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Goldenberg E, Sonigo C, Rakrouki S, Vinolas C, Eustache F, Puy V, Willekens C, Lazarovici J, Sifer C, Becquart C, Mayeur A, Benoit A, Grynberg M, Peigné M. Hematologic cancers in women: from fertility preservation to post-cancer fertility outcomes. Hum Reprod 2025:deaf071. [PMID: 40302200 DOI: 10.1093/humrep/deaf071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 02/26/2025] [Indexed: 05/01/2025] Open
Abstract
STUDY QUESTION How do hematological characteristics affect ovarian reserve, ovarian response to ovarian stimulation, and fertility outcomes? SUMMARY ANSWER Although lymphoma characteristics impact serum AMH levels, they do not affect, per se, the response to ovarian stimulation and the number of mature oocytes recovered at the time of fertility preservation; in addition, fertility in survivors of hematologic malignancies is relatively conserved. WHAT IS KNOWN ALREADY Hematologic cancers can affect young women of reproductive age. While survival rates have improved over the years due to advances in treatment protocols, the treatments used can impact fertility. Fertility preservation methods, such as oocyte or ovarian tissue cryopreservation, are increasingly offered, but concerns remain about reduced ovarian reserve and response to ovarian stimulation in women with these cancers, which may influence the effectiveness of fertility preservation strategies. Moreover, fertility potential after hematologic cancers has been poorly studied. STUDY DESIGN, SIZE, DURATION This is a retrospective, observational bi-centric cohort study. All patients with hematologic cancer (lymphoma, leukemia, myeloma, and myelodysplastic syndrome) who underwent fertility preservation before gonadotoxic treatment (n = 286) from January 2013 to March 2023 were included. For fertility after cancer, and use of frozen oocytes/embryos, the endpoint date was 7 July 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS Only patients with lymphoma were included for analysis of ovarian reserve (n = 238) and ovarian response to ovarian stimulation (n = 230). Low ovarian reserve and impaired ovarian response to ovarian stimulation were defined as AMH <1.2 ng/ml and ≤9 mature oocytes retrieved after ovarian stimulation, respectively, according to POSEIDON criteria. A Cox regression model was used to determine predictive factors of impaired response to ovarian stimulation, low ovarian reserve, and pregnancy after cancer. Cumulative incidence of pregnancy and cumulative use of frozen oocytes/embryos was calculated in all patients suffering from hematological malignancies. MAIN RESULTS AND THE ROLE OF CHANCE There was an impact of lymphoma characteristics on AMH levels independent of age. After adjustment based on POSEIDON Groups 3 and 4, no specific impact of lymphoma characteristics (e.g. stage, clinical, or biologic B signs) on ovarian response to ovarian stimulation was observed. Regarding post-cancer fertility in the whole population, among the women who tried to conceive, 62% achieved at least one pregnancy, and 85% of these occurred naturally. After adjustment, positive predictive factors for pregnancy were age <35 years, being in a relationship at the first oncofertility consultation, and absence of hematopoietic stem cell transplantation. LIMITATIONS, REASONS FOR CAUTION Limitations include potential biases due to the heterogeneity of hematological conditions and the retrospective design, which may lead to missing data. Additionally, the duration of follow-up may not be sufficient to evaluate long-term fertility outcomes. WIDER IMPLICATIONS OF THE FINDINGS Lymphoma characteristics did not affect the response to ovarian stimulation in terms of mature oocyte retrieval, although AMH levels were impaired. Reassuring post-cancer fertility data support informed decision-making regarding fertility preservation techniques. Larger prospective studies are needed to tailor oncofertility counseling, ensuring optimized care and reproductive outcomes. STUDY FUNDING/COMPETING INTEREST(S) Medical editorial support was provided by Peter Todd of Tajut Ltd (Kaiapoi, New Zealand) and was funded by AFPR (Advances in Fertility Preservation and Reproduction). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Goldenberg
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - C Sonigo
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Paris-Saclay, Antoine Beclère Hospital, Clamart, France
| | - S Rakrouki
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - C Vinolas
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - F Eustache
- CECOS, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - V Puy
- CECOS, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
- Embryology Unit, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - C Willekens
- Department of Hematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - J Lazarovici
- Department of Hematology, Hôpital Privé d'Antony, Antony, France
| | - C Sifer
- Embryology Unit, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
| | - C Becquart
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Paris-Saclay, Antoine Beclère Hospital, Clamart, France
| | - A Mayeur
- Histology-Embryology-Cytogenetic Laboratory, AP-HP, Université Paris-Saclay, Hôpital Antoine Beclère, Clamart, France
| | - A Benoit
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Paris-Saclay, Antoine Beclère Hospital, Clamart, France
| | - M Grynberg
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Paris-Saclay, Antoine Beclère Hospital, Clamart, France
| | - M Peigné
- Department of Reproductive Medicine and Fertility Preservation, AP-HP, Université Sorbonne Paris Nord, Jean Verdier Hospital, Bondy, France
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Su HI, Lacchetti C, Letourneau J, Partridge AH, Qamar R, Quinn GP, Reinecke J, Smith JF, Tesch M, Wallace WH, Wang ET, Loren AW. Fertility Preservation in People With Cancer: ASCO Guideline Update. J Clin Oncol 2025; 43:1488-1515. [PMID: 40106739 DOI: 10.1200/jco-24-02782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 01/09/2025] [Indexed: 03/22/2025] Open
Abstract
