Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases

Tschudin, Sibil; Bitzer, Johannes

doi:10.1093/humupd/dmp015

Cited by 220 publications

(180 citation statements)

References 48 publications

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“…Therefore, strategies for preventing fertility loss have been sought (Tschudin & Bitzer, 2009). Studies concerning the protective effect provided by carnitine against late cardiac complications generated by doxorubicin have been carried out (Lipshultz et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Carnitine partially protects the rat testis against the late damage produced by doxorubicin administered during pre‐puberty

et al. 2014

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SUMMARYDoxorubicin, an anticancer drug, is widely included in chemotherapy protocols to combat childhood cancer. Carnitine, an important quaternary amine, is present in testis and epididymis and is involved in sperm maturation; it has been used in infertility treatment. In a previous study, our group observed that L-carnitine given before etoposide, another chemotherapeutic drug, reduces the spermatogenic damage and protects germ cells against apoptosis. This study aimed to evaluate the antiapoptotic and cytoprotective actions of L-carnitine in long-and mid-term basis, on the seminiferous epithelium of doxorubicin-treated pre-pubertal rats. Fortyeight 30-day-old male Wistar rats were distributed into four groups: sham-control; doxorubicin; carnitine; carnitine/doxorubicin (L-carnitine injected 1 h before doxorubicin). The rats were submitted to euthanasia at 64 and 100 days of age and their testes were collected for biometric, morphometric, and histopathological analyses. The numerical density of apoptotic germ cells was obtained (TUNEL method). In adult phase (100 days), the following spermatic parameters were analyzed: mature spermatid (19 step) count and sperm daily production per testis; sperm number and transit time through the epididymal caput/corpus and cauda; frequency of morphologically abnormal spermatozoa (from epididymal fluid), as well as sperm DNA integrity (Comet assay). The testicular and spermatic parameters at both ages were improved in rats treated with carnitine before doxorubicin. At 64 days, the TUNEL-positive germ cell frequency was lower in the carnitine/doxorubicin-treated rats comparatively to the doxorubicin-treated rats. At 100 days of age, the sperm DNA fragmentation was also lower in the previously carnitine-treated rats, as evidenced by the analysis of three parameters. Carnitine reduced the late testicular and spermatic damages caused by doxorubicin, probably providing a partial cytoprotection against the deleterious action of doxorubicin administration to pre-pubertal rats. However, further studies shall be undertaken to investigate the protective mechanisms involved in such germ cell preservation.

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Section: Discussionmentioning

confidence: 99%

Carnitine partially protects the rat testis against the late damage produced by doxorubicin administered during pre‐puberty

et al. 2014

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“…Cronbach's a of the decisional regret scale (T1) was 0.61. At baseline we measured anticipated regret, with two items asking after the extent to which women expected to have regret if they did not pursue FP now, when they would appear to be infertile after cancer treatment and if they did pursue FP now, when they would appear to still be fertile after cancer (van Dijk, van Roosmalen, Otten, & Stalmeier, 2008).…”

Section: (I) Feasibility Outcomesmentioning

confidence: 99%

“…The success rates of these options range from 5 to 25% . Despite an increasing number of studies and guidelines demonstrating the need for discussion of FP issues with cancer patients, information provision about treatment-induced infertility and FP techniques and referral for FP are still not sufficient and often provided too late (Dunn & Steginga, 2000;Jenninga, Hilders, Louwe, & Peters, 2008;Nakayama et al, 2009;Quinn et al, 2007;Rosen, Rodriguez-Wallberg, & Rosenzweig, 2009;Thewes et al, 2005;Tschudin & Bitzer, 2009). …”

Section: Introductionmentioning

confidence: 99%

Feasibility and effects of a decision aid about fertility preservation

et al. 2016

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This paper reports on the feasibility and preliminary effects of a decision aid (DA) about female fertility preservation (FP). We conducted a pilot multicentre randomized controlled trial of women with breast cancer aged 18-40 who were randomized to brochures or the DA. Over 18 months, 62 women were eligible, of which 42 were invited by their healthcare provider (74%) to participate in the study. A total of 36 women signed up for participation and 26 (72%) were randomized to brochures (n ¼ 13) or the DA (n ¼ 13). In both groups, many women (87%) read the brochures and eight women used all available brochures. In the intervention group, 7/13 women logged in to the DA. Women who received brochures had slightly less decisional conflict, whereas knowledge improved in both groups. Our results indicate that both brochures about FP and a detailed DA have beneficial effects with regard to knowledge, but the DA seemed to introduce slightly more decisional conflict (DC) than the brochures. Although we encountered challenges with recruitment, our design and measurements seem feasible and the effects of the information materials seem promising, hence justifying conducting a larger study. ARTICLE HISTORY

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“…The quality of life of these patients may be severely impaired if fertility preservation options are not discussed prior to treatment [1].…”

Section: Introductionmentioning

confidence: 99%

Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment

Dolmans

Ouderaen

Demylle

et al. 2015

J Assist Reprod Genet

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Purpose The aim of this study was to evaluate long-term embryo cryopreservation, utilization, and success rate in patients subjected to gonadotoxic treatments in the context of cancer. Methods This is a retrospective study on patients (n=54) undergoing ovarian stimulation and IVF for fertility preservation between January 1997 and June 2014. Embryos were slowfrozen and stored until the women were cured and able to undergo embryo transfer. Results Fifty-four women underwent 66 oocyte pick-up procedures in total, and embryos were obtained from 52 of the 54 patients. Four patients died before their frozen embryos could be thawed. Of the remaining 48, 9 women returned to use their embryos, resulting in 6 pregnancies (66 % cumulative pregnancy rate), two of which ended in miscarriage. The live birth rate per patient was thus 44 % (4/9). The true come-back rate, calculated after applicable exclusions, was found to be 23 %. Conclusion IVF followed by embryo freezing is a widely established technique for fertility preservation, but little has been published on the outcomes in cancer patients. While we found the number of good-quality embryos to be lower than in a normal population, the cumulative live birth rate was similar to that achieved with fresh embryos in non-cancer patients. The utilization rate of this fertility preservation method can be considered high.

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Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases

Abstract: The existing literature demonstrates the need for and the limits of current counselling. Future research should target the means to facilitate the decision-making process for patients and health professionals.

Cited by 220 publications

References 48 publications

Carnitine partially protects the rat testis against the late damage produced by doxorubicin administered during pre‐puberty

Carnitine partially protects the rat testis against the late damage produced by doxorubicin administered during pre‐puberty

Feasibility and effects of a decision aid about fertility preservation

Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment

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