Fertility Preservation In Patients Research Articles

Fertility preservation in Malaysian pediatric cohort: a survey of healthcare providers' knowledge, practice, attitude, perceptions and barriers.

Impaired future fertility potential secondary to gonadotoxic therapies for childhood cancer is a shattering aftermath faced by childhood cancer survivors. Fertility preservation (FP) has emerged as a key to mitigate this unwelcomed sequelae. FP services catering to the needs of children and adolescents (C&A) population in developing countries are limited. Malaysia recently launched its pioneering pediatrics FP services. To evaluate healthcare providers' (HCPs) FP knowledge, practice behaviors, attitudes, perceptions, and barriers towards FP counseling/services (C/S) for the C&A cohort. A questionnaire-based study was conducted utilizing a questionnaire consisting of 51 items which was adapted from G.Quinn et al. The questionnaire was distributed both online and physically amongst HCPs in a tertiary center. Ethical committee approval was granted by the Research Ethical Committee, Universiti Kebangsaan Malaysia. A total of 102 HCPs completed the questionnaires. The majority of respondents were Malays (74.5%), females (80.4%), gynecology/pediatrics specialty (76.5%), and had children (88.2%). Nearly 72% of HCPs demonstrated good knowledge of FP. Almost 73% of HCPs consulted reproductive specialists (RES) on potential fertility issues and over 80% of HCPs referred patients who enquired on fertility issues to RES. Only 17% of HCPs practiced FP discussion, 12% reported no available person to discuss FP, and 10% of HCPs were unaware of who to discuss FP with. Patients' inability to afford FP (30.4%) tops the list of barriers to FP C/S, followed by limited available information on FP for patients (17.6%) and patients too ill to delay treatment (12.7%). Most HCPs (88.2%) demonstrated unfavorable attitudes towards FP C/S. In general, the majority of our HCP respondents demonstrated good current FP knowledge and practice behaviors. Mitigating several controversial issues in FP would improve HCPs' attitude towards FP. Main barriers to the uptake of FP C/S for C&A were patient and resource barriers. Addressing these issues by funding aid for FP procedures, increasing FP knowledge dispersion, as well as developing age-appropriate FP-related educational materials would improve FP service provision for C&A in the future. In conclusion, successful corrective action combined with strategic planning points to a promising future for Malaysia's FP services provision for C&A.

OTO-IVM is a method of fertility preservation for patients with ovarian tumors

Introduction. An increasing number of patients of reproductive age get cancer and are highly interested in preserving fertility. Survival rates for cancer patients are improving. Methods of reproductive technologies are being improved to preserve the ability to bear children. Rehabilitation aimed to ensure a satisfactory quality of life takes on a new meaning, and with the development of new technologies, the level of possible assistance also changes. Today, rehabilitation measures for cancer patients of reproductive age should undoubtedly include all possible ways to preserve and restore fertility. Aim: preservation of fertility in patients with ovarian tumors. Material and Methods. After ovariectomy, the ovaries were transported to the embryology laboratory, where oocyte-cumulus complexes were extracted and subsequently matured using the OTO-IVM (ovarian tissue oocyte in vitro maturation) method. The resulting mature oocytes (Metaphase II) were cryopreserved by vitrification or, if a partner was available, fertilized by ICSI (intracytoplasmic sperm injection), the embryos were cultured to the blastocyst stage and also cryopreserved by vitrification. Cryopreserved oocytes and embryos can be used by patients after cancer treatment in assisted reproductive technology programs. Results. A total of 218 OCCs were recovered, 29.8 % were degraded oocytes (n=65). The proportion of OCC suitable for ripening was 153 (70.2 %). After 36 or 48 hours, 65 oocytes matured in 13 patients, which amounted to 42.5 % of oocytes without signs of degradation. In 11 patients the OCC was removed from the tumor-affected ovary. 149 oocytes were obtained, of which 50 (33.6 %) were oocytes with signs of degradation. The remaining 99 (66.4 %) of OCCs had satisfactory quality; after maturation, the Metaphase II stage reached in 49 (49.5 %) of oocytes. As a result, biological material was cryopreserved in 13 of 15 patients: 5 embryos and 60 oocytes.

Utility and Outcomes of Ovarian Tissue Cryopreservation and Transplantation for Gynecologic Cancers: A Systematic Review and Meta-analysis.

