Offered Fertility Preservation Research Articles

Cancer Therapy, Gonadal Function, and Fertility Preservation: Narrative Review.

Fertility preservation was designed to help young patients overcome complications of cancer treatments, but its effectiveness is unknown. We sought to investigate how often patients with cancer are offered fertility preservation and if patients offered fertility preservation are more likely to have offspring. We searched Embase (through 2022) and PubMed (through 2022). Our broad computerized search strategy was built upon using the keywords "chemotherapy," "radiation," and "fertility." The search took place on December 1, 2022. We included randomized and observational studies and excluded reviews and case reports/series. Eighty-five articles that answered at least one of the research questions were included. Studies assessing fertoprotective therapies often rely on surrogate markers for fertility. Multiple factors affect these markers of fertility. The median premature ovarian failure rate among the intervention group was 18% (IQR, 12%-20%), and among the control group, it was 25% (IQR, 19%-33%). Five of 11 studies reported a significant benefit from fertoprotective therapy. Pregnancies occurred in a median of 21% (IQR, 6%-52%) of patients in the intervention group and 11% (IQR, 7-44) of patients in the control group, with three of seven studies reporting a higher percentage of pregnancies among the intervention group. We reviewed the literature on several questions surrounding fertility preservation and found that there is limited and low-quality research on these therapies in cancer. Hence, there is a strong need for studies, especially randomized studies, that follow patients with cancer who undergo fertility preservation and assess outcomes in which patients are most interested.

Semen Cryopreservation in Oncofertility

Oncofertility, an interdisciplinary field, aims at improving the uality of life of cancer patients prone to iatrogenic infertility by offering fertility preservation options for a potentially fertile future. Semen cryopreservation (SC) is a well-established and effective way of preserving fertility in adolescent and young adult cancer-diagnosed males as they face potential fertility loss due to cancer and its treatments. The pathophysiology of certain cancers, such as testicular cancer or Hodgkin’s lymphoma, has been shown to have an adverse effect on semen uality. Ablative therapies like chemotherapy and radiotherapy can result in compromised sperm parameters depending on the dose and the type of the drug or radiation. Hence, it is recommended to encourage cancer-diagnosed males to store sperm prior to gonadotoxic therapy to restore potential fertility in the future. Despite the feasibility of SC, this option remains underutilised due to several limitations.

Minimally Invasive Management of Uterine Fibroids - Role of Transvaginal Radiofrequency Ablation

Minimally invasive approaches in management of common gynecological pathologies such as uterine fibroids are of outmost importance to offer fertility preservation and cost-effective solutions. Transvaginal radiofrequency ablation in day surgery setting offers an efficient volume reduction solution with improvement of fibroid related symptoms in patients undergoing accurate pre-operative selection.

Going Going Gonad: Assessing Iron Staining Impact on Fertility for Patients with Sickle Cell Disease

