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Sonmezer M, Sükür YE, Saçinti KG, Ozkavukcu S, Kankaya D, Seval GC, Atabekoglu CS, Oktay K. IS IT SAFE TO PERFORM OVARIAN CRYOPRESERVATION AND TRANSPLANTATION IN PATIENTS WITH LEUKEMIA A 5-YEAR SURVIVAL ANALYSIS DATA. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lafuente SG, Turan V, Oktay K. OOCYTE CRYOPRESERVATION WITH IN VITRO MATURATION, A FEASIBLE OPTION FOR FERTILITY PRESERVATION IN ADOLESCENTS WITH MOSAIC TURNER SYNDROME. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arkfeld C, Gayete-Lafuente S, Turan V, Oktay K. P-477 Ovarian stimulation and PGT-A outcomes with random start letrozole protocol for fertility preservation in breast cancer patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Data on random start letrozole ovarian stimulation (RSL) in breast cancer patients is scant. We studied RSL outcomes from a single-center with fertility preservation expertise.
Summary answer
RSL appears to result in high oocyte and embryo/blastocyst yield, with an age-appropriate aneuploidy rate.
What is known already
With increasing utility of neoadjuvant chemotherapy regimens in breast cancer, young women have limited time to undergo fertility preservation (FP) by oocyte or embryo cryopreservation. Random start stimulation protocols were developed to complete an ovarian stimulation cycle in the shortest time possible before cancer patients started chemotherapy. In addition, letrozole protocols were developed to mitigate the potential risks of high estrogen levels during ovarian stimulation in breast cancer patients. Even though both random start and letrozole supplemented ovarian stimulation have been studied individually, there is limited data on combining both strategies in random start letrozole (RSL) protocols.
Study design, size, duration
We reviewed our records from 2014 to 2021. We included the first FP cycle of all breast cancer patients undergoing RSL ovarian stimulation for oocyte or embryo cryopreservation. Cancer stages were grouped as 0-4, 0 being ductal carcinoma in situ (DCIS). Twenty-eight cycles met the criteria. Main outcome measures were number of oocytes retrieved and embryos cryopreserved. Secondary outcome measures were fertilization, blastocyst, and euploidy rates for the embryo cryopreservation group.
Participants/materials, setting, methods
Ovarian stimulation began on cycle days 3-26 with letrozole 5 mg/day initiated simultaneously with rFSH. The rFSH dose was based on age and antral follicle counts (AFC). Oocyte maturation was triggered with leuprolide acetate, rhCG or both 35h prior to retrieval.
Main results and the role of chance
The mean age was 33.5±4.9 years (range 26-40) and BMI 22.3±2.9(18.4-30.3). The mean breast cancer stage at FP was 1.7±0.9 (0-4), with 42.3% being stage-I disease. 77% of cases were estrogen receptor positive. AMH was 2.7±2.4 (0.16-7.9) and AFC 18.5±8.9(4-42). Ovarian stimulation began on cycle-day 13.7±7.3(2-26). 15(54%) cycles were started in the follicular and 13(46%) in the luteal-phase. The mean total rFSH dose was 3880±1615.4 IU(1275-8325) with a stimulation length of 11.8±2.4 days(8-19).
Mean oocytes retrieved were 16.4±6.9(1-36) with a maturity rate of 71.4±17.9%(35.7-94.4). From 13 patients, 10.4±4.7(1-22) oocytes were cryopreserved. Among the 15 patients proceeding to embryo cryopreservation, the fertilization rate was 96.9±6.8%(80-100), resulting in 7.1±4.4(1-15) embryos. 24 embryos were cryopreserved on day-3 and 82 as blastocysts. PGT-A was performed in 72% of the cases, with euploidy rate of 37.7±24.4%(0-63.6). There was no difference in oocyte or embryo yield between follicular and luteal start patients. Likewise, fertilization rates and euploidy rates were similar. The comparative results are summarized in Table 1.
To date, two patients conceived utilizing cryopreserved embryos. Both pregnancies resulted in healthy term babies.
Limitations, reasons for caution
Though our report is one of the largest series of RSL, it can be strengthened with longer follow up that includes pregnancy outcomes in a greater proportion of patients.
Wider implications of the findings
This is the first detailed report of the RSL protocol utility with PGT-A results in a breast-cancer population. RSL appears to result in high oocyte-yield, fertilization, and blastocyst formation rates, with age-appropriate euploidy. Additionally, the outcomes appear to be similar between patients undergoing follicular and luteal phase start RSL.