To evaluate the utility, success, and safety of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for fertility preservation in patients with gynecologic cancers. A comprehensive search was performed of the MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases to identify relevant studies on the utility and outcomes of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for gynecologic cancers from inception until January 23, 2024. Two reviewers independently performed the study selection, data extraction, and risk-of-bias assessment, and the results were then reviewed together. Twenty-three studies were included in the current systematic review. The resultant data were meta-analyzed to produce a pooled-effect estimate of the utility of ovarian tissue cryopreservation and autologous transplantation in gynecologic cancers as a proportion of all indications. We found that 7.5% and 9.6% of women undergoing ovarian tissue cryopreservation and autologous transplantation, respectively, had gynecologic cancers. In comparison, hematologic malignancies and breast cancer accounted for approximately 66.0% of all indications for these procedures. The return rate for autologous cryopreserved ovarian tissue transplantation in gynecologic cancers (6.0%) was not statistically different from those for other indications. Among women with gynecologic cancer who underwent ovarian stimulation, 27.3% had at least one child, and the ovarian endocrine function was restored in 78.1% of the women after autologous transplantation. The median graft longevity was 32 months, and no graft-site recurrence was reported after autologous transplantation in women with gynecologic cancer. Our results suggest that ovarian tissue cryopreservation and autologous transplantation are feasible options for preserving ovarian function in women with gynecologic cancers, although ovarian tissue cryopreservation is underutilized, and further studies are needed to determine the longer-term outcomes of autologous transplantation. PROSPERO, CRD42024498522.

In Vitro Maturation of Oocytes Obtained from Ovarian Cortex Among Postpubertal Hematological Cancer Patients Undergoing Fertility Preservation.

Purpose: In vitro maturation (IVM) of oocytes obtained from ovarian tissue during ovarian tissue cryopreservation (OTC) is a technique for fertility preservation in patients with cancer obviating the need to postpone chemotherapy initiation. Little is known about IVM outcomes in hematological malignancies, especially post-chemotherapy. The purpose of this study was to evaluate the effect of cytotoxic treatment on the potential to retrieve immature oocytes and mature them in vitro and examine the association between serum inflammatory markers and these results. Methods: In this retrospective study, we evaluated inflammation markers, including B symptoms and IVM outcomes of 78 chemotherapy-naive and exposed patients diagnosed with Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), or acute myeloid leukemia (AML). Results: The mean number of oocytes found was 7.2 ± 7.2. The average number of oocytes matured by IVM was 2.8 ± 3.5, and a mean IVM rate was 32.1 ± 27.7%. All patients in the ALL and AML groups had previous exposure to chemotherapy before OTC, compared with 50.0% (7/14) and 31.9% (15/47) in the NHL and HL groups, respectively. Among patients with lymphoma, chemotherapy exposure was associated with the reduced number of retrieved oocytes (9.8 ± 7.7 vs. 5.3 ± 5.7 oocytes, p = 0.049) in the HL group but not with the number of mature oocytes or IVM rate. B symptoms were not associated with IVM outcomes. Lymphocyte count (ß = 1.584; p = 0.038) and lactate dehydrogenase (ß = 0.009; p = 0.043) were the only significant parameters associated with the number of matured oocytes in a linear regression model. Conclusion: IVM is a promising assisted reproductive technology, which holds great potential for patients in need of urgent fertility preservation or those who cannot receive hormonal stimulation. Our results demonstrate the feasibility of the technique even in the presence of B symptoms and elevated inflammation markers and in patients with previous exposure to chemotherapy.