PURPOSE To provide updated fertility preservation (FP) recommendations for people with cancer. METHODS A multidisciplinary Expert Panel convened and updated the systematic review. RESULTS One hundred sixty-six studies comprise the evidence base. RECOMMENDATIONS People with cancer should be evaluated for and counseled about reproductive risks at diagnosis and during survivorship. Patients interested in or uncertain about FP should be referred to reproductive specialists. FP approaches should be discussed before cancer-directed therapy. Sperm cryopreservation should be offered to males before cancer-directed treatment, with testicular sperm extraction if unable to provide semen samples. Testicular tissue cryopreservation in prepubertal males is experimental and should be offered only in a clinical trial. Males should be advised of potentially higher genetic damage risks in sperm collected soon after cancer-directed therapy initiation and completion. For females, established FP methods should be offered, including embryo, oocyte, and ovarian tissue cryopreservation (OTC), ovarian transposition, and conservative gynecologic surgery. In vitro maturation of oocytes may be offered as an emerging method. Post-treatment FP may be offered to people who did not undergo pretreatment FP or cryopreserve enough oocytes or embryos. Gonadotropin-releasing hormone agonist (GnRHa) should not be used in place of established FP methods but may be offered as an adjunct to females with breast cancer. For patients with oncologic emergencies requiring urgent oncologic therapy, GnRHa may be offered for menstrual suppression. Established FP methods in children who have begun puberty should be offered with patient assent and parent/guardian consent. The only established method for prepubertal females is OTC. Oncology teams should ensure prompt access to a multidisciplinary FP team. Clinicians should advocate for comprehensive FP services coverage and help patients access benefits.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- H Irene Su
- University of California, San Diego, San Diego, CA
| | | | | | | | | | | | | | - James F Smith
- University of California, San Francisco, San Francisco, CA
| | | | - W Hamish Wallace
- Royal Hospital for Children & Young People & University of Edinburgh, Edinburgh, United Kingdom
| | | | - Alison W Loren
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Jaeck S, Depuydt C, Bernard V, Ammar O, Hocké C, Carrière J, Chansel-Debordeaux L. How to Preserve Fertility in Reproductive-Age Women with Cancer. J Clin Med 2025; 14:1912. [PMID: 40142718 PMCID: PMC11942802 DOI: 10.3390/jcm14061912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 03/06/2025] [Accepted: 03/08/2025] [Indexed: 03/28/2025] Open
Abstract
Chemotherapy and radiotherapy, among other gonadotoxic treatments, can significantly affect ovarian reserve and function, potentially leading to premature ovarian insufficiency (POI) and sterility. With the increasing survival rates among young female cancer patients, fertility preservation (FP) has become an essential aspect of cancer care. The decision to pursue FP depends on various factors, including patient age, ovarian reserve, the type of treatment, and its gonadotoxic potential. Several FP strategies are available, including oocyte, embryo, and ovarian tissue cryopreservation. While oocyte and embryo cryopreservation are the gold standard techniques, ovarian tissue cryopreservation and in vitro maturation (IVM) present viable alternatives for patients who cannot undergo ovarian stimulation or for whom stimulation is contraindicated. Despite significant advances within the FP practice, challenges remain in ensuring timely FP counseling, equitable access to services, and optimizing long-term reproductive outcomes. Continued research is needed to refine existing FP techniques, explore innovative approaches, and address ethical considerations in FP decision-making. This review explores current FP options, their clinical applications, and future directions to improve reproductive outcomes in young women undergoing gonadotoxic treatments.
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Affiliation(s)
- Sébastien Jaeck
- Reproductive Biology Unit-CECOS, University Hospital of Bordeaux, 33000 Bordeaux, France; (S.J.); (C.D.)
| | - Chloé Depuydt
- Reproductive Biology Unit-CECOS, University Hospital of Bordeaux, 33000 Bordeaux, France; (S.J.); (C.D.)
- U1312-BRIC Team Biotherapies Genetics and Oncology-BioGO, Bordeaux University, 33000 Bordeaux, France;
| | - Valérie Bernard
- U1312-BRIC Team Biotherapies Genetics and Oncology-BioGO, Bordeaux University, 33000 Bordeaux, France;
- Gynecological Surgery, Medical Gynecology and Reproductive Medicine Department, University Hospital of Bordeaux, 33000 Bordeaux, France; (C.H.); (J.C.)
| | - Omar Ammar
- Clinical Research and Development Division, Louise, 33300 Bordeaux, France;
| | - Claude Hocké
- Gynecological Surgery, Medical Gynecology and Reproductive Medicine Department, University Hospital of Bordeaux, 33000 Bordeaux, France; (C.H.); (J.C.)
| | - Jennifer Carrière
- Gynecological Surgery, Medical Gynecology and Reproductive Medicine Department, University Hospital of Bordeaux, 33000 Bordeaux, France; (C.H.); (J.C.)
| | - Lucie Chansel-Debordeaux
- Reproductive Biology Unit-CECOS, University Hospital of Bordeaux, 33000 Bordeaux, France; (S.J.); (C.D.)
- U1312-BRIC Team Biotherapies Genetics and Oncology-BioGO, Bordeaux University, 33000 Bordeaux, France;
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Erden M, Gayete-Lafuente S, Vural NA, Oktay KH. Utility and Outcomes of Ovarian Tissue Cryopreservation and Transplantation for Gynecologic Cancers: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 144:481-492. [PMID: 39173181 PMCID: PMC11499045 DOI: 10.1097/aog.0000000000005708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE 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. DATA SOURCES 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. METHODS OF STUDY SELECTION 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. TABULATION, INTEGRATION, AND RESULTS 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. CONCLUSION 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. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42024498522.
