Preservation Counseling Research Articles

FERTILITY PRESERVATION IN TRANSGENDER MEN AND THE NEED FOR UNIFORM TEMPLATES FOR COMPREHENSIVE COUNSELING: A REVIEW

Data suggest that transgender individuals have similar family building desires as cisgender ones [1]. The ASRM Ethics Committee recommends that all transgender persons have access to fertility services and preservation counseling before gender transition [1]. Although the importance of this is well recognized, there are no standardized templates to guide this counselling. Our objective was to review the literature to assess best practices for the counseling of transgender men who desire gender- affirming surgery.

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

Fertility Preservation Discussion in Adult Male Cancer Patients Is Underutilized and Varies Based on Age

Introduction. Oncofertility is often omitted in pretreatment discussion and planning. This study seeks to evaluate the prevalence and influencing factors of cryopreservation discussions. Methods. A retrospective review was performed on 3,133 male patients aged 18–60 years with a cancer diagnosis at a single institution. Data was collected for cryopreservation discussion and if cryopreservation of sperm was performed. Age, race, cancer location, primary treatment, and chemotherapy status were also recorded. Results. A total of 2,504 patients were included for analysis. There was documentation of counseling in 14.1% and 5.0% underwent cryopreservation. Logistic regression indicated a significant effect of age, race, site of cancer, primary treatment, and chemotherapy treatment on whether cryopreservation was discussed (χ2 P Conclusion. Our study indicates that cryopreservation is vastly under-discussed, especially in older patients and those who do not receive chemotherapy. It is important to include preservation options and counseling for all patients.

QL-24 * FERTILITY PRESERVATION IN PATIENTS WITH PRIMARY BRAIN TUMORS (PBTS)

BACKGROUND: There have been modest gains in survival of younger patients with PBTs. Given their improving prognosis, more patients of child-bearing age see procreation as feasible. The goals of this study were to describe the patients referred for fertility preservation (FP) counseling, determine which patients pursued FP, and investigate the fertility outcomes of these patients. METHODS: This was an IRB-approved retrospective review of PBT patients, ages 18-45, who were referred for FP counseling with a nurse specialist between 2009-2013. RESULTS: There were 69 patients referred for FP counseling: 38 men (mean age 32.9) and 31 women (mean age 31.9). Median KPS was 90. Eighty-eight percent had gliomas; 57% grade III and 17% grade IV. Other tumor types included CNS lymphoma, ependymoma, meningioma, and pineoblastoma. Sixty-seven percent were referred for counseling at initial diagnosis, while 33% were referred at recurrence/progressive disease. Of the patients referred for counseling, 50 (73%) pursued referral to a sperm bank or reproductive endocrinologist (87% of men, 55% of women). There was no statistically significant difference in referral acceptance by age, race, marital status, religion, or tumor grade. Patients were more likely to accept referral if they had no prior children (p = 0.048). After treatment with chemotherapy (including temozolomide and lomustine) and radiation, three men conceived naturally and two men conceived using banked sperm. Two women conceived naturally, one after radiation therapy and one with an untreated low grade glioma. No women conceived from cryopreserved eggs or embryos to date. CONCLUSIONS: Despite the historically poor prognosis of patients with PBTs, there is significant interest in FP among these patients, particularly if they have no prior children. Therefore, oncology clinicians must develop strategies to incorporate FP counseling into practice. Further investigation into clinician referral patterns, patient satisfaction with information provided about fertility, and outcomes of FP is warranted.

Quality-of-life (QOL) assessment at time of fertility preservation (FP) counseling in female cancer patients: Results of a university-based registry at two years.

e19674 Background: Objectives - 1) Establish a prospective registry with long-term follow-up of female cancer patients (CP) who presented for initial consultation for FP; 2) Introduce the FACT-B QO...