O-234 Indication for fertility preservation in patients with endometriosis

Abstract Endometriosis is a complex gynecological condition that not only causes debilitating symptoms but also significantly impacts fertility. As the disease affects approximately 10% of women of reproductive age, addressing fertility preservation strategies becomes paramount. The conventional treatments for endometriosis, such as medical therapy and surgery, often fail to fully address its adverse effects on ovarian reserve and reproductive potential. Consequently, there is a growing interest in exploring fertility preservation options, particularly oocyte cryopreservation (OOC), for endometriosis patients. Despite the prevalence and impact of endometriosis on fertility, comprehensive data and guidelines specifically tailored to fertility preservation in this population remain scarce. The available evidence suggests that endometriosis, particularly when it involves ovarian endometriomas, is associated with a significant reduction in ovarian reserve, as indicated by lower levels of anti-Müllerian hormone (AMH). Surgical interventions, often necessary for managing endometriosis-related complications, can further compromise ovarian function and diminish fertility prospects. However, recent studies have shed light on the potential benefits of OOC in preserving fertility for endometriosis patients. OOC offers a minimally invasive approach with no impact on ovarian reserve compared to other fertility preservation techniques. Despite the lack of randomized controlled trials, our retrospective data have demonstrated promising outcomes, with a notable number needed to treat (NNT) of 16 for one successful pregnancy. This underscores the significance of discussing and considering OOC as part of the treatment plan for endometriosis patients, especially those at risk of ovarian compromise due to the disease or its management. The decision to pursue fertility preservation through OOC should be made on a case-by-case basis, taking into account various factors such as disease severity, patient age, ovarian reserve, and treatment history. French guidelines recommend considering OOC for endometriosis patients with bilateral ovarian endometriomas larger than 3 cm or those with endometriomas on a single ovary. Initiating fertility preservation discussions early, preferably before surgical intervention, allows patients to make informed decisions regarding their reproductive future. It is crucial to acknowledge the challenges and uncertainties associated with fertility preservation in endometriosis patients. Socio-economic factors, patient preferences, and the lack of clear criteria for selecting candidates for OOC pose significant hurdles. Furthermore, the effectiveness and cost-effectiveness of OOC in this population warrant further investigation. In addition to OOC, alternative fertility preservation options, such as ovarian tissue preservation, could be considered, particularly in cases where ovarian stimulation is not feasible or declined by the patient. However, data on the efficacy and safety of ovarian tissue preservation specifically in endometriosis patients are limited, highlighting the need for further research in this area. In conclusion, fertility preservation, particularly through OOC, holds promise for mitigating the adverse effects of endometriosis on ovarian function and fertility. While uncertainties persist, integrating fertility preservation discussions into the comprehensive management of endometriosis is essential. This ensures that patients are empowered to make informed decisions about their reproductive health and maximizes their chances of achieving desired fertility outcomes despite the challenges posed by endometriosis.

O-235 Techniques and outcomes of fertility preservation in patients with endometriosis

O-235 Techniques and outcomes of fertility preservation in patients with endometriosis

P-365 Fertility preservation in patients with borderline ovarian tumors: safety and reproductive outcomes

Abstract Study question Do borderline ovarian tumors (BOT) patients, undergoing controlled ovarian stimulation (COS) face higher recurrence risks, and what are the associated reproductive outcomes? Summary answer Even in advanced-stage or bilateral BOT, COS does not significantly impact recurrence rates. Additionally, COS for fertility preservation(FP)provides a viable option for future reproductive potential. What is known already The primary approach for treating BOTs involves surgical intervention, emphasizing complete tumor removal. Conservative surgery is an option for young women seeking to preserve reproductive potential. However, the recurrence risk following conservative surgery is significant, reaching up to 25%, necessitating repeat surgeries that impact ovarian reserve. Existing evidence on the safety of COS in terms of BOT recurrence remains inconclusive. Concerns about a potential association between COS and tumor progression persist, particularly in advanced-stage and bilateral disease cases. This study address these gaps in knowledge and provide more clarity on the safety of COS in BOT patients. Study design, size, duration A retrospective cohort study was conducted across two tertiary, university-affiliated medical centres: IRCCS San Raffaele Hospital, Milan, Italy, and SHEBA Medical Hospital, Tel-Aviv University, Israel. The study included 165 patients diagnosed with borderline ovarian tumors who underwent conservative surgery between 2012 and 2023. Participants/materials, setting, methods Participants aged 18-42 years with BOT (stages I-III) and undergoing conservative treatment were stratified into two groups: those opting COS for FP(41 patients)and a control group without such intervention (124 patients). COS involved GnRH antagonist random-start protocols utilizing menotropins and/or recombinant FSH. GnRH-agonist or hCG were used for triggering. Oocyte vitrification or fertilization and embryo freezing was performed. Statistical analyses, including Pearson’s chi-square, Fisher’s exact test, T test, and logistic regression, were employed for evaluation. Main results and the role of chance In the course of COS cycles and oocyte retrieval, no complications were observed. Among 165 participants, 33% experienced BOT recurrence over a median of 28.5 months (range: 12.7 to 42.7). Patients with recurrence were younger (29 vs. 32 years, P = 0.04), had advanced-stage (26 vs. 18, p < 0.0001), and bilateral disease (38% vs. 19%, p = 0.01). Of the 41 undergoing COS, 19 experienced recurrence, comparable to the control group (36 patients, p = 0.055). Notably, all COS-related recurrences were BOT histotype, not invasive carcinoma, managed through a second surgery. No significant differences in ovarian stimulation cycles (2.4 vs 1.7, p = 0.7) or retrieved oocytes (11.8 vs 10.6, p = 0.6) were detected between women with and without recurrence. In multivariate analysis, advanced disease significantly increased recurrence odds (aOR=3.7, 95% CI: 1.7-7.9, P < 0.001), while COS did not (aOR=1.7, 95% CI: 0.7-3.9, P = 0.16). This suggests that while age and disease stage play roles, COS alone may not significantly influence recurrence rates. Importantly, among women undergoing COS for FP, 17 achieved at least one pregnancy, totaling 24 pregnancies, with 18 live births. Six were spontaneous, and three used frozen embryos from FP cycles. This underscores the reproductive success of FP through COS, providing hope for fulfilling childbearing desires post-BOT diagnosis. Limitations, reasons for caution Limitations include the retrospective nature, a selection bias in the COS group, and the rarity of the disease leading to a small sample size. Despite these, the recurrence rate in the COS group was comparable to a systematic review, and caution is advised in interpreting these results. Wider implications of the findings Our study suggests that COS does not significantly contribute to recurrence risk in BOT patients, even in advanced stages. FP through COS enhances the likelihood of live births in these patients. While cautious interpretation is warranted, these findings offer hope and call for larger prospective studies to confirm these results. Trial registration number not applicable