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Affiliation(s)
- Murat Erden
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Sonia Gayete-Lafuente
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Nazli Aylin Vural
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
- Department of Gynecological Oncology, Yozgat State Hospital, Yozgat, Turkey
| | - Kutluk H. Oktay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
- Innovation Institute for Fertility Preservation New York, NY and New Haven, CT
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Peigné M, Mur P, Laup L, Hamy AS, Sifer C, Mayeur A, Eustache F, Sarandi S, Vinolas C, Rakrouki S, Benoit A, Grynberg M, Sonigo C. Fertility outcomes several years after urgent fertility preservation for patients with breast cancer. Fertil Steril 2024; 122:504-513. [PMID: 38679360 DOI: 10.1016/j.fertnstert.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To study the fertility outcomes of women who tried to conceive after breast cancer (BC) treatment and fertility preservation. DESIGN Retrospective observational, bicentric cohort study. SETTING University hospital. PATIENTS Patients with BC. INTERVENTION All patients who had undergone fertility preservation before BC treatment between January 2013 and July 2019 were included (n = 844). The endpoint date was March 1, 2022. Patients with missing data on pregnancy attempts after a cancer diagnosis (n = 195) were excluded from the pregnancy analysis. MAIN OUTCOME MEASURES Cumulative incidences of pregnancy and live birth (LB) were calculated. For women who became pregnant, the time to conception was calculated between the first fertility preservation consultation and the estimated day of conception. For those who did not conceive, we considered the time between the first fertility preservation consultation and the endpoint date, or the date of patient death. A Cox regression model was used to study the predictive factors for pregnancy and LB. RESULTS Among the 649 patients with available data on pregnancy attempts after BC diagnosis, 255 (39.3% [35.5-43.2]) tried to conceive (median follow-up of 6.5 years). Overall, 135 (52.9% [46.6-59.2]) of these patients achieved a pregnancy, mainly through unassisted conception (79.3% [72.8-84.8]), and 99 reported an LB (representing 38.8% of patients who attempted conception). In our cohort, 48 months after the first fertility preservation consultation, the cumulative incidence of pregnancy was 33.1% ([27.6-37.9]). After adjustment for age, parity, type of chemotherapy administration, and endocrine therapy, only multiparity at diagnosis and absence of chemotherapy were positive predictive factors of pregnancy after cancer. Of the 793 patients who had vitrified oocytes and embryos, 68 used them (27% [21.3-32.5] of the patients who tried to conceive), resulting in 8 LBs (11.8% [5.2-21.9]). Women who used their cryopreserved oocytes and embryos were older at the first consultation of fertility preservation (hazard ratio 1.71 [1.42-2.21]), and chose more often to vitrify embryos (hazard ratio 1.76 [1.28-2.23]). CONCLUSION Although pregnancy rates after fertility preservation for patients with BC are low, most conceptions are achieved without medical assistance. Our findings provide useful information to advise women on the different techniques of fertility preservation, their efficacy, and safety, as well as the relatively high chances of unassisted conception.
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Affiliation(s)
- Maëliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France.
| | - Pauline Mur
- Department of Reproductive Medicine and Fertility Preservation, Antoine Beclère Hospital, AP-HP-Université Paris-Saclay, Clamart, France
| | - Laëtitia Laup
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Christophe Sifer
- Embryology Unit, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Anne Mayeur
- Histology-Embryology-Cytogenetic Laboratory, Antoine Beclère Hospital, AP-HP-Université Paris- Saclay, Clamart, France
| | - Florence Eustache
- Le Centre d'Études et de Conservation des Œufs et du Sperme (CECOS), Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Solmaz Sarandi
- Embryology Unit, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Claire Vinolas
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Sophia Rakrouki
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Antoine Beclère Hospital, AP-HP-Université Paris-Saclay, Clamart, France
| | - Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, AP-HP-Université Sorbonne Paris Nord, Bondy, France; Department of Reproductive Medicine and Fertility Preservation, Antoine Beclère Hospital, AP-HP-Université Paris-Saclay, Clamart, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Antoine Beclère Hospital, AP-HP-Université Paris-Saclay, Clamart, France; Physiologie et Physiopathologie Endocrinienne, Inserm, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Boumerdassi Y, Labrosse J, Hammami F, Dahoun M, Bouyer J, O'Neill L, Sarandi S, Peigné M, Cedrin I, Grynberg M, Sifer C. Impact of oxygen tension during in vitro maturation: a sibling-oocyte prospective double-blinded study. Fertil Steril 2024; 121:615-621. [PMID: 38103883 DOI: 10.1016/j.fertnstert.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To determine whether oxygen (O2) tension (20% vs. 5%) has an impact on oocyte maturation rates and morphology during in vitro maturation (IVM). DESIGN A prospective, observational, monocentric, sibling-oocyte study. SETTING University Hospital. PATIENTS A total of 143 patients who underwent IVM for fertility preservation purposes from November 2016 to April 2021 were analyzed. Patients were included when ≥2 cumulus-oocyte complexes (COCs) were retrieved. The cohort of COCs obtained for each patient was randomly split into two groups: group 20% O2 and group 5% O2. INTERVENTION Cumulus-oocyte complexes were incubated for 48 hours either under 5% O2 or 20% O2. After 24 and 48 hours of culture, every oocyte was assessed for maturity and morphology, to estimate oocyte quality. Morphology was evaluated considering six parameters (shape, size, ooplasm, perivitelline space, zona pellucida, and polar body characteristics), giving a total oocyte score ranging from -6 to +6. MAIN OUTCOME MEASURES Maturation rates and total oocyte scores were compared using paired-sample analysis between group 20% O2 and group 5% O2. RESULTS Patient median age was 31.4 [28.1-35.2] years-old. The mean serum antimüllerian hormone levels and antral follicle count were 3.2 ± 2.3 ng/mL and 27.2 ± 16.0 follicles, respectively. A mean of 10.7 COCs per cycle were retrieved, leading to 6.1 ± 2.4 metaphase II oocytes vitrified (total maturation rate = 57.3%; 991 metaphase II oocytes/1,728 COCs). A total of 864 COCs were included in each group. Oocyte maturation rates were not different between the two groups (group 20% O2: 56.82% vs. group 5% O2: 57.87%, respectively). Regarding oocyte morphology, the mean total oocyte score was significantly higher in group 5% O2 compared with group 20% O2 (3.44 ± 1.26 vs. 3.16 ± 1.32, P=.014). CONCLUSION As culture under low O2 tension (5% O2) improves oocyte morphology IVM, our results suggest that culture under hypoxia should be standardized. Additional studies are warranted to assess the impact of O2 tension on oocyte maturation and the benefit of IVM under low O2 tension for embryo culture after utilization of frozen material.