Trial registration number
not applicable
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Affiliation(s)
- C Arkfeld
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
| | - S Gayete-Lafuente
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
| | - V Turan
- Istanbul Health and Technology University School of Medicine, Obstetrics and Gynecology , Istanbul, Turkey
| | - K Oktay
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
- Innovation Fertility Preservation and IVF, Reproductive Endocrinology and Infertility , New York, U.S.A
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Oktay K, Marin L, Bedoschi G, Pacheco F, Sugishita Y, Kawahara T, Taylan E, Acosta C, Bang H. Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data. Fertil Steril 2022; 117:181-192. [PMID: 34801235 PMCID: PMC8863399 DOI: 10.1016/j.fertnstert.2021.08.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold. DESIGN Case series with meta-analytic update. SETTING Academic. PATIENT(S) Seven recipients of RA-ACOTT. INTERVENTION(S) Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7-12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case. MAIN OUTCOME MEASURE(S) Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data. RESULT(S) Ovarian function returned 13.9 ± 2.7 weeks (11-16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation. CONCLUSION(S) In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.
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Affiliation(s)
- Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA,Innovation Institute for Fertility Preservation, New York, NY 10028, USA
| | - Loris Marin
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA,Department of Women’s and Children’s Health, University of Padua, Padua, PD 35100, Italy
| | - Giuliano Bedoschi
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA,Division of Reproductive Medicine, Department of Gynecology & Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
| | - Fernanda Pacheco
- Innovation Institute for Fertility Preservation, New York, NY 10028, USA,Classiclínica, Porto Alegre, Rio Grande do Sul, 90000-000, Brazil
| | - Yodo Sugishita
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA,St Marianna University, Yokohama, Japan
| | - Tai Kawahara
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA,St Marianna University, Yokohama, Japan
| | - Enes Taylan
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Carlo Acosta
- Innovation Institute for Fertility Preservation, New York, NY 10028, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
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Sugishita Y, Taylan E, Kawahara T, Shahmurzada B, Suzuki N, Oktay K. Comparison of open and a novel closed vitrification system with slow freezing for human ovarian tissue cryopreservation. J Assist Reprod Genet 2021; 38:2723-2733. [PMID: 34398400 DOI: 10.1007/s10815-021-02297-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/03/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate the differences concerning post-thawing/warming follicle survival, DNA damage and apoptosis in human ovarian tissues cryopreserved by slow freezing, open, or closed vitrification methods. METHODS A total of 50 pieces of 5 × 5 × 1 mm ovarian cortical pieces were harvested (5 donor ovaries; mean age 31 ± 6.62 years). From each donor, one cortical piece was used as baseline; the remaining were randomly assigned to slow freezing (SF), vitrification using open device (VF-open), or closed device (VF-closed) groups. After 8-10 weeks of cryostorage, tissues were evaluated 4 h after thawing/warming. Histological analysis was evaluated for follicle survival (primordial and primary follicle densities) by H&E staining. The percentages of primordial and primary follicles with DNA double-strand breaks (γH2AX) and apoptotic cell death pathway activation (AC3) were immunohistochemically assessed. Data were analysed using one-way ANOVA and LSD post hoc comparison. RESULTS Compared to the baseline, primordial follicle (pdf) densities significantly declined in all cryopreserved groups (SF, VF-open, and VF-closed, P < 0.05). However, the total and non-apoptotic pdf densities were similar among SF, VF-open, and VF-closed. SF and VF with either open or closed devices did not increase the percentages of primordial or primary follicles with DNA double-strand breaks (DSBs) or apoptosis compared to the baseline or among the freezing methods in the present study. CONCLUSION Based on the intact primordial follicle survival, DNA damage, and apoptosis rates after thawing/warming, SF vs VF with either open or newly developed closed devices appear to be comparable.
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Affiliation(s)
- Yodo Sugishita
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB 224, New Haven, CT, 06520, USA
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Frontier Medicine, Institute of Medical Science, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Enes Taylan
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB 224, New Haven, CT, 06520, USA
| | - Tai Kawahara
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB 224, New Haven, CT, 06520, USA
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Bunyad Shahmurzada
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB 224, New Haven, CT, 06520, USA
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB 224, New Haven, CT, 06520, USA.
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Szymanska KJ, Tan X, Oktay K. Unraveling the mechanisms of chemotherapy-induced damage to human primordial follicle reserve: road to developing therapeutics for fertility preservation and reversing ovarian aging. Mol Hum Reprod 2021; 26:553-566. [PMID: 32514568 DOI: 10.1093/molehr/gaaa043] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Among the investigated mechanisms of chemotherapy-induced damage to human primordial follicle reserve are induction of DNA double-strand breaks (DSBs) and resultant apoptotic death, stromal-microvascular damage and follicle activation. Accumulating basic and translational evidence suggests that acute exposure to gonadotoxic chemotherapeutics, such as cyclophosphamide or doxorubicin, induces DNA DSBs and triggers apoptotic death of primordial follicle oocytes within 12-24 h, resulting in the massive loss of ovarian reserve. Evidence also indicates that chemotherapeutic agents can cause microvascular and stromal damage, induce hypoxia and indirectly affect ovarian reserve. While it is possible that the acute reduction of the primordial follicle reserve by massive apoptotic losses may result in delayed activation of some primordial follicles, this is unlikely to be a predominant mechanism of loss in humans. Here, we review these mechanisms of chemotherapy-induced ovarian reserve depletion and the potential reasons for the discrepancies among the studies. Based on the current literature, we propose an integrated hypothesis that explains both the acute and delayed chemotherapy-induced loss of primordial follicle reserve in the human ovary.