P-355 Effect of biphasic CAPA-IVM on ovarian tissue oocytes of transgender men

Abstract Study question Can CAPA-IVM (Biphasic in-vitro maturation) with C-type natriuretic peptide (CNP), followed by in vitro maturation (IVM) improve ovarian tissue oocyte (OTO) maturation in transgender patients? Summary answer CAPA-IVM did not show any significant difference in maturation competence and frequency of chromosomal aberrations when compared with standard and in-house IVM. What is known already OTO-IVM is a method of fertility preservation in patients where prior ovarian stimulation is undesired. It has resulted in live births in cancer and polycystic ovarian syndrome (PCOS) patients. CAPA-IVM has further improved oocyte competency in these patients by synchronizing nuclear and cytoplasmic maturity. Similarly, OTO can be collected from transgender men without ovarian stimulation during gender reassignment surgery. While oocytes do survive and mature, OTO-IVM in transgender men is characterized by decreased fertilization rate and severely compromised developmental competency. We investigated whether CAPA-IVM can improve cytoplasmic immaturity for transgender OTO. Study design, size, duration Patients were recruited from July 2022 to July 2023. Both ovaries were collected from 9 transgender patients (age= 20-24 years, mean age=22 years) who underwent gender reassignment surgery after testosterone treatment (mean length= 34 months). All ovaries were collected in cold medium (4oC) and manipulation was performed within 30 minutes of the collection for the retrieval of cumulus oocyte complexes (COCs). Participants/materials, setting, methods Collected COCs were cultured either in in-house IVM and Standard (Medicult) IVM medium for 48 hours or in biphasic CAPA-IVM for 54 hours (24 hours pre-maturation culture and 30 hours IVM). Following maturation, oocytes were analyzed for calcium (Ca2+)-releasing potential and developmental competency after ICSI. In vitro matured MI (metaphase I) oocytes from stimulated IVF patients served as controls. Genetic analysis was performed on subsequent embryos to detect chromosomal abnormalities in all groups. Main results and the role of chance After culturing 330 COCs, the survival rate following maturation was similar in the in-house IVM (79%) compared to Medicult (72%, p = 0.221) and CAPA-IVM (73%, p = 0.251). A similar maturation rate (i.e. 55-57%) was observed in the different groups. Following ICSI, 15/25 (60%) CAPA-IVM, 13/19 (68.5%) Medicult IVM, and 17/28 (61%) in-house IVM oocytes were normally fertilized, which was lower than controls (24/29, 83%). Blastocyst rate was inferior in all OTO groups and significantly lower (p = 0.031) in Medicult-IVM (0/13) compared to controls (7/24). Ca2+-releasing potential of oocytes was determined as a product of amplitude and frequency, in arbitrary units (AU). The average values for CAPA-IVM (1.74AU), Medicult IVM (1.24AU), and in-house IVM (1.54AU) were significantly lower (p = 0.022, p = 0.008 and p = 0.017 respectively) compared to controls (4.76AU). Shallow whole genome sequencing of developed embryos (Day 2- Day 5) showed that 8/13 (61.5%) in CAPA-IVM, 4/8 (50%) in In-house IVM, 1/6 (17%) in Medicult, and 4/12 (33%) in the Control group were chromosomally normal. Limitations, reasons for caution The limited inclusion of patients warrants caution in the interpretation of the results. Moreover, the lack of a better control group might mask the properties of OTO-IVM. Wider implications of the findings Our preliminary results do not demonstrate an improvement in oocyte maturation and embryo development with the implementation of CAPA-IVM. However, future proteomics and transcriptomic studies would shed more light on the advantages of the current IVM systems and decipher the true potential of OTO-IVM from transgender men. Trial registration number not applicable