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Affiliation(s)
- Yasmine Boumerdassi
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France; Université Sorbonne Paris Nord, Villetaneuse, France
| | - Julie Labrosse
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Fatma Hammami
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Mehdi Dahoun
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Jean Bouyer
- Centre for Research in Epidemiology and Population Health, Université Paris Saclay, France
| | - Louis O'Neill
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Solmaz Sarandi
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Isabelle Cedrin
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France; Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Clamart, France; Université Paris Saclay, Le Kremlin Bicêtre, France; Université Paris-Diderot, Paris, France
| | - Christophe Sifer
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France; Équipe RHuMA, UMR-BREED, UFR Simone Veil Santé, Montigny le Bretonneux, France.
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Takae S, Harada M, Nakamura K, Furuyama S, Ono M, Osuga Y, Suzuki N. Reproductive outcomes of embryo cryopreservation and transfer at the start-up phase of fertility preservation in Japan. Reprod Med Biol 2024; 23:e12581. [PMID: 38899000 PMCID: PMC11185938 DOI: 10.1002/rmb2.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To verify the effectiveness of embryo transfer (ET) using cryopreserved embryo as fertility preservation (FP). Methods This study was a questionnaire survey. The total number of embryo cryopreservation (EC) was investigated between 2014 and 2020. And for patients who underwent ET among study period, details of EC, outcome of ET, number of live births, and mortality were investigated. Results Of the 150 facilities, 114 responded (76.0%). A total of 1420 EC were performed during the study period; and ET was performed for 417 patients. Breast cancer was the most common primary disease. A total of 199 live births (including prospective) were obtained by ET; 1.7 EC and 2.2 ET were performed per patient, and live birth rate was 21.4% per ET (28.1% on 35-37-year-old patients). The number of EC and ET increased with age. The final birth rate, including pregnancies other than FP, was 51.8%. Ovarian stimulation with aromatase inhibitors was commonly used, although with no effect on live birth rates. Random start stimulation was also common, experienced by 36.3% of breast cancer patients. Conclusion Reproductive outcomes of ETs following EC as FP are acceptable. This research project was registered in the University Hospital Medical Information Network (UMIN000043664).
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Affiliation(s)
- Seido Takae
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityKanagawaJapan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Kentaro Nakamura
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityKanagawaJapan
| | - Sayako Furuyama
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityKanagawaJapan
| | - Masanori Ono
- Department of Obstetrics and GynecologyTokyo Medical UniversityShinjuku‐kuTokyoJapan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Nao Suzuki
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityKanagawaJapan
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Das M, Son WY. In vitro maturation (IVM) of human immature oocytes: is it still relevant? Reprod Biol Endocrinol 2023; 21:110. [PMID: 37993914 PMCID: PMC10664544 DOI: 10.1186/s12958-023-01162-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
In vitro maturation (IVM) of human immature oocytes has been shown to be a viable option for patients at risk of ovarian hyperstimulation syndrome (OHSS), those seeking urgent fertility preservation and in circumstances where controlled ovarian stimulation is not feasible. Moreover, IVM techniques can be combined with ovarian tissue cryobanking to increase the chances of conception in cancer survivors. The clinical applications of IVM in the field of reproductive medicine are rapidly expanding and the technique is now classified as non-experimental. In contrast to conventional IVF (in vitro fertilization), IVM offers several advantages, such as reduced gonadotropin stimulation, minimal risk of ovarian hyperstimulation syndrome (OHSS), reduced treatment times and lower costs. However, the technical expertise involved in performing IVM and its lower success rates compared to traditional IVF cycles, still pose significant challenges. Despite recent advances, such as innovative biphasic IVM systems, IVM is still an evolving technique and research is ongoing to refine protocols and identify techniques to improve its efficiency and effectiveness. A comprehensive understanding of the distinct mechanisms of oocyte maturation is crucial for obtaining more viable oocytes through in vitro methods, which will in turn lead to significantly improved success rates. In this review, the present state of human IVM programs and future research directions will be discussed, aiming to promote a better understanding of IVM and identify potential strategies to improve the overall efficiency and success rates of IVM programs, which will in turn lead to better clinical outcomes.
