FERTILITY PRESERVATION IN WOMEN

Toxicity of chemotherapy and radiotherapy

by Hamish Wallace and Dror Meirow

Introduction: toxicity of chemotherapy and radiotherapy Cancer in childhood is rare, with approximately 1400 new cases per year, and a cumulative risk of around one in 500 by the age of 15 years in resource-rich countries. With long-term survival rates approaching 73%, it has been estimated that, by the year 2010, about one in 715 of the adult population will be a long-term survivor of childhood cancer (1). Cancer is more common after puberty during the reproductive lifespan of men and women (2,3), but many of these patients are cured by different treatment modalities. Long-term survivors are nevertheless at risk of developing a number of late sequelae (4), including impaired fertility, adverse pregnancy outcomes and health problems in offspring (5,6). Loss of fertility is one of the most devastating consequences of cytotoxic therapy for these young patients who, having overcome their disease, have expectations of a normal reproductive life. Read more »

Ovariostasis

by Sam Kim

Ovariostasis The efficacy of GnRH analog treatment to protect gonads from the cytotoxic effects of cancer therapy is controversial. It appears that GnRH analogs are more useful for female than male cancer patients, since previous studies have shown no difference in testicular failure rates after chemotherapy in male patients with or without GnRH agonist protection (1, 2). On the other hand, most animal and human studies have shown that GnRH agonist can protect primordial follicles during chemotherapy, because prepubertal ovaries were found to be more resistant to alkylating agents (3, 4). The precise mechanism by which GnRH analogs protect primordial follicles from alkylating agents is still unknown. Read more »

Embryo cryopreservation (IVF)

by Pedro Barri

Embryo cryopreservation (IVF) Survival rates of young cancer patients have shown a positive trend in recent decades, particularly in case of breast cancer and Hodgkin's disease. Advances in treatment modalities have raised awareness of the need for effective and safe fertility preservation procedures for young women with malignancies. The Ethics Committee of the American Society for Reproductive Medicine (ASRM) and the American Society of Clinical Oncology (ASCO) recommend that physicians advise cancer patients of their fertlity-preserving options before cancer treatment is initiated and inform them that sperm and embryo freezing are the only established methods of fertility preservation. Other fertility preservation methods should be considered investigational and should only be performed in centers with the necessary expertise. Read more »

Cryopreservation of mature and immature oocytes

by Debra Gook

Cryopreservation of mature and immature oocytes Although human embryo cryopreservation has been used as an important adjunct to infertility treatment for over fifteen years now and thousands of normal babies have been born from this technology, the same cannot be said of human oocyte freezing. Oocyte cryopreservation has potentially major clinical and psychological benefits for single women of reproductive age, who are at risk of losing their capacity to produce oocytes as a result of toxic anticancer treatments. Read more »

Cryopreservation of ovarian cortex
Technical aspects

by Marie-Madeleine Dolmans

Ovarian tissue cryopreservation : technical aspects In most female cancer patients, aggressive chemotherapy and radiotherapy lead to ovarian failure. Restoration of ovarian function after chemotherapy or radiotherapy has two main goals: to improve quality of life and restore reproductive function. For patients who need immediate chemotherapy, ovarian tissue cryopreservation, undertaken before cancer treatment, could be a means of preserving fertility without delaying the initiation of chemotherapy. The aim of this strategy is to reimplant ovarian tissue into the pelvic cavity (1) (orthotopic site) or a heterotopic site, such as the forearm (2), once treatment is completed and the patient is disease-free. The first live birth after orthotopic reimplantation of cryopreserved ovarian tissue was published in 2004 in The Lancet (1). Read more »

Cryopreservation of ovarian cortex
Reimplantation of cryopreserved ovarian cortex: technique (video) and results

by Jacques Donnez

Cryopreservation of ovarian cortex : Reimplantation of cryopreserved ovarian cortex - technique (video) and results

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Cryopreservation of ovarian cortex
In vitro maturation of ovarian follicles

by Johan Smitz

Cryopreservation of ovarian cortex : In vitro maturation of ovarian follicles Increased knowledge of follicle growth regulation and oocyte maturation, as well as the development of innovative culture systems, require multidisciplinary teamwork. Ultimately, these research efforts will one day allow us to replace oocytes in cured cancer patients without risk. Read more »

Whole ovary cryopreservation

by Pascale Jadoul

Whole ovary cryopreservation Ovarian cryopreservation and transplantation procedures have so far been almost exclusively limited to avascular cortical fragments, which are grafted without vascular anastomosis and are completely dependent on the establishment of neovascularization after grafting. Consequently, the cells in the graft undergo significant ischemic and reperfusion damage (1), which can induce a high rate of follicular loss (2,3,4). Reducing the ischemic interval between transplantation and revascularization is therefore essential to maintaining the viability and function of the graft. The best way to achieve this would be by transplantation of intact ovary with vascular anastomosis, allowing immediate revascularization of the transplant. Read more »

Whole ovary transplantation
Lessons learned from experimental studies

by Tommaso Falcone

Lessons from experimental studies Whole ovary transplantation has the potential to eliminate many of the limitations associated with transplantation of cortical pieces and thus prolong the longevity of the graft. Read more »