P-381 Fertility preservation in patients with testicular cancer

Abstract Study question Do the clinical stage and histological characteristics of testicular cancer affect sperm quality? Summary answer Sperm concentration, motility and normal morphology significantly decreased in patients with testicular cancer. However, semen parameters were not significantly associated with tumor histology. What is known already Testicular cancer is rare in most countries, with an incidence ranging from ∼1/100,000 to 10/100,000, and represents about 1% of all cancers in men, but about 60% of all cancers in young males aged between 15 and 35 years. Additionally, the incidence of testicular cancer has doubled in the last 20-40 years. While it is clear that chemotherapy treatment can negatively impact infertility, it is increasingly recognized that male-factor infertility may play a significant role in the overall health status of men, and men with infertility may be at higher risk of developing testicular cancer. Study design, size, duration Retrospective data from 284 males, diagnosed with testicular cancer, undergoing to semen cryopreservation before surgery or chemo- or radiotherapy treatments, from January 2016 to June 2022 at Maternal and Child Department, Gynecology and Obstetrics Unit, Couple Sterility Center at Federico II, University of Naples, were included in the study. Participants/materials, setting, methods All patients signed their informed consent to cryopreservation. In order to have an internal control group coming from the same region, results of semen analysis from male partners of couples with certain female factors (bilateral tubal imperviousness or in case of egg donation) were included in the study. After semen collection and liquefaction, the semen specimens were cryopreserved following manufacturer’s protocol with media conteining TEST-yolk buffer. Main results and the role of chance Overall, taking in to consideration the semen cryopreservation, per WHO 2021 criteria, we observed that the majority of semen parameters of patients with testicular cancer resulted between 5°percentile and 25° percentile. The unique parameter over the 50°percentile was the semen volume. Comparing results from male partners of couples with certain female factors and testicular cancer patients several features were significant different. Especially, semen volume resulted significantly increased in cases respect to the control (p = 0,011). Instead, from microscopic evaluation semen concentration, percentage of total sperm motility and % of spermatozoa with normal morphology appeared significantly decreased in patients with testicular cancer (p = 0,000; p = 0,000; p = 0,002). Based on Histopathological Classification of Testicular Tumors the 59% (168/284) were classified as classic seminoma, 14% (41/284) mixed germ cell tumors including seminomatous and nonseminomatous cell tumors, 13% (38/284) nonseminomatous mixed germ cell tumors, 12% (35/284) nonseminomatous germ cell tumors including 4 cases of teratoma and 30 cases of embryonal carcinoma and 2 cases of cariocarcinoma. However, abnormal semen parameters were not significantly associated with tumor histology. Limitations, reasons for caution No information about semen quality after thawing and ICSI outcome could represent the main limitation for a complete information of the preservation program in these patients. Wider implications of the findings We presented our monocentric experience of oncofertility preservation program with especially attention to testicular cancer patients. Presented data emphasizes the importance of semen monitoring in young men and the fertility preservation in management of the patient. Trial registration number not applicable

P-345 Too cool to be late: the discrepancy between the required and obtained number of oocytes in a social fertility preservation program