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Affiliation(s)
- Mausumi Das
- Department of Reproductive Medicine, Queen Charlotte and Hammersmith Hospitals, Imperial College Healthcare NHS Trust, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Varlas VN, Borș RG, Crețoiu R, Bălescu I, Bacalbașa N, Cîrstoiu M. Fertility-sparing surgery: a hopeful strategy for young women with cancer. J Med Life 2023; 16:974-980. [PMID: 37900072 PMCID: PMC10600681 DOI: 10.25122/jml-2023-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 10/31/2023] Open
Abstract
Fertility preservation in cancer patients is currently based on either assisted reproductive technology or fertility-sparing surgery. Loss of fertility may be caused by excisional surgery associated with an adnexal or uterine pathology or secondary to gonadal insufficiency caused by chemotherapy or radiation. The counseling of these patients is very important, being carried out jointly by the oncologist, gynecologist, and reproductive medicine specialist. Reproductive surgery usually requires avoiding laparotomy to significantly reduce the formation of adhesions and trauma or tissue damage. This is done using standard laparoscopic surgery or robotic surgery (computer-assisted laparoscopy), a method increasingly used and accessible to all specialists who want to maintain the fertility of their patients with various oncological diseases.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
- Department of Obstetrics Gynecology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Rebeca Crețoiu
- Department of Pituitary and Neuroendocrine Disorders, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Irina Bălescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | - Nicolae Bacalbașa
- Department of Visceral Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Monica Cîrstoiu
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Romania
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Nogueira D, Fajau-Prevot C, Clouet M, Assouline P, Deslandres M, Montagut M. Outcomes of Different In Vitro Maturation Procedures for Oocyte Cryopreservation for Fertility Preservation and yet Another Live Birth in a Cancer Patient. Life (Basel) 2023; 13:1355. [PMID: 37374137 DOI: 10.3390/life13061355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
To ensure patient care in an oncological fertility preservation (FP) programme, specialists must provide technology that best suits the patients' clinical conditions. In vitro oocyte maturation (IVM) and ovarian tissue cryopreservation (OTC) are possible fertility preservation treatments for women in need of urgent oncological treatment. IVM consists of the retrieval of immature oocytes from small antral follicles, with no or minimal ovarian stimulation by gonadotropins. Therefore, IVM has become a pertinent option for fertility preservation, especially for cases whereby ovarian stimulation is unfeasible or contra-indicated. Existing data on immature oocytes, retrieved transvaginally (OPU-IVM) or extracted from ovarian tissue 'ex vivo' (OTO-IVM), are still limited on technical consistency, efficacy, and safety. The present retrospective cohort study includes 89 women undergoing fertility preservation using IVM methodologies and 26 women undergoing ovarian stimulation (OS) in concomitant period. In total, 533 immature oocytes were collected from IVM patients, achieving a maturation rate of 57% and 70% in OTO-IVM and 73% and 82% in OPU-IVM at 24 h and 48 h in culture, respectively. The observed high maturation rates might be due to the use of patients' serum in its innate status, i.e., without heat-inactivation. This permitted 7.6 ± 5.7 and 4.6 ± 4.9 oocytes to be vitrified in OTO-IVM and OPU-IVM, respectively, compared to 6.8 ± 4.6 from OS patients. Regarding OS patients, two of them underwent embryo transfer following the insemination of warmed oocytes after complete remission, resulting in a single live birth from one patient. Upon follow-up of two OTO-IVM patients after the termination of their oncological treatment, a total of 11 warmed oocytes lead to a transfer of a single embryo, but pregnancy was not achieved. From OPU-IVM, six embryos were transferred in three patients 4.25 years after oocyte vitrification, leading to the live birth of a healthy boy. The present case of live birth is among the first cases reported so far and supports the notion that IVM might be a relevant and safe FP option for cancer patients when oocyte preservation is required but ovarian stimulation is contra-indicated.
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Affiliation(s)
- Daniela Nogueira
- Fertility Institute La Croix du Sud-INOVIE Fertilité, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
- ART Fertility Clinics, Abu Dhabi P.O. Box 60202, United Arab Emirates
| | - Carole Fajau-Prevot
- Department of Gynecology, Clinique La Croix du Sud, 54 Chemin de Ribaute, 31130 Toulouse, France
| | - Muriel Clouet
- Department of Gynecology, Clinique La Croix du Sud, 54 Chemin de Ribaute, 31130 Toulouse, France
| | - Patrick Assouline
- Department of Obstetrics and Gynecology, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
| | - Marion Deslandres
- Department of Gynecology, Institut Universitaire du Cancer de Toulouse, 1 Av. Irène Joliot-Curie, 31100 Toulouse, France
| | - Marie Montagut
- Fertility Institute La Croix du Sud-INOVIE Fertilité, Clinique La Croix du Sud, 52 Chemin de Ribaute, 31130 Toulouse, France
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11
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Sellami I, Beau I, Sonigo C. Chemotherapy and female fertility. ANNALES D'ENDOCRINOLOGIE 2023; 84:382-387. [PMID: 36967045 DOI: 10.1016/j.ando.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Chemotherapy to treat cancer is usually responsible for early ovarian follicle depletion. Ovarian damage induced by cancer treatments frequently results in infertility in surviving patients of childbearing age. Several fertility preservation techniques have been developed. Nowadays, oocyte or embryo cryopreservation with or without ovarian stimulation and cryopreservation of the ovarian cortex are the most commonly used. However, these methods may be difficult to implement in some situations, and subsequent use of the cryopreserved germ cells remains uncertain, with no guarantee of pregnancy. Improved knowledge of the molecular mechanisms and signaling pathways involved in chemotherapy-induced ovarian damage is therefore necessary, to develop new strategies for fertility preservation. The effects of various chemotherapies have been studied in animal models or in vitro on ovarian cultures, suggesting various mechanisms of gonadotoxicity. Today the challenge is to develop molecules and techniques to limit the negative impact of chemotherapy on the ovaries, using experimental models, especially in animals. In this review, the various theories concerning ovarian damage induced by chemotherapy will be reviewed and emerging approaches for ovarian protection will be explained.