Introduction: Medical advances in the care of patients with sickle cell disease (SCD) and other hemoglobinopathies have allowed for the focus of care to shift and incorporate long-term quality of life metrics, such as fertility. Concerns for reproductive health in patients with SCD stem from the underlying disease itself as well as from medical therapies that are offered such as hydroxyurea, chronic red blood cell transfusions, and stem cell transplant (SCT). Iron deposition from chronic transfusions in other tissues is known to result in end organ damage and lifelong consequences. While little is known about iron overload and fertility, one study noted testicular iron deposition on MRI in pubertal males with transfusion-dependent beta-thalassemia; results were notable for lower sperm concentrations and a lower percentage of sperm with normal morphology, indicating that iron overload likely has an impact on fertility for patients. Iron deposition has not been studied in the pre-pubertal hemoglobinopathy population. Fertility counseling in this patient population does not often occur until patients are considering SCT as a curative therapy option, as the conditioning regimens for SCT are gonadotoxic. Without a good understanding of the impact of chronic transfusions on fertility for patients with hemoglobinopathies, it is difficult to determine the optimal time to offer fertility preservation to families. We aim to assess iron overload on testicular tissue to gain a better understanding of the impact that medical management and chronic transfusions can have on fertility for a patient with SCD. Methods: Our study is a cross-sectional evaluation of patients with SCD who underwent testicular tissue cryopreservation (TTC) as a part of a multicenter research protocol through the University of Pittsburgh Medical Center (UPMC) prior to SCT. As part of the TTC protocol, each patient provided a small piece of tissue for research, with the remaining cryopreserved for patient use. All samples were evaluated for the presence of germ cells. For this study, demographics, treatment data, imaging results, and labs pertinent to hormonal profile and iron status were obtained. All samples from patients with SCD and thalassemia will undergo additional pathology review to evaluate for the presence of germ cells and iron. At the time of this abstract, the tissue for two patients had been analyzed. Results: Banked research tissue from UPMC includes 77 patients with SCD and 21 patients with beta thalassemia major. Of the 77 SCD patient samples, 42 were found to have germ cells, 34 have not yet been analyzed and 1 had no germ cells present. Of the 21 samples from patients with beta thalassemia major, 17 were found to have germ cells, 3 were not yet analyzed and 1 had no germ cells present. To date, we have obtained pathology review on two patients, both with Hb SS genotype and were on the maximum tolerated dose of hydroxyurea prior to TTC. Patient 1 had been on hydroxyurea for 7 years and had 13 units of blood transfusions, and Patient 2 on hydroxyurea for 4 years and 6units of blood transfusions prior to TTC. Both patients were found to have normal testicular tissue histopathology with presence of germ cells and without evidence of iron on staining (Table 1). Conclusions: Based on our preliminary data it can be noted that patients without significant iron burden, based on low ferritin and a limited transfusion history may not have a significant impact on their testicular histopathology with their iron staining being negative. We will expand our patient cohort to include patients who have a severe disease course requiring more blood transfusions to determine whether this is associated with increased iron deposition in their testicular tissue and/or reduced germ cell numbers. This information will allow teams to optimize the timing of fertility discussions and possible preservation in this patient population, even outside of curative treatment.

Should patients with leukemia be offered fertility preservation?

Should patients with leukemia be offered fertility preservation?

Reproduction in life and death: should cancer patients with a poor prognosis be offered fertility preservation interventions?

In the context of a cancer diagnosis, fertility preservation interventions are used to mitigate the potential impact of gonadotoxic cancer treatment upon fertility. They provide patients with cancer the option to freeze their reproductive material to have their own biological child following treatment. The evidence suggests some clinicians are less likely to have fertility preservation discussions with patients who have an aggressive or metastatic cancer which has a poor prognosis. Although this is contrary to current policy recommendations, there is a lack of guidance relating to offering fertility preservation in the context of a poor prognosis to support clinicians. Controversy surrounds posthumous reproduction, and whether the wishes of the cancer patient, when living and deceased should take precedence over others' wellbeing. We consider the question of whether cancer patients with a poor prognosis should be offered FP from an ethics perspective. We structure the paper around key arguments to which multiple ethical principles might pertain, first establishing a central argument in favour of offering fertility preservation based on respect for autonomy, before exploring counterarguments. We conclude by proposing that a defeasible assumption should be adopted in favour of offering fertility preservation to all cancer patients who might benefit from it. It is important to recognise that patients could benefit from fertility preservation in many ways, and these are not limited to having a parenting experience. The burden of proof rests on the clinician in collaboration with their multi-disciplinary team, to show that there are good grounds for withholding the offer.

Are There Any Developments in the Attitudes and Practices of Oncologists Regarding Fertility Preservation in Saudi Arabia After 12 Years?

The current practice of offering fertility preservation (FP) counseling and treatment has become one of the focal points in patient care throughout cancer treatment. The turning point was the approval of the Council of Senior Religious Scholars four years ago to freeze tissues from the ovarian membrane, the entire ovary, and the eggs for later use in reproduction to preserve the offspring. Thus, we aimed to assess any development in oncologists' knowledge, attitude, and referral practices regarding FP in Saudi Arabia. This is a cross-sectional survey using a self-administered questionnaire. We assessed oncologists' opinions on the importance of FP, their perception of the patient's preferences, and factors to consider when discussing the subject. Then, we assessed the knowledge and referral practices, including the timing of referral before starting cancer treatment. Most oncologists showed good knowledge and positive attitudes toward FP; however, their referral practices could be better. Most were familiar with FP options. The most significant factors influencing the oncologist-patient FP discussion were the number of existing children, marital status, cost, and type of cancer (96.6%, 76.7%, 65.7%, and 58.9%, respectively). There is a significant improvement in the knowledge and attitude of oncologists toward FP. However, patients' counseling and referral to fertility services still need to be improved. There is a shortfall in the clinical practice guidelines for FP in cancer patients in Saudi Arabia. The implementation of clinical practice guidelines would enhance FP. However, patients' counseling and referral to fertility services still need to be improved. The lack of proper guidelines on FP is affecting oncologists' practice.