Abstract Study question What are the outcomes of thawed oocytes from social fertility preservation (SFP) programs by age? Is the number of cryopreserved oocytes sufficient to achieve pregnancy? Summary answer The outcomes of thawed oocytes from SFP programs diminish with age, and the number of cryopreserved oocytes is below the desirable quantity for pregnancy achievement. What is known already Social fertility preservation empowers women to safeguard their fertility by anticipating age-related decline and diminished efficacy of fertility treatments in older ages. The effectiveness of oocyte vitrification programs, and consequently fertility preservation, depends on the patient’s age. Previous reports on fertility preservation indicate that, typically, a larger number of oocytes are retrieved in patients aged ≤35 when compared to older patients. Although these reports document that oocyte vitrification preserves developmental potential akin to fresh oocytes, uncertainties persist regarding patient awareness of the adequate number of cryopreserved oocytes needed for pregnancy. Study design, size, duration This historical cohort study, conducted at a university-affiliated IVF center from January 2012 to December 2022, analyzed data from 1,332 vitrified oocyte ICSI cycles involving 1,000 SFP program participants. Fertility preservation patients and oocyte thawing cycles (n = 132) were categorized by age as follows: <30 years (n = 55 and 24), 30-35 years (n = 250 and 33), 36-40 years (n = 480 and n = 42), and >40 years (n = 215 and 33) for preservation and thawing, respectively. Participants/materials, setting, methods Laboratory and clinical outcomes were compared among the groups. In a subsequent analysis, data from PGT cycles conducted in our laboratory (n = 480) from January to December 2022 were utilized to determine blastulation and euploidy rates within vitrified oocytes. This data, combined with literature findings, was employed to estimate the average number of oocytes required for a patient to reach a 95% cumulative probability of pregnancy. These estimates were then compared with our database findings. Main results and the role of chance There were 1,332 cycles of SFP involving 1,000 patients. Among them, 121 (12.2%) returned for oocyte thawing and underwent 132 ICSI cycles. A significant difference in the survival rate was observed among thawed oocytes from patients under 30 compared to those over 40 years-old (<30: 90.7 ± 33, 30-35: 81.4 ± 40.4, 36-40: 83.4 ± 35.5, and >40: 72.3 ± 34, p = 0.047). Additionally, a significantly higher pregnancy rate was observed in the 30–35 age group when compared to those in the group aged >40 years-old (< 30: 50.0 ± 17.7, 30-35: 56.0 ± 85.0, 36-40: 46.3 ± 69.0, and >40: 21.4 ± 93.0, p = 0.048). However, there was no significant difference when comparing fertilization, blastulation, and implantation rates. In the general group, an appropriate number of oocytes to be cryopreserved to achieve a pregnancy chance of 95% would be 17. For patients aging < 30, 30-35, 36-40, and > 40, that would be 7.47, 10.7, 22.5, and 42.8, respectively. Overall, 92 out of 1,000 patients (9.2%) obtained an adequate number of oocytes. When the group was stratified by age, it was observed that 54.5%, 27.2%, 2.5%, and 0% of the patients obtained an adequate number of oocytes to achieve pregnancy. Limitations, reasons for caution The retrospective nature of the study and the small patient cohort included in the analysis, when divided by age, may pose limitations. However, the low number of patients returning to utilize their oocytes in SFP is a consistent limitation across all studies. Wider implications of the findings These findings underscore the importance of appropriate counseling and encouragement for patients undergoing SFP earlier, ensuring a larger number of oocytes are cryopreserved. This aligns with SFP’s primary objective: enhancing women’s reproductive autonomy by enabling the postponement of childbearing and preserving the biological relationship with future offspring. Trial registration number N/A

Ovarian Tissue Cryopreservation for Fertility Preservation in Patients with Hemoglobin Disorders: A Comprehensive Review.

Hemoglobin diseases like sickle cell disease (SCD) and β-thalassemia (BT) present fertility challenges for affected patients. SCD and BT result from abnormal hemoglobin production or structure and pose numerous health concerns. Despite medical advancements improving the quality of life or even providing cures, SCD and BT pose unique fertility concerns for women. Young women with these disorders already contend with reduced ovarian reserve and a narrower fertile window, a situation that is compounded by the gonadotoxic effects of treatments like medications, transfusions, stem cell transplants, and gene therapy. While crucial for disease control, these interventions may lead to reproductive health issues, increasing infertility and early menopause risks. Ovarian tissue cryopreservation (OTC) offers potential for future motherhood to women with hemoglobin disorders facing infertility related to curative treatments. OTC involves surgically removing, preparing, and freezing ovarian tissue containing primordial follicles capable of producing mature oocytes, offering advantages over oocyte cryopreservation alone. However, the application of OTC for patients with hemoglobin disorders presents unique challenges, including special health risks, financial barriers, and access to care. This comprehensive literature review delves into the current state of ovarian tissue cryopreservation for fertility preservation in patients with hemoglobin disorders. Empowering patients with informed reproductive choices in the context of their hemoglobin disorders stands as the ultimate goal.