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Affiliation(s)
- Katarzyna J Szymanska
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Xiujuan Tan
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Turan V, Lambertini M, Lee DY, Wang E, Clatot F, Karlan BY, Demeestere I, Bang H, Oktay K. Association of Germline BRCA Pathogenic Variants With Diminished Ovarian Reserve: A Meta-Analysis of Individual Patient-Level Data. J Clin Oncol 2021; 39:2016-2024. [PMID: 33891474 PMCID: PMC8260903 DOI: 10.1200/jco.20.02880] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether germline BRCA (gBRCA) pathogenic variants are associated with decreased ovarian reserve. MATERIALS AND METHODS An individual patient-level data meta-analysis was performed using five data sets on 828 evaluable women who were tested for gBRCA. Of those, 250 carried gBRCA, whereas 578 had tested negative and served as controls. Of the women with gBRCA, four centers studied those affected with breast cancer (n = 161) and one studied unaffected individuals (n = 89). The data were adjusted for the center, age, body mass index, smoking, and oral contraceptive pill use before the final analysis. Anti-Müllerian hormone (AMH) levels in affected women were drawn before presystemic therapy. RESULTS The mean age of women with versus without gBRCA1/2 (34.1 ± 4.9 v 34.3 ± 4.8 years; P = .48) and with gBRCA1 versus gBRCA2 (33.7 ± 4.9 v 34.6 ± 4.8 years; P = .16) was similar. After the adjustments, women with gBRCA1/2 had significantly lower AMH levels compared with controls (23% lower; 95% CI, 4 to 38; P = .02). When the adjusted analysis was limited to affected women (157 with gBRCA v 524 without, after exclusions), the difference persisted (25% lower; 95% CI, 9 to 38; P = .003). The serum AMH levels were lower in women with gBRCA1 (33% lower; 95% CI, 12 to 49; P = .004) but not gBRCA2 compared with controls (7% lower; 95% CI, 31% lower to 26% higher; P = .64). CONCLUSION Young women with gBRCA pathogenic variants, particularly those affected and with gBRCA1, have lower serum AMH levels compared with controls. They may need to be preferentially counseled about the possibility of shortened reproductive lifespan because of diminished ovarian reserve.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
- Department of Obstetrics and Gynecology, Health and Technology University School of Medicine, Istanbul, Turkey
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Erica Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Florian Clatot
- Department of Medical Oncology, Henri Becquerel Centre, Rouen, France
| | - Beth Y. Karlan
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Isabelle Demeestere
- Fertility Clinic, Research Laboratory on Human Reproduction, CUB-Erasme, and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA
| | - Kutluk Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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Titus S, Szymanska KJ, Musul B, Turan V, Taylan E, Garcia-Milian R, Mehta S, Oktay K. Individual-oocyte transcriptomic analysis shows that genotoxic chemotherapy depletes human primordial follicle reserve in vivo by triggering proapoptotic pathways without growth activation. Sci Rep 2021; 11:407. [PMID: 33431979 PMCID: PMC7801500 DOI: 10.1038/s41598-020-79643-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Gonadotoxic chemotherapeutics, such as cyclophosphamide, can cause early menopause and infertility in women. Earlier histological studies showed ovarian reserve depletion via severe DNA damage and apoptosis, but others suggested activation of PI3K/PTEN/Akt pathway and follicle ‘burn-out’ as a cause. Using a human ovarian xenograft model, we performed single-cell RNA-sequencing on laser-captured individual primordial follicle oocytes 12 h after a single cyclophosphamide injection to determine the mechanisms of acute follicle loss after gonadotoxic chemotherapy. RNA-sequencing showed 190 differentially expressed genes between the cyclophosphamide- and vehicle-exposed oocytes. Ingenuity Pathway Analysis predicted a significant decrease in the expression of anti-apoptotic pro-Akt PECAM1 (p = 2.13E-09), IKBKE (p = 0.0001), and ANGPT1 (p = 0.003), and reduced activation of PI3K/PTEN/Akt after cyclophosphamide. The qRT-PCR and immunostaining confirmed that in primordial follicle oocytes, cyclophosphamide did not change the expressions of Akt (p = 0.9), rpS6 (p = 0.3), Foxo3a (p = 0.12) and anti-apoptotic Bcl2 (p = 0.17), nor affect their phosphorylation status. There was significantly increased DNA damage by γH2AX (p = 0.0002) and apoptosis by active-caspase-3 (p = 0.0001) staining in the primordial follicles and no change in the growing follicles 12 h after chemotherapy. These data support that the mechanism of acute follicle loss by cyclophosphamide is via apoptosis, rather than growth activation of primordial follicle oocytes in the human ovary.