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Affiliation(s)
- Ines Sellami
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance publique Hôpitaux de Paris, Antoine Beclere Hospital, 92140, Clamart, France; Université Paris Saclay, Inserm, physiologie et physiopathologie endocrinienne, 94276, Le Kremlin-Bicêtre, France
| | - Isabelle Beau
- Université Paris Saclay, Inserm, physiologie et physiopathologie endocrinienne, 94276, Le Kremlin-Bicêtre, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance publique Hôpitaux de Paris, Antoine Beclere Hospital, 92140, Clamart, France; Université Paris Saclay, Inserm, physiologie et physiopathologie endocrinienne, 94276, Le Kremlin-Bicêtre, France.
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12
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Fraison E, Huberlant S, Labrune E, Cavalieri M, Montagut M, Brugnon F, Courbiere B. Live birth rate after female fertility preservation for cancer or haematopoietic stem cell transplantation: a systematic review and meta-analysis of the three main techniques; embryo, oocyte and ovarian tissue cryopreservation. Hum Reprod 2023; 38:489-502. [PMID: 36421038 PMCID: PMC9977128 DOI: 10.1093/humrep/deac249] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/21/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION What are the chances of achieving a live birth after embryo, oocyte and ovarian tissue cryopreservation (OTC) in female cancer survivors? SUMMARY ANSWER The live birth rates (LBRs) following embryo and oocyte cryopreservation are 41% and 32%, respectively, while for IVF and spontaneous LBR after tissue cryopreservation and transplantation, these rates are 21% and 33%, respectively. WHAT IS KNOWN ALREADY Currently, fertility preservation (FP) has become a major public health issue as diagnostic and therapeutic progress has made it possible to achieve an 80% survival rate in children, adolescents and young adults with cancer. In the latest ESHRE guidelines, only oocyte and embryo cryopreservation are considered as established options for FP. OTC is still considered to be an innovative method, while it is an acceptable FP technique in the American Society for Reproductive Medicine guidelines. However, given the lack of studies on long-term outcomes after FP, it is still unclear which technique offers the best chance to achieve a live birth. STUDY DESIGN, SIZE, DURATION We performed a systematic review and meta-analysis of published controlled studies. Searches were conducted from January 2004 to May 2021 in Medline, Embase and the Cochrane Library using the following search terms: cancer, stem cell transplantation, FP, embryo cryopreservation, oocyte vitrification, OTC and reproductive outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 126 full-text articles were preselected from 1436 references based on the title and abstract and assessed via the Newcastle-Ottawa Quality Assessment Scale. The studies were selected, and their data were extracted by two independent reviewers according to the Cochrane methods. A fixed-effect meta-analysis was performed for outcomes with high heterogeneity. MAIN RESULTS AND THE ROLE OF CHANCE Data from 34 studies were used for this meta-analysis. Regarding cryopreserved embryos, the LBR after IVF was 41% (95% CI: 34-48, I2: 0%, fixed effect). Concerning vitrified oocytes, the LBR was 32% (95% CI: 26-39, I2: 0%, fixed effect). Finally, the LBR after IVF and the spontaneous LBR after ovarian tissue transplantation were 21% (95% CI: 15-26, I2: 0%, fixed-effect) and 33% (95% CI: 25-42, I2: 46.1%, random-effect), respectively. For all outcomes, in the sensitivity analyses, the maximum variation in the estimated percentage was 1%. LIMITATIONS, REASONS FOR CAUTION The heterogeneity of the literature prevents us from comparing these three techniques. This meta-analysis provides limited data which may help clinicians when counselling patients. WIDER IMPLICATIONS OF THE FINDINGS This study highlights the need for long-term follow-up registries to assess return rates, as well as spontaneous pregnancy rates and birth rates after FP. STUDY FUNDING/COMPETING INTEREST(S) This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare. REGISTRATION NUMBER CRD42021264042.
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Affiliation(s)
- E Fraison
- Service de Médecine de la Reproduction, Hospices Civils de Lyon, Hôpital Mère Enfant, Bron, France.,Université Claude Bernard, Faculté de Médecine Laennec, Lyon, France.,INSERM Unité 1208, Bron, France
| | - S Huberlant
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU Carémeau, Nîmes, France.,Université de Montpellier-Nîmes, Nîmes Cedex 2, France
| | - E Labrune
- Service de Médecine de la Reproduction, Hospices Civils de Lyon, Hôpital Mère Enfant, Bron, France.,Université Claude Bernard, Faculté de Médecine Laennec, Lyon, France.,INSERM Unité 1208, Bron, France
| | - M Cavalieri
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU François Mitterrand, Dijon, France
| | - M Montagut
- Service de Médecine de la Reproduction, Clinique Croix du Sud, Quint-Fonsegrives, France
| | - F Brugnon
- Assistance Médicale à la Procréation, CECOS, CHU Clermont Ferrand, CHU Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, IMoST, INSERM 1240, Faculté de Médecine, Clermont-Ferrand, France
| | - B Courbiere
- Service d'Assistance Médicale à la Procréation, Plateforme Cancer & Fertilité OncoPACA-Corse, AP-HM, Hôpital La Conception, Marseille, France.,Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, Marseille, France
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13
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Sellami I, Mayeur A, Benoit A, Zeghari F, Peigné M, Roufael J, Grynberg M, Sonigo C. Oocyte vitrification for fertility preservation following COS does not delay the initiation of neoadjuvant chemotherapy for breast cancer compared to IVM. J Assist Reprod Genet 2023; 40:473-480. [PMID: 36752941 PMCID: PMC10033766 DOI: 10.1007/s10815-023-02739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The objective of the present study was to evaluate whether oocyte vitrification following controlled ovarian stimulation (COS) for fertility preservation (FP) delays the initiation of neoadjuvant chemotherapy (NAC) for breast cancer (BC) as compared to in vitro maturation (IVM). METHODS We performed a retrospective cohort study including all BC patients eligible for oocyte vitrification following COS or in vitro maturation (IVM) before initiation of NAC between January 2016 and December 2020. The inclusion criteria were female patients aged between 18 and 40, with confirmed non metastatic BC, with indication of NAC, who have had oocyte retrieval for FP after COS, or IVM + / - cryopreservation of ovarian tissue (OTC). Various time points related to cancer diagnosis, FP, or chemotherapy were obtained from a medical record review. RESULTS A total of 197 patients with confirmed BC who had oocyte retrieval following COS (n = 57) or IVM + / - OTC (n = 140) for FP prior to NAC were included. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COS or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36. 8 ± 13.5 days; p = 0.89). CONCLUSIONS The indication of NAC for BC should not be considered as an impediment to urgent COS for oocyte vitrification for FP.