Oocyte retrieval in social fertility preservation: challenging traditional beliefs on gonadotropin dosing and follicular size

ObjectivesTo investigate treatment approaches for fertility preservation patients, with a focus on timing of oocyte retrieval, and to determine whether their characteristics differ from those of other IVF patients. Additionally, to evaluate the significance of follicle size on triggering day in the context of fertility preservation.MethodsThis retrospective cohort study was conducted in a tertiary, university-affiliated medical center. It compared 140 matched patients undergoing social fertility preservation to 140 patients undergoing IVF treatment due to male factor infertility.ResultsPatients undergoing fertility preservation received a higher initial gonadotropin dose and had more oocytes retrieved than the control group. Within the fertility preservation cohort, a negative correlation was observed between the rate of large follicles and the number of retrieved oocytes. While there was no significant association between rate of large follicles and oocyte maturation rate in the entire group, age-stratified analysis revealed a negative relationship. Analysis revealed that although traditional treatment determinants such as follicular size and gonadotropin dosing were considered, peak estradiol levels were consistently identified as significant predictors of treatment outcomes.ConclusionsPhysicians may modify treatments for fertility preservation, emphasizing a higher gonadotropin dosage to maximize oocyte retrieval. Elevated estradiol levels can serve as a real-time predictive marker for the number of mature oocytes. While treatment strategies can influence outcomes, intrinsic patient factors, particularly baseline ovarian function, remain crucial. These results challenge beliefs regarding the importance of larger follicles and suggest the need for a tailored approach, considering patient age and specific fertility preservation objectives.

Fertility Preservation in Patients with Breast Cancer

Fertility Preservation in Patients with Breast Cancer

Changing the Perspective on Fertility Preservation for Women with Metastatic or Advanced Stage Cancer.

In this Perspective we share the personal story of a 33-year-old patient diagnosed with metastatic breast cancer and her journey through fertility preservation, surrogacy, and eventually motherhood, highlighting misconceptions about fertility preservation in this population. There are nearly 1 million women under the age of 50 diagnosed and living with cancer in the USA. These patients are met with life-altering decisions, including those that may limit their reproductive ability. While there have been tremendous advances and advocacy in the field of oncofertility, there has been limited focus on patients with advanced stage or metastatic cancer. We describe five key misconceptions surrounding fertility preservation in patients with advanced stage cancer, offering a review of the literature and our approach to challenging topics like desiring fertility preservation in the face of Stage 4 disease, the safety and timing of ovarian stimulation during cancer treatment, and passing away following fertility preservation. We review the importance of assessing perceptions of fertility preservation in patients with metastatic cancer and highlight the lack of research in this area as a call to action.

Future Fertility Among Pediatric Cancer Patients: Experiences and Perspectives of Health Workers in a Low-Resource Setting.

Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.

The impact analysis of multidisciplinary integrated postabortion care services on contraceptive compliance and fertility preservation in patients undergoing induced abortion

The impact analysis of multidisciplinary integrated postabortion care services on contraceptive compliance and fertility preservation in patients undergoing induced abortion

Abstract 2233: Limited adherence to clinical practice guidelines on fertility preservation for patients with early-onset cancer

Abstract Background: ASCO Clinical Practice Guidelines on fertility preservation (FP) recommend that healthcare providers discuss the possibility of infertility—including FP options—for cancer patients of reproductive-age as early as possible before treatment initiation. However, the evaluation of patient perceptions on provider adherence to these FP guidelines is largely undetermined. We sought to assess patient-reported provider adherence to FP guidelines for adults ages 18 to 49 years when diagnosed with a first primary cancer (early-onset). Patients and Methods: The Reproductive Health After Cancer Diagnosis and Treatment (REACT) Study is a patient-partnered study in cooperation with 23 community partners and patient advocates. Adults with a first primary early-onset cancer were recruited over an 8-week period (October to December 2021). Patient-reported provider adherence to FP guidelines, reproductive health history, sociodemographic, cancer and cancer impact questions were prospectively collected via patient questionnaire using a secure, web-based application. To examine the association of provider non-adherence with patient-level factors, logistic regression models were fitted to estimate odds ratios (OR) and 95% CI. Results: Among 647 patients diagnosed with early-onset cancer between 2006 and 2021 (mean [SD] age, 36.8 [7.8] years), a total of 376 (58.1%) reported that a healthcare professional involved in their cancer care did not discuss FP options before starting cancer treatment. Patients with thyroid, lung, ovarian and colorectal cancers reported the highest rates of provider non-adherence to FP guidelines (all ≥63% non-adherence). Females with cervical (OR 2.87, 95% CI: 1.11-7.41), colorectal (OR 2.05, 95% CI: 1.15-3.68), lung (OR 15.79, 95% CI:5.66-44.1) and ovarian (OR 10.90, 95% CI: 3.19-37.3) cancers, Hodgkin (OR 4.00, 95% CI: 1.15-13.98) and non-Hodgkin lymphoma (OR 4.65, 95% CI: 1.11-19.47) were more likely to report provider non-adherence to FP guidelines compared to breast cancer patients in models adjusted for diagnosis age and year, self-reported race/ethnicity, marital status and insurance coverage at cancer diagnosis. Similar patterns were observed for male patients with early-onset colorectal and lung cancers compared with testicular cancer patients. No overall or sex-specific associations were observed between patient-reported provider non-adherence and race/ethnicity, insurance coverage or diagnosis year. Conclusions: Nearly six of every 10 early-onset cancer patients reported that a healthcare professional involved in their cancer care did not discuss FP options prior to cancer treatment. The development of tailored, effective strategies for implementation of clinical practice guidelines on FP and delivery of concordant reproductive healthcare to a growing population of reproductive-age individuals with cancer is needed. Citation Format: Samantha R. Keller, Mark A. Lewis, Allison Rosen, Hyo K. Park, Rebecca Babyak, Jill Feldmann, Fei Ye, Rajiv Agarwal, Kristen K. Ciombor, Timothy M. Geiger, Cathy Eng, Michelle K. Roach, Digna R. Velez Edwards, Michele L. Cote, Richard Viskochil, Andreana N. Holowatyj. Limited adherence to clinical practice guidelines on fertility preservation for patients with early-onset cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2233.