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Affiliation(s)
- S Titus
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - K J Szymanska
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - B Musul
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - V Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - E Taylan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - R Garcia-Milian
- Bioinformatics Support Program, Yale School of Medicine, New Haven, CT, USA
| | - S Mehta
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - K Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
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Turan V, Oktay K. BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging. Hum Reprod Update 2020; 26:43-57. [PMID: 31822904 DOI: 10.1093/humupd/dmz043] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/26/2019] [Accepted: 11/05/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Oocyte aging has significant clinical consequences, and yet no treatment exists to address the age-related decline in oocyte quality. The lack of progress in the treatment of oocyte aging is due to the fact that the underlying molecular mechanisms are not sufficiently understood. BRCA1 and 2 are involved in homologous DNA recombination and play essential roles in ataxia telangiectasia mutated (ATM)-mediated DNA double-strand break (DSB) repair. A growing body of laboratory, translational and clinical evidence has emerged within the past decade indicating a role for BRCA function and ATM-mediated DNA DSB repair in ovarian aging. OBJECTIVE AND RATIONALE Although there are several competing or complementary theories, given the growing evidence tying BRCA function and ATM-mediated DNA DSB repair mechanisms in general to ovarian aging, we performed this review encompassing basic, translational and clinical work to assess the current state of knowledge on the topic. A clear understanding of the mechanisms underlying oocyte aging may result in targeted treatments to preserve ovarian reserve and improve oocyte quality. SEARCH METHODS We searched for published articles in the PubMed database containing key words, BRCA, BRCA1, BRCA2, Mutations, Fertility, Ovarian Reserve, Infertility, Mechanisms of Ovarian Aging, Oocyte or Oocyte DNA Repair, in the English-language literature until May 2019. We did not include abstracts or conference proceedings, with the exception of our own. OUTCOMES Laboratory studies provided robust and reproducible evidence that BRCA1 function and ATM-mediated DNA DSB repair, in general, weakens with age in oocytes of multiple species including human. In both women with BRCA mutations and BRCA-mutant mice, primordial follicle numbers are reduced and there is accelerated accumulation of DNA DSBs in oocytes. In general, women with BRCA1 mutations have lower ovarian reserves and experience earlier menopause. Laboratory evidence also supports critical role for BRCA1 and other ATM-mediated DNA DSB repair pathway members in meiotic function. When laboratory, translational and clinical evidence is considered together, BRCA-related ATM-mediated DNA DSB repair function emerges as a likely regulator of ovarian aging. Moreover, DNA damage and repair appear to be key features in chemotherapy-induced ovarian aging. WIDER IMPLICATIONS The existing data suggest that the BRCA-related ATM-mediated DNA repair pathway is a strong candidate to be a regulator of oocyte aging, and the age-related decline of this pathway likely impairs oocyte health. This knowledge may create an opportunity to develop targeted treatments to reverse or prevent physiological or chemotherapy-induced oocyte aging. On the immediate practical side, women with BRCA or similar mutations may need to be specially counselled for fertility preservation.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology, Uskudar University School of Medicine, Istanbul, Turkey.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Kutluk Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Olguner SK, Celiktas M, Oktay K, Arslan A, Bilgin E, Gezercan Y, Okten AI, Gulsen M. Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain. Niger J Clin Pract 2020; 23:835-841. [PMID: 32525120 DOI: 10.4103/njcp.njcp_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. Results Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.
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Affiliation(s)
- S K Olguner
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - M Celiktas
- Department of Spine Surgery, Ortopedia Hospital, Adana, Turkey
| | - K Oktay
- Department of Neurosurgery, Gaziantep Medical Park Hospital, Adana, Turkey
| | - A Arslan
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - E Bilgin
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - Y Gezercan
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - A I Okten
- Department of Neurosurgery, Adana City Training Research Hospital, Adana, Turkey
| | - M Gulsen
- Department of Spine Surgery, Ortopedia Hospital, Adana, Turkey
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Abstract
e24059 Background: As societal shifts have led to more women delaying childbearing, a diagnosis of breast cancer is increasingly more likely to occur prior to the completion of family building. Therefore, understanding impact of chