Update on fertility preservation from the Barcelona International Society for Fertility Preservation–ESHRE–ASRM 2015 expert meeting: indications, results and future perspectives

Introduction Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility‐preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. Material and methods The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC‐referral to OTC. A literature search for “random start” protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. Results The time from OTC‐referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13‐17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13‐14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later. Conclusions It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

“…Women treated with cyclophosphamide should be informed of the subsequent infertility risk, as >80% of them wish to preserve their fertility . In adults, the first established option is oocyte/embryo cryopreservation . However, estradiol elevations induced by COS could aggravate SLE.…”

Section: Autoimmune Diseasesmentioning

confidence: 99%

“…Similar figures can be found in our center (Figure ). These non‐oncological indications primarily include immunological, gynecological, hematological, or genetic pathologies . Ovarian failure can be induced either by the pathology itself (genetic disorders, autoimmune pathologies, inflammatory or intrinsic disorders), or by medical (eg immunosuppression using cyclophosphamide) or surgical treatments involving the ovaries.…”

Section: Introductionmentioning

confidence: 99%

Challenges of fertility preservation in non‐oncological diseases

Condorelli

Demeestere

2019

Clinicians should provide fertility counseling to all patients receiving gonadotoxic treatment. International scientific societies have mainly focused on oncological patients, and fewer efforts have been made to apply these recommendations to women diagnosed with benign disease (eg benign hematological diseases, autoimmune diseases, and gynecological or genetic disorders). However, these indications account for 8%‐13% of the demand for fertility preservation. The risk of premature ovarian failure due to treatment, or to the disease itself, can be considered fairly high for many young women. Counseling and adequate management of these women require particular attention due to the severe health conditions that are associated with some of these diseases. In this review, we address specific issues related to providing adequate fertility counseling and management for women who have been diagnosed with the major non‐oncological indications, based on the literature and on our clinical experience.

“…Further, it is currently considered the most established technique in women who want to freeze eggs for medical reasons, such as cancer, autoimmune diseases, medical conditions causing ovarian insufficiency, and hematopoietic stem cell transplantation. Finally, it allows the reproductive autonomy of women and can be used for elective fertility preservation in women who are conscious of age‐related fertility decline but are not ready to become pregnant . In this regard, time to egg retrieval, age and number of oocytes available for freezing are decisive factors to optimize the cumulative chance of pregnancy with frozen oocytes .…”

Section: Introductionmentioning

confidence: 99%

A brief history of oocyte cryopreservation: Arguments and facts

Iussig

Maggiulli

Fabozzi

et al. 2019

The term “cryopreservation” refers to the process of cooling cells and tissues and storing them at subzero temperatures in order to stop all biological activity and preserve their viability and physiological competences for future use. Cooling to subzero temperatures is not a physiological condition for human cells; this is probably due to the high content of water in the living matter, whose conversion to ice crystals may be associated with severe and irreversible damage. Among reproductive cells and tissues, metaphase II oocytes are notably vulnerable to cryopreservation, mainly because of their large size, low surface area to volume ratio, relatively high water content and presence of the meiotic spindle. As human biological systems lack efficient internal defense mechanisms against chilling injuries, it is of the utmost importance to supply adequate external support, in terms of cryoprotectant additives, appropriate cooling/warming rates, and suitable long‐term storage. Over the years, scientists have proposed different cryopreservation strategies in the effort to achieve an optimized recipe ensuring cell survival and, at the same time, maintenance of the physiological functions and abilities necessary to continue life. However, despite the first success obtained in the 1980s with frozen oocytes, it was not until recently that notable improvements in the cryopreservation technique, thanks to the advent of vitrification, allowed a breakthrough of this fine procedure.