Reproductive outcomes in women opting for fertility preservation after fertility-sparing surgery for borderline ovarian tumors.

What are the reproductive outcomes of women who had fertility preservation (FP) using either oocyte or embryo vitrification after fertility-sparing surgery (FSS) for a borderline ovarian tumor (BOT)? A retrospective, single-center cohort study was conducted between January 2013 and December 2021. Patients with BOT who resorted to FP by vitrifying oocytes or embryos were included. Both clinical and reproductive parameters were reviewed. The primary outcome was live birth. In total, thirteen patients who performed 31 FP cycles were included. Of those, six patients achieved eight live births after a mean follow-up period of 79 months. Three further pregnancies are still ongoing. All pregnancies/live births were obtained without using their cryopreserved oocytes or embryos. Women who had FSS for BOT have favorable prospects of live offspring, even without the need to use their cryopreserved material. Fertility preservation in patients with BOT has to be considered as a tool to mitigate the risk of infertility that may arise in case of BOT recurrence requiring castrating surgery.

Fertility preservation in patients with hematopoietic diseases

The prognosis of hematopoietic diseases has been improving over the past several decades, and measures to fulfill patients' wishes to have children are needed to improve survivors' quality of life. In Japan, the Japan Society for Fertility Preservation has taken the lead in developing guidelines, a national registry, and a nationwide uniform subsidy system. When considering fertility preservation in patients with hematopoietic diseases, interdisciplinary collaboration between oncology and onco-fertility is necessary to solve problems specific to hematopoietic diseases, such as the short time window between the onset of disease and the start of treatment, complications associated with fertility preservation treatment such as bleeding or ovarian hyperstimulation syndrome, and contamination of collected tissue with hematopoietic tumor cells. This article outlines the basic concept of fertility preservation in patients with hematopoietic diseases and recently established strategies for women with chronic myelogenous leukemia. It will also share some treatment innovations that can be considered in cases when fertility preservation treatment may be challenging.

Fertility Preservation in Patients With Cancer: Nurses' Views, Experiences, and Perceptions of Benefits and Barriers.

To evaluate nurses' views, experiences, and perceptions of the benefits and barriers to fertility preservation (FP) care for patients with cancer. The sample consisted of 236 nurses who provided care before gonadotoxic treatment for people with cancer in three university hospitals in Istanbul, Turkey, from January to June 2018. The data were collected using a participant information form and the Oncology FP Survey. The main research variables were nurses' views, experiences, and perceptions of benefits and barriers to FP care. Data were evaluated using means, SDs, frequencies, and the Mann-Whitney U test. Patients and their families were informed about FP most of the time. This information was given by physicians about half the time and by nurses less than one-fourth of the time. Mean scores on the Oncology FP Survey were moderate and indicated challenges among nurses in self-confidence, self-awareness of personal limitations, and perceived barriers when providing effective FP care. Nurses face challenges in providing counseling about FP options for patients with cancer and their families. Increasing self-confidence, reducing personal limitations, and decreasing perceived barriers to FP care through appropriate training may improve nurses' ability to provide FP counseling.