Seeking Fertility Preservation Research Articles

Immature oocyte retrieval in the luteal phase to preserve fertility in cancer patients

As cancer treatment outcomes improve, the number of women with cancer seeking fertility preservation increases. Currently, embryo/oocyte cryopreservation appears to provide the best fertility preservation option. However, patients may not have sufficient time to undergo ovarian stimulation prior to chemotherapy and/or the hormones used in ovarian stimulation are contraindicated for certain tumours. In-vitro maturation has been suggested as an effective treatment for these patients. This report presents three women aged 21, 30 and 40 years, without male partners, seeking fertility preservation prior to chemotherapy. They were first seen during the luteal phase of their menstrual cycle and were to undergo gonadotoxic treatment imminently. They underwent immature oocyte retrieval in the luteal phase and seven, five and seven immature oocytes were recovered, respectively. After in-vitro maturation, five, three and five metaphase II (MII) oocytes were vitrified. Two patients later underwent one and two more retrievals, respectively, in the follicular phase of the next cycle(s) and additional oocytes were cryopreserved. These results suggest that immature oocytes recovered in the luteal phase can successfully be matured in vitro; therefore, if there is not sufficient time for conventional follicular-phase oocyte retrieval in a stimulated/unstimulated cycle prior to chemotherapy, a retrieval in the luteal phase could be considered.

The impact of uterine artery embolization on fertility and pregnancy outcome

Uterine artery embolization for management of symptomatic fibroids is an effective and increasingly popular treatment option. There are several studies evaluating the effects of uterine artery embolization on later pregnancies; however, the effects on fertility are still largely uncertain. This paper reviews the current literature on the effects of this technique on fertility and pregnancy outcome. Two recent studies have reported pregnancy rates following uterine artery embolization in women seeking pregnancy. A small, third study reported preliminary results in a randomized controlled trial comparing uterine artery embolization with myomectomy in women wishing to preserve fertility. The body of medical literature supports use of uterine artery embolization as an effective treatment for symptoms of vaginal bleeding and pelvic pressure from uterine fibroids. Patient selection is critical in determining the appropriateness of this treatment option. Myomectomy remains the standard of care for women with symptomatic fibroids seeking fertility preservation.

In vitro maturation of germinal vesicle oocytes recovered after premature luteinizing hormone surge: description of a novel approach to fertility preservation

To report a novel approach to fertility preservation by in vitro maturation and embryo cryopreservation after LH surge and ovulation. Case report. Two university-based reproductive endocrinology clinics. Forty-year-old woman with breast cancer seeking fertility preservation before chemotherapy. The plan was ovarian stimulation and retrieval of mature oocytes, followed by IVF; however, premature LH surge and ovulation occurred before oocyte retrieval. Because no mature oocyte was recovered, follicles <10 mm in diameter were also aspirated. Recovery of immature oocytes after ovulation, in vitro maturation of these oocytes, and fertilization and vitrification of generated embryos. Four immature oocytes were recovered, and two matured in vitro. After fertilization with intracytoplasmic sperm injection, embryos progressed to the four-cell stage on day 2 and were vitrified for future use. This case illustrates that under time constraints, immature oocytes can be recovered after ovulation and used to generate embryos for fertility preservation.

P-483: Factors influencing decision making in women seeking fertility preservation at a Tertiary Care Center Program

Fertility after cancer therapy has become a major concern as a quality-of-life measure in cancer survivors, whose number has dramatically increased in the past two decades. Our objective was to determine factors effecting the decision by women with cancer to undergo fertility preservation and the selection of procedure.

Prospects for Oocyte Banking and In Vitro Maturation

There is little debate about the desirability of human oocyte ("egg") banking but plenty of discussion about its prospects. Egg banking is needed by young cancer patients before they undergo potentially sterilizing treatment and is a desirable alternative to in vitro fertilization and embryo cryopreservation. However, egg banking is inefficient-oocytes are sensitive to chilling, often fail to survive freeze-thawing, and are susceptible to cytoskeletal damage and aneuploidy. Currently, even the most optimistic success rates offer patients only a slim chance of pregnancy if few oocytes are available. Ultra-rapid freezing with vitrification may offer advantages over conventional equilibrium cooling protocols and needs to be investigated further. Likewise, freezing immature oocytes followed by in vitro maturation offers practical and theoretical advantages, but this method is still inefficient. Nevertheless, all these technologies are improving, and egg banking will eventually become an option for patients seeking fertility preservation.