Reproductive capacity after gender-affirming testosterone therapy.

Transgender and nonbinary people with female birth sex may utilize testosterone therapy for masculinization. Individuals interested in reproduction using their own gametes should be offered fertility preservation prior to starting testosterone. However, logistical and practical barriers prevent many from accessing fertility preservation options prior to starting testosterone. Some of these transmasculine and nonbinary individuals may later become interested in carrying a pregnancy or using their oocytes for reproduction after being on testosterone. Many questions remain about the reproductive impact of long-term masculinizing testosterone therapy. Emerging literature has documented pregnancies and successful assisted reproduction for some people after taking testosterone, but it is not known whether individuals can expect these successful outcomes. Testosterone appears to impact the reproductive tract, including the ovaries, uterus, and fallopian tubes, but the reversibility and functional impact of these changes also remain unclear. A greater understanding of the impact of masculinizing testosterone on reproductive capacity remains a priority area for future research.

Fertility preservation among women diagnosed with cancer in South Africa

There is a growing trend worldwide to offer fertility preservation to newly diagnosed cancer patients, but little research exploring the experience of fertility preservation among this population exists. Our aim was to explore fertility preservation among female cancer survivors in South Africa. We conducted interviews with 10 women who received fertility preservation at fertility clinics in Cape Town and Johannesburg, South Africa. Interviews lasted between 38 and 76 min and were audio recorded, transcribed, and then entered into ATLAS.ti. We analysed the interviews using reflexive thematic analysis. Four themes were constructed, namely (1) entering fertility preservation: motivation and risk, (2) an emotional rollercoaster, (3) needing more information, and (4) a costly source of hope. Participants reflected on choosing between cancer treatment and delaying the cancer treatment to accommodate for fertility preservation, with the importance of biological motherhood reported as a key factor. Both the cancer diagnosis and hormones taken as part of treatment resulted in participants feeling highly emotional. Participants expressed a need for more information on fertility preservation. Finally, even though the process was costly, participants reported that it was a worthwhile endeavour as it instilled in them a sense of hope. Our findings indicate that there is a need to increase awareness of fertility preservation in South Africa. Moreover, considering the pressure that patients are under, their emotional states, and their lack of adequate information, it is important for healthcare professionals to pay careful attention to the needs of patients throughout the process and provide patients with referrals to psychological services when needed. Our findings also indicate gaps in the informed consent process between patients and healthcare professionals that must be addressed by the latter.

O-177 The importance of an onco-fertility program for pediatric oncology patients

Abstract Study question How to start an onco-fertility program in a pediatric oncology unit as standard of care Summary answer An active onco-fertility program helps to offer the best option for future fertility for pediatric oncology patients. Awareness of fertility risk is necessary. What is known already Infertility after treatment for pediatric oncology is an important late effect Of these patients, 25-35 % classify as high risk (HR) for infertility. With the increasing survival chance (>80%) this late effect plays an important role. Study design, size, duration An onco-fertility program was started in 2018 with the start of a centralized hospital for pediatric oncology patients (yearly 600 patients) navigated by a nurse-practitioner. The program runs with intense collaboration between the different specialties. All new patients are identified. Fertility-risk is based on the international fertility guidelines. Participants/materials, setting, methods All patients are informed on fertility risk by their oncologist. All HR children are additionally counseled by the onco-fertility nurse-practitioner and referred for further counseling to gynecology for ovarian tissue cryopreservation(OTC) or urology for sperm cryopreservation or testicular biopsy (in research setting). Monthly the onco-fertility working-group members discuss difficult cases and research in the field. Survivors have the possibility for fertility consultations. Main results and the role of chance Awareness of treatment (chemotherapy, radiotherapy and surgery) on fertility in children has increased from 2018 till now 2023 among oncologists, nursing staff, carers of the child, and the patients themselves. We offer fertility preservation mainly in the high risk for infertility group but also for low risk groups we offer information and counseling . In the outpatient clinic for survivors, there is an increasing number of consults yearly on fertility questions From 2018 till 2022 we saw a fourfold of consults. The number of high risk for infertility over the years is stable around 30%. Over the years we see an increasing number of patients who have fertility preservation done in time In the girls this increased from 32% in 2018 to nearly 40% in 2022. For the boys it increased from 37% in 2018 to 57% in 2022 Limitations, reasons for caution This is an ongoing programme in a large pediatric oncology unit in a first world country where this programme is possible. insurance is well organized We realize that in other countries it is much more difficult to run this program Wider implications of the findings In 75% of survivors risk of infertility is the most important late effect. Therefore running an onco fertility program at the start of the patient journey offering the patient the best options for fertility preservation will help the patient in future to improve their quality of life concerning fertility issues. Trial registration number not applicable

