 different Arab countries responded to the questionnaire. Among the responders, 89 (52.4%) were from Egypt and the central region, 60 (35.3%) were from North Africa and 21 (12.4%) were from the Gulf region.While most participants considered a dedicated training ‘necessary’, only 43 oncologists (25.3%) received a formal training. Only 17 participants (10%) had a fertility clinic in their centre, 44 (25.9%) and 13 (7.6%) had to refer patients to other centres or other cities, respectively. A total of 96 oncologists (56.5%) did not have access to a fertility preservation service.Out of 147 responders, 79 (53.7%) offered fertility preservation only in patients presenting with early disease and 38 (25.9%) did not offer fertility preservation. In terms of proposed strategies, 50 responders (29.4%) offered embryo cryopreservation, 79 (46.5%) oocyte cryopreservation and 48 (28.2%) ovarian tissue cryopreservation.ConclusionA large gap exists between international clinical practice guidelines and current practices of fertility preservation in Arab countries. Barriers to optimum service delivery include the lack of physician awareness/training, unavailability of some advanced techniques and a lack of dedicated fertility clinics within the cancer centres.

Fertility Desire and Motivation Among Individuals with Gender Dysphoria: A Comparative Study

Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.

Fertility preservation in transgender and non-binary adolescents and young adults

Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.

Fertility preservation in boys facing gonadotoxic cancer therapy.

Patient survival following childhood cancer has increased with contemporary radiation and chemotherapy techniques. However, gonadotoxicity associated with treatments means that infertility is a common consequence in survivors. Novel fertility preservation options are emerging, but knowledge about these options amongst urologists and other medical professionals is lacking. Pre-pubertal boys generally do not produce haploid germ cells. Thus, strategies for fertility preservation require cryopreservation of tissue containing spermatogonial stem cells (SSCs). Few centres worldwide routinely offer this option and fertility restoration (including testicular tissue engraftment, autotransplantation of SSCs and in vitro maturation of SSCs to spermatozoa) post-thaw is experimental. In pubertal boys, the main option for fertility preservation is masturbation and cryopreservation of the ejaculate. Assisted ejaculation using penile vibratory stimulation or electroejaculation and surgical sperm retrieval can be used in a sequential manner after failed masturbation. Physicians should inform boys and parents about the gonadotoxic effects of cancer treatment and offer fertility preservation. Preclinical experience has identified challenges in pre-pubertal fertility preservation, but available options are expected to be successful when today's pre-pubertal boys with cancer become adults. By contrast, fertility preservation in pubertal boys is clinically proven and should be offered to all patients undergoing cancer treatment.

The ethics of offering fertility preservation to pediatric patients: A case-based discussion of barriers for clinicians to consider

Decisions about fertility preservation can be difficult in general but the recent application of preservation techniques to pediatric patients has ushered in a host of new ethical considerations. Fertility preservation (FP) may be considered for all patients who are at risk for infertility due to their medical diagnosis or treatment, including those undergoing gonadotoxic chemotherapy, those with differences of sex development (DSD) undergoing gonadectomy,1-3 and transgender patients undergoing gender affirming surgery. The focus of this paper is to review the ethical issues involved in offering FP to pediatric oncology patients and, to a lesser extent, the new ethical issues that apply to patients with DSD. Some of the techniques and approach to counseling will also apply to transgender individuals, although that is beyond the scope of this work. We aim to discuss several barriers to offering FP and to advise how to counsel families in the setting of rapid changes in this field. Families should be educated about:•Infertility risk assessment and options for FP.•Experimental nature of certain technologies.•Appropriate consent of minor individuals and the concept of assent to treatment.•Financial barriers to storage and use of genetic material.•Time-sensitive nature of decision making.•Ownership of genetic material over the lifetime of a patient.Specific guidance for clinicians regarding some of these points was recently published in an American Academy of Pediatrics Clinical Report,1 and we will illustrate the use of these guidelines in four case presentations.

NAVIGATING PARENT-CHILD DISAGREEMENT ABOUT FERTILITY PRESERVATION IN MINORS: A SCOPING REVIEW AND ETHICAL ANALYSIS

Offering fertility preservation (FP) prior to gonadotoxic therapy is standard of care. Periodically, parents and children disagree about whether to pursue FP for the minor. This study reviews existing literature on parent-child disagreements regarding FP, weighs relevant rights and interests, and offers recommendations for how to navigate these ethically challenging situations.

ACCESS TO ONCOFERTILITY SERVICES IN THE UNITED STATES: A GEOSPATIAL ANALYSIS

To characterize the distribution of centers offering fertility preservation (FP) to cancer patients in the United States (US), and to quantify the proportion of the population eligible for these services with geographic access to FP care.

Breast Cancer in Adolescent and Young Adult Women Under the Age of 40 Years.

In the United States, one in 196 women is diagnosed with breast cancer under the age of 40 years. Adolescents and young adults (AYAs), of age 15-39 years at diagnosis, experience a number of unique challenges when confronting breast cancer. The incidence of invasive breast cancer has increased among AYA women in the United States since 2004, and most of this change is due to an increase in young women diagnosed with distant disease. AYAs are more likely than older women to present with aggressive subtypes and advanced disease, and they often require systemic staging at diagnosis. Clinical trials should be considered whenever possible, particularly in AYAs with locally advanced or metastatic disease at diagnosis and those with disease progression or recurrence. A significant proportion of AYAs carry germline cancer predisposition mutations, which necessitates prompt genetic testing for all AYAs at diagnosis and may influence choice of local therapy. Suppression of ovarian function, as an adjunct to chemotherapy, may improve breast cancer survival in AYAs. To provide optimal care for AYAs with breast cancer, clinicians should engage multidisciplinary teams that offer fertility preservation, genetic counseling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.

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.

Knowledge and awareness about fertility preservation among female patients with cancer : a cross-sectional study

ObjectiveThe incidence of women in the reproductive age group diagnosed with cancer has recently increased. However, very few patients opt for or are offered fertility preservation (FP) strategies because of a significant lack in awareness. The present study was conducted to evaluate the knowledge of the effect of cancer treatment on fertility and available options for FP.MethodsThis was a cross-sectional study conducted at a tertiary care center from March 2019 through August 2019. One hundred female patients with gynecological or nongynecological cancer and 18-40 years of age were interviewed. The participants were categorized on the basis of the modified Kuppuswamy socioeconomic status (SES) scale and the responses of the patients in the different categories were compared.ResultsMore than half the patients (63%) were in the 20–35-year age group. Most of the patients (71%) were married, and of them, 28 (39.4%) desired to have children. Only 32% of the patients were aware of the detrimental effect of cancer and its treatment on future fertility, and of them, only 28% could specify the gonadotoxic effect of chemotherapy. Knowledge was significantly higher in the upper and middle SES levels than it was in the lower SES level (P<0.001). More than half of the patients (68%) were not aware of the existing FP options, whereas one-third of the patients (32%) were given information about FP by their physicians.ConclusionThe overall awareness of the gonadotoxic effect of cancer therapy and available FP options in the present study was poor. Awareness of FP among both patients and clinicians needs to be increased.

Effect of a Knowledge-Translation Intervention on Breast Surgeons' Oncofertility Attitudes and Practices.

The breast surgeon, generally the first oncology specialist consulted, is ideally suited to offer fertility preservation (FP) referral to young women with breast cancer (YWBC). In the authors' 2015 survey of 84 surgeons participating in the pan-Canadian RUBY study of YWBC, oncofertility knowledge and rates of FP referral were suboptimal. The authors designed an oncofertility knowledge-translation intervention for surgeons. A customized oncofertility toolbox was created including a seminar/webinar, an option grid, a three-question FP survey sent upon registration of each RUBY patient, and a management checklist. In 2018, the 28 site lead surgeons were re-invited to participate in a follow-up telephone interview, and 85 non-site lead surgeons were invited to complete a follow-up online questionnaire. A total of 27 site lead surgeons consented to be re-interviewed. After the intervention, 85% indicated that they "routinely" initiated a fertility discussion compared with 54% at baseline (p < 0.005), with 56% stating that the toolbox had been helpful for making positive changes in their practice regarding oncofertility, and 44% stating that they found it easier to initiate a fertility discussion. Among the 55 non-site lead surgeons who completed the questionnaire, a significant improvement in oncofertility knowledge was found. The percentage reporting "rarely" or "never" discussing FP options decreased from 41 to 14% (p < 0.005), and 84% stated that they referred patients who had not completed their families and were at risk for infertility to FP consultation compared with 32% before the intervention (p < 0.001). A multi-pronged but simple knowledge-translation intervention improved the attitudes, knowledge, and FP practice of Canadian breast surgeons.

Hope and Happy Futurity in the Cryotank: Biomedical Imaginaries of Ovarian Tissue Freezing

ABSTRACT In Denmark, female patients who undergo chemo- and radiation therapy are, prior to treatment, increasingly offered fertility preservation in the form of ovarian tissue freezing. In the cryotank, the frozen ovarian tissue awaits the recovery of the patient, after which it can be thawed and implanted into the remaining ovary or the abdominal wall. Here it potentially restores the ovarian function and enables women to become pregnant and experience genetic motherhood. Promising reproductive futures, the biomedical imaginary of ovarian tissue preservation is entangled with visions of possibilities and risk management as well as gendered understandings of reproduction and the ‘good life.’ From the get-go, ovarian tissue freezing has been informed by an optimistic imaginary of scientific progress. Not only were freezing programs established before clinical evidence testified to the success of the technique in humans; the envisioning of improvements and new applications also anticipates future scientific breakthroughs, such as in vitro maturation of eggs. In the imaginary of hopefulness and reproductive futurity, frozen ovarian tissue becomes an object of vitality which (re)installs the cancer patient as a reproductive citizen. Moreover, ovarian tissue is imagined as a bountiful material with different potentiality than egg freezing. In Denmark, the biomedical imaginary romanticizes the restoration of ‘natural’ fertility and spontaneous pregnancies. Thus, the potentiality of ovarian tissue freezing is imagined within a normative framework privileging ‘natural’ conception, yet simultaneously destabilizing the very notion of the age-span of ‘natural fertility.’

2171 Need for Fertility Preservation in Woman with Endometriosis

Study Objective To evaluate the impact of endometriosis for ovarian reserve via measurements of serum anti-Mullerian hormone, follicle stimulating hormone, estradiol and to indicate groups of patients where fertility preservation should be considered. Design From August 2017 to July 2018 a prospective cohort study was performed. It included 50 patients below 35 years with confirmed endometriosis who were followed by laparoscopic surgery. AMH, FSH and Estradiol levels were assessed before and approximately one month after surgery. The stage of endometriosis was evaluated by rAFS and rEnzian classification. Setting N/A. Patients or Participants N/A. Interventions All patients filled in a questionnaire of medical history and previous treatment. Afterwards they underwent laparoscopic removal of all endometriotic lesions. Post operatively they were divided into groups using rAFS and rEnzian classification. Measurements and Main Results The AMH level of operated patients was importantly reduced after surgery (from 2.95 ± 2.14 [mean ± SD] at baseline to 1.05 ± 1.56 at follow-up). There was a statistically significant correlation between the rate of serum AMH decline and stage of endometriosis according to rAFS classification (p=0,014). The decline was about 0,31 ± 0,8 [mean ± SD]; 0,08 ± 0,64; 1,68 ±1,44; 1,38± 1,9 respectively in group I, II, III, IV. In addition, patients with bilateral ovarian endometriomas showed the highest decline of AMH levels compared with unilateral ovarian endometriosis (about 2,16 ± 2,45 in bilateral group; about 1,42 ±1,31 in unilateral endometriosis). However, also patients who were not observed with cysts had a decreased level of AMH after surgery about 0,44 ± 1,2. FSH and Estradiol levels were not statistically significant. Conclusion The rate of serum AMH is significant indicator of ovarian reserve. It should be marked before all endometriosis surgeries as its level might be declined even in minimal and mild stages. Since it is reduced postoperatively all patients with endometriosis should be offered fertility preservation techniques.

Oocyte Cryopreservation in Oncological Patients: Eighteen Years Experience of a Tertiary Care Referral Center.

Objective: The aim of the present study is to report our experience on elective women fertility preservation before cancer treatment.Study Design: This is a single-center retrospective observational study, including all patients who underwent elective fertility preservation before oncological treatment between January 2001 and March 2019 at our Institute.Results: Of a total of 568 women who received fertility counseling, 244 (42.9%) underwent 252 oocyte retrieval cycles after controlled ovarian stimulation for cryopreservation. The majority of patients were diagnosed with breast cancer (59.9%), followed by women affected by Hodgkin's and non-Hodgkin's lymphoma (27.4%). A minority comprised patients diagnosed with other malignancies that affected soft tissues (2.8%), ovary borderline type (2.4%), digestive system (1.6%), leukemia (1.6%), uterine cervix (1.2%). The remaining 3.1% were affected by other cancer types. The mean age of the cohort was 31.3 ± 6.4 years and the mean oocyte retrieval was 13.5± 8.4. Of 11 women who returned to attempt a pregnancy, three performed two thawed cycles. We obtained four pregnancies from 24 embryo transfers (Pregnancy Rate 36.4% for couple): two miscarriages and two live births. Overall, 95.7% of oocytes are still in storage.Conclusions: A close collaboration between Cancer and Fertility Center in a tertiary care hospital is essential to provide a good health service in oncological patients. Offering fertility preservation is no longer considered optional and must be included in every therapeutic program for women who receive an oncological diagnosis in their reproductive age. Oocyte cryopreservation appears to be a good opportunity for fertility preservation. Our results, although they are obtained in a small sample, are encouraging, even if only 4.5% of patients returned to use their gametes.

Fertility preservation knowledge, attitudes and intentions among children by proxy and adolescents with cancer

The current study aimed to assess knowledge, attitudes and intentions in relation to fertility preservation among children, by proxy, and adolescents with cancer. Although fertility preservation options have been developed to mitigate the adverse long-term effects of life-saving cancer treatment on fertility, fertility is difficult for children and adolescents to conceptualize, especially when they face a cancer diagnosis. This was a descriptive, semi-quantitative analysis. Adolescents and parents of children or adolescents within 6 months of a cancer diagnosis and undergoing gonadotoxic treatment were invited to participate. Seventy-one families completed and returned the study's questionnaire (91 questionnaires) over a period of 26 months. The vast majority of participants were aware of the gonadotoxic effects of cancer treatment (85%) and had positive attitudes towards fertility preservation (>90%), but only a portion of them (20%) were willing to take action towards this goal. Although adolescent-parent pairs had similar attitudes towards fertility preservation, adolescents tended to be more sceptical about experimental fertility preservation options. Male post-pubertal cancer patients were more likely to be offered fertility preservation counselling or referral to a specialist in comparison to their younger and female counterparts. Fertility preservation care has advanced but there are still gender and age differences in counselling and treatment initiation in the paediatric and adolescent cancer population. Interventions to improve provider-patient-parent communication regarding fertility preservation and to help patients address the observed intention-behaviour gap in relation to fertility preservation options are needed.