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Affiliation(s)
- Ines Sellami
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France.
| | - Anne Mayeur
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital, AP-HP, Paris Saclay University, 92140, Clamart, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France
| | - Fayçal Zeghari
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France
| | - Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, APHP, 93140, Bondy, France
- University Paris XIII, 93000, Bobigny, France
| | - Jad Roufael
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France
| | - Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France
- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, APHP, 93140, Bondy, France
- University Paris XIII, 93000, Bobigny, France
- BFA-Unite de Biologie Fonctionnelle Et Adaptative, UMR 8251, CNRS, ERL U1133 Inserm, Universite de Paris, Paris, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, 92140, Clamart, France
- Inserm U1185, Physiologie Et Physiopathologie Endocrinienne, Université Paris Saclay, 94276, Le Kremlin-Bicêtre, France
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Sonigo C, Amsellem N, Mayeur A, Laup L, Pistilli B, Delaloge S, Eustache F, Sifer C, Rakrouki S, Benoit A, Peigné M, Grynberg M. Disease-free survival does not differ according to fertility preservation technique for young women with breast cancer. Fertil Steril 2023; 119:465-473. [PMID: 36473609 DOI: 10.1016/j.fertnstert.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To study whether fertility preservation strategies using ovarian stimulation or without using it impact long-term disease-free survival of patients with breast cancer. DESIGN Retrospective bicentric cohort study. SETTING Two university hospitals. PATIENT(S) In this study, 740 women with breast cancer, aged 18-43 years, who received primary fertility preservation between 2013 and 2019 after a diagnosis of localized breast cancer were included. INTERVENTION(S) Overall, 328 patients underwent at least 1 ovarian stimulation cycle (STIM group) and 412 had a technique without hormonal administration (no STIM group). MAIN OUTCOME MEASURE(S) Disease-free survival and overall survival up to May 2021 were compared between the 2 groups by log-rank test. Cox proportional-hazard regression model was used for multivariable analyses. RESULT(S) Out of the 740 women who underwent fertility preservation, follow-up data were available for 269 women in the STIM group (82%) and 330 (80%) in the no STIM group. Kaplan-Meier estimates of disease-free survival at 4 years were 87.9% (82.8%-92.2%) and 83.1% (78.4%-87.3%) in the STIM and no STIM groups, respectively. After adjustment on prognostic parameters, no significant difference in breast cancer recurrence rate was observed between the STIM and no STIM groups (hazard ratios, 0.83 [0.64-1.08]). Kaplan-Meier estimate of overall survival at 4 years was 97.6% (95.3%-99.2%) and 93.6% (90.9%-95.9%) in the STIM and no STIM groups, respectively. Overall survival was higher in the STIM group than no STIM group (log-rank test). After adjustment on prognostic parameters, the risk of death remained significantly lower in the STIM group (Hazard Ratio, 0.55 [0.35-0.85]). CONCLUSION(S) In our cohort, STIM for fertility preservation in breast cancer did not significantly impact disease-free survival but was associated with higher overall survival. The disease-free survival and overall survival of young patients with breast cancer were not impacted by fertility preservation techniques irrespective of the timing of chemotherapy (neoadjuvant or adjuvant) and the use of ovarian stimulation. Nevertheless, because death and recurrence were rare events, these results should be taken with caution.
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Affiliation(s)
- Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France; Universite Paris-Saclay, Inserm, Physiologie et physiopathologie endocrinienne, Le Kremlin-Bicetre, France.
| | - Noémi Amsellem
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Anne Mayeur
- Histology-Embryology-Cytogenetic Laboratory, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Laetitia Laup
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Barbara Pistilli
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Florence Eustache
- Department of Biology of Reproduction and CECOS, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Christophe Sifer
- Department of Biology of Reproduction and CECOS, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Sophia Rakrouki
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France; Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
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15
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16
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Dolmans MM, Hossay C, Nguyen TYT, Poirot C. Fertility Preservation: How to Preserve Ovarian Function in Children, Adolescents and Adults. J Clin Med 2021; 10:jcm10225247. [PMID: 34830528 PMCID: PMC8621487 DOI: 10.3390/jcm10225247] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 01/15/2023] Open
Abstract
Chemotherapy, pelvic radiotherapy and ovarian surgery have known gonadotoxic effects that can lead to endocrine dysfunction, cessation of ovarian endocrine activity and early depletion of the ovarian reserve, causing a risk for future fertility problems, even in children. Important determinants of this risk are the patient’s age and ovarian reserve, type of treatment and dose. When the risk of premature ovarian insufficiency is high, fertility preservation strategies must be offered to the patient. Furthermore, fertility preservation may sometimes be needed in conditions other than cancer, such as in non-malignant diseases or in patients seeking fertility preservation for personal reasons. Oocyte and/or embryo vitrification and ovarian tissue cryopreservation are the two methods currently endorsed by the American Society for Reproductive Medicine, yielding encouraging results in terms of pregnancy and live birth rates. The choice of one technique above the other depends mostly on the age and pubertal status of the patient, and personal and medical circumstances. This review focuses on the available fertility preservation techniques, their appropriateness according to patient age and their efficacy in terms of pregnancy and live birth rates.