Barriers to offering female fertility preservation to pediatric and young adult oncology patients: A national survey of pediatric hematology oncology providers in the United States and Canada.

e24088 Background: The American Society of Clinical Oncology (ASCO) recently updated its guidelines on fertility preservation based on similar rates of pregnancy from oocyte and embryo preservation. However, fertility preservation in female pediatric and young adults undergoing cancer treatment remains a challenge due to barriers in communication, lack of awareness and resources. Methods: A survey created using SurveyMonkey was sent electronically to all physicians who were Children’s Oncology Group (COG) members (2190), weekly for 4 weeks. Results: 304 physicians (13.8%) responded to the survey. While most providers discuss the possibility of infertility with all female patients (83%), only 43% offer fertility preservation irrespective of age. Cancer diagnosis is a key factor in the decision to offer fertility preservation to patients (63%). Ewing sarcoma (75%), osteosarcoma (69%), and bone marrow transplant candidacy (70%) are the most common diagnoses associated with physician offering of fertility preservation. It is typically offered prior to the first round of chemotherapy (53%). Seventy-five percent of providers report that insufficient time before starting chemotherapy is a major barrier to offering fertility preservation. Severity of patient illness (58%), insurance issues and high cost (19%), provider belief that it is not necessary in every patient (25%), and lack of data supporting female fertility preservation and experimental methods (16%) are other barriers which impact the decision to offer fertility preservation. Ovarian suppression (77%), cryopreservation (egg freezing) (85%), and ovarian tissue freezing (66%) are the most discussed fertility preservation options with only one out of four providers discussing freezing embryos. Only one out of five providers check Anti-Mullerian hormone (AMH) levels prior to starting cancer treatment; however, two out of five check AMH levels after completion of therapy. Most providers do not check AMH levels. Conclusions: Despite high risk for infertility among female cancer patients due to treatment and several advances that have been made in the field, the practice of offering fertility preservation is not universal due to various barriers at the physician and institutional level. Physician education and familiarity with ASCO’s newer guidelines is one way to promote a healthier dialogue and informed decision making. We also conclude that detailed guidelines and monitoring practices for diminished ovarian reserve are lacking and need further thought.[Table: see text]

Differences in oncofertility beliefs, knowledge, and practice between medical oncologists and advanced practice providers: Identifying quality improvement targets.

e18747 Background: Despite the deleterious effects of systemic cancer treatment on fertility, many young adult cancer patients do not receive fertility preservation. Historically, oncofertility was discussed by the medical oncologist (MO), but an increasing advanced practice provider (APP) oncology workforce provides opportunities for quality improvement (QI) in oncofertility care. To identify levers for QI interventions, we explored how fertility beliefs, knowledge, and practice of MOs differ from APPs. Methods: MOs and APPs working in inpatient, outpatient, academic and community clinical settings were identified from providers at The Jonsson Comprehensive Cancer Center (JCCC). Participants completed an online survey prior to a fertility preservation seminar. Survey questions queried beliefs about fertility preservation, knowledge about guideline recommendations, and individual fertility practices in the 3 months prior to survey completion. Responses were collected anonymously through a HIPAA-compliant web platform. Pearson chi-squared and two-sample T tests were used for statistical comparisons between MOs and APPs using STATA v15.1. This study received exempt status from the University of California Los Angeles (UCLA) Institutional Review Board. Results: 32 (52.5%) APPs and 29 (47.5%) MOs completed the survey. APPs were younger than MOs (28% vs. 14% were 30-39 years, p = 0.072) and more frequently female (91% vs. 38%, p < 0.001). Practice specialties varied equally between both groups and they had similar distribution of post-training oncology experience. Participants saw an average of 6.0 (APP) and 5.7 (MO) new cancer patients of reproductive age per month. While APPs and MOs reported concern about the effects of cancer treatment on fertility, APPs were more likely to agree with the statement “Offering fertility preservation to patients before cancer therapy compromises their oncological treatment” than MOs (44% vs. 31%, p = 0.047). APPs reported less familiarity with fertility preservation guidelines (scale 0-10, mean 4.3 vs. 5.8, p = 0.013) and MOs were more comfortable discussing specific fertility preservation techniques. There were no significant differences in referral practices. In the 3 months prior to survey, MOs reported having fertility discussions more frequently than APPs (52% vs 28%, p = 0.047) and more regularly had discussions before treatment initiation (97% vs. 78%, p = 0.033). Conclusions: Improving oncofertility care for young cancer patients is an important quality metric. This exploratory study demonstrated significant differences in beliefs, knowledge, and practice between MOs and APPs regarding fertility preservation for cancer patients. These results will shape our future QI initiatives, which will target system, practice, and education with a specific focus on non-MO providers.

Knowledge, acceptability and personal attitude toward pre-implantation 1 genetic testing (PGT) and pre-natal diagnosis (PND) for females carrying BRCA pathogenic variant according to fertility preservation experience.

Preimplantation genetic testing (PGT-M) and prenatal diagnosis (PND) followed by medical termination of pregnancy when the fetus is affected are two procedures developed to avoid the transmission of a severe hereditary disease which can be proposed to females that carried BRCA pathogenic variants. These females can also be offered fertility preservation (FP) when diagnosed with cancer or even before a malignancy occurs. The aim of the study was to evaluate the acceptability and personal attitude of women carrying a BRCA mutation toward techniques that can prevent BRCA transmission to their progeny. Female mutated for BRCA1 or BRCA2 were invited to complete an online survey of 49 queries anonymously between June and August 2022. A total of 87 participants responded to the online survey. Overall, 86.2% of women considered that PGT-M should be proposed to all BRCA mutation carriers regardless of the severity of the family history, and 47.1% considered or would consider PGT-M for themselves. For PND, these percentages were lower reaching 66.7% and 29.9%, respectively. Females with personal history of breast cancer or FP achievement were more prone to undergo PND for themselves despite the overall acceptability of this procedure. Among the subgroup who had undergone FP (n = 58), there was no significant difference in acceptance of principle and personal attitude toward PGT-M and PND compared to the group without FP. BRCA pathogenic variants female carriers do need information about reproductive issues, even if they are not prone to undergo PGT-M nor PND for themselves. N/A.

Desire for biological parenthood and patient counseling on the risk of infertility among adolescents and adults with hemoglobinopathies.

Both diagnosis and treatment of hemoglobinopathies have been associated with an increased risk of fertility impairment. German guidelines recommend annual monitoring of fertility parameters to enable early detection of fertility impairment and/or to offer fertility preservation (FP) when indicated. We explored the general desire for parenthood, the frequency of recalling fertility counseling and testing, and the utilization of FP in adolescents and adults with hemoglobinopathies. In a cross-sectional study, patients aged 12-50years, treated in Germany, Austria, or Switzerland, were surveyed on fertility-related aspects. Medical data, including fertility testing results, were collected from patient records. Overall, 116/121 eligible patients, diagnosed with sickle cell disease (70.7%), thalassemia (27.6%), or other hemoglobinopathy (1.7%), participated in our study (57.8% female, median age 17.0years, range 12-50years). All participants required treatment of the underlying hemoglobinopathy: 68.1% received hydroxyurea, 25.9% required regular blood transfusions, and 6.0% underwent hematopoietic stem cell transplantation (HSCT). Most patients (82/108, 75.9%) stated a considerable to strong desire for (future) parenthood, independent of sex, education, diagnosis, or subjective health status. Fertility counseling was only recalled by 32/111 patients (28.8%) and least frequently by younger patients (12-16years) or those treated with regular blood transfusions or hydroxyurea. While fertility testing was documented for 59.5% (69/116) in medical records, only 11.6% (13/112) recalled previous assessments. FP was only used by 5.4% (6/111) of patients. Most patients with hemoglobinopathies wish to have biological children, yet only few recalled fertility counseling and testing. Adequate patient counseling should be offered to all patients at risk for infertility.