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Affiliation(s)
- Marie-Madeleine Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Av. Mounier 52, 1200 Brussels, Belgium; (C.H.); (T.Y.T.N.)
- Department of Gynecology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200 Brussels, Belgium
- Correspondence:
| | - Camille Hossay
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Av. Mounier 52, 1200 Brussels, Belgium; (C.H.); (T.Y.T.N.)
| | - Thu Yen Thi Nguyen
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Av. Mounier 52, 1200 Brussels, Belgium; (C.H.); (T.Y.T.N.)
| | - Catherine Poirot
- Department of Hematology, AYA Unit, Saint Louis Hospital AP-HP, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Médecine Sorbonne Université, Site Pitié Salpêtrière, 91 Bd de l’Hôpital, 75013 Paris, France
- Department of Reproductive Biology, Cochin Hospital AP-HP, 123 Bd de Port Royal, 75014 Paris, France
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Coker Appiah L, Fei YF, Olsen M, Lindheim SR, Puccetti DM. Disparities in Female Pediatric, Adolescent and Young Adult Oncofertility: A Needs Assessment. Cancers (Basel) 2021; 13:5419. [PMID: 34771582 PMCID: PMC8582476 DOI: 10.3390/cancers13215419] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Advancements in cancer screening and implementation of targeted treatments have significantly improved survival rates to 85% for pediatric and AYA survivors. Greater than 75% of survivors will live to experience the long-term adverse outcomes of cancer therapies, termed late effects (LE), that disrupt quality of life (QoL). Infertility and poor reproductive outcomes are significant disruptors of QoL in survivorship, affecting 12-88% of survivors who receive at-risk therapies. To mitigate risk, fertility preservation (FP) counseling is recommended as standard of care prior to gonadotoxic therapy. However, disparities in FP counseling, implementation of FP interventions, and screening for gynecologic late effects in survivorship persist. Barriers to care include a lack of provider and patient knowledge of the safety and breadth of current FP options, misconceptions about the duration of time required to implement FP therapies, cost, and health care team bias. Developing strategies to address barriers and implement established guidelines are necessary to ensure equity and improve quality of care across populations.
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Affiliation(s)
- Leslie Coker Appiah
- Division of Academic Specialists in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Denver, CO 80045, USA
- Pediatric and Adolescent Gynecology, Children’s Hospital Colorado, Denver, CO 80045, USA
| | - Yueyang Frances Fei
- Pediatric and Adolescent Gynecology, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Mallery Olsen
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
| | - Steven R. Lindheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wright State University, Dayton, OH 45409, USA;
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Diane M. Puccetti
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
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18
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Kim S, Lee S, Park HT, Song JY, Kim T. Genomic Consideration in Chemotherapy-Induced Ovarian Damage and Fertility Preservation. Genes (Basel) 2021; 12:1525. [PMID: 34680919 PMCID: PMC8535252 DOI: 10.3390/genes12101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy-induced ovarian damage and fertility preservation in young patients with cancer are emerging disciplines. The mechanism of treatment-related gonadal damage provides important information for targeting prevention methods. The genomic aspects of ovarian damage after chemotherapy are not fully understood. Several studies have demonstrated that gene alterations related to follicular apoptosis or accelerated follicle activation are related to ovarian insufficiency and susceptibility to ovarian damage following chemotherapy. This may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions after chemotherapy. This review highlights the importance of genomic considerations in chemotherapy-induced ovarian damage and multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.
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Affiliation(s)
- Seongmin Kim
- Gynecologic Cancer Center, CHA Ilsan Medical Center, CHA University College of Medicine, 1205 Jungang-ro, Ilsandong-gu, Goyang-si 10414, Korea;
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Hyun-Tae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Jae-Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
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19
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Kim S, Kim SW, Han SJ, Lee S, Park HT, Song JY, Kim T. Molecular Mechanism and Prevention Strategy of Chemotherapy- and Radiotherapy-Induced Ovarian Damage. Int J Mol Sci 2021; 22:ijms22147484. [PMID: 34299104 PMCID: PMC8305189 DOI: 10.3390/ijms22147484] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Fertility preservation is an emerging discipline, which is of substantial clinical value in the care of young patients with cancer. Chemotherapy and radiation may induce ovarian damage in prepubertal girls and young women. Although many studies have explored the mechanisms implicated in ovarian toxicity during cancer treatment, its molecular pathophysiology is not fully understood. Chemotherapy may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions. Oxidative stress and the radiosensitivity of oocytes are the main causes of gonadal damage after radiation treatment. Fertility preservation options can be differentiated by patient age, desire for conception, treatment regimen, socioeconomic status, and treatment duration. This review will help highlight the importance of multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.
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Affiliation(s)
- Seongmin Kim
- Gynecologic Cancer Center, CHA Ilsan Medical Center, CHA University College of Medicine, 1205 Jungang-ro, Ilsandong-gu, Goyang-si 10414, Korea;
| | - Sung-Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Soo-Jin Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
- Correspondence: ; Tel.: +82-2-920-6773
| | - Hyun-Tae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Jae-Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
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