Assessment of the knowledge, attitudes, and perceptions of Filipino obstetrics and gynecology residents on fertility preservation: A cross-sectional study.

As primary reproductive healthcare providers, residents-in-training must be equipped with the knowledge of proven and available methods for fertility preservation. The study evaluated Filipino obstetrics and gynecology residents' current knowledge, attitudes, and perceptions about fertility preservation. A cross-sectional survey was conducted among obstetrics and gynecology residents in the Philippines. A 24-item questionnaire was distributed to the different accredited training institutions of the Philippine Obstetrical and Gynecological Society by electronic mail. Univariate descriptive statistics were reported as mean for continuous variables and frequency with percentage for categorical variables. The chi-square test was used to determine differences in responses. A total of 143 respondents from different year levels of training were enrolled in the study. Most were female trainees (88.11%) from the National Capital Region (44.76%). Most respondents agreed that discussions about childbearing intentions (99.30%) and age-related fertility decline (98.60%) should be initiated during a patient's gynecological consult. Residents were most familiar with oocyte freezing (84.62%), fertility-sparing surgeries (83.22%), and the use of GnRH agonists (80.42%) as fertility preservation techniques. Despite being most familiar with oocyte freezing, the respondents have mainly referred patients for fertility-sparing surgeries (48.95%) and the use of GnRH agonists (48.25%). There was an overall reassuring perception and attitude of obstetrics and gynecology residents on fertility preservation. A standardized curriculum with teaching-learning activities on fertility preservation may be used to improve trainees' knowledge. There was a disparity in the knowledge and actual referral or utilization of the different methods, reflecting the inaccessibility of the procedures specific to their institutions. This highlights the need to improve accessibility and offer fertility preservation as a public health service.

Perspectives surrounding fertility preservation and posthumous reproduction for adolescent and young adults with terminal cancer: Survey of allied health professionals.

While all reproductive-aged individuals with cancer should be offered fertility preservation (FP) counseling, there is little guidance over offers to adolescent and young adults (AYA) with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). The Enriching Communication skills for Health professionals in Oncofertility (ECHO/ENRICH) trains Allied Health Professionals (AHPs) to improve communication with AYAs with cancer. Little is known about AHPs' role in assisting in FP and PAR decisions. This is a cross-sectional survey of ECHO/ENRICH trainees' attitudes and experience with FP and PAR in AYA with terminal cancer. The response rate was 61% (365/601). While 69% felt comfortable discussing FP with terminal AYA after ECHO/ENRICH training, 85% desired further education. The majority (88%) agreed FP should be an option for AYA with cancer, though some agreed offering FP provided false hope (16%) or was a waste of resources (7%). Most shared that avoidance of FP discussions was common practice, especially in the medically fragile, late-stage disease, or among minors. Many attributed lack of conversations to oncology team goals. Only 9% had prior experience with PAR. Many were conflicted about how PAR reproductive material should be gifted and who should be permitted to use PAR. Several raised moral concerns for PAR, or discomfort advising family. Many voiced desire for additional PAR-specific education. ECHO/ENRICH trainees had varied levels of exposure to FP in terminal AYA and limited experiences with PAR. Many expressed uncertainties with PAR, which may be alleviated with further training and transparent institutional policies.

A COMPARATIVE ANALYSIS OF CENTERS OFFERING ONCOFERTILITY SERVICES IN THE UNITED STATES: IDENTIFYING GAPS AND OPPORTUNITIES TO INCREASE ACCESS TO FERTILITY PRESERVATION CARE

To identify fertility centers capable of offering fertility preservation (FP) to patients with cancer and other fertility-threatening conditions within the United States (US) and compare practice characteristics and geographic distribution of fertility centers with and without the capacity to offer FP services.

Fertility preservation counselling for women with endometriosis: a European online survey.

Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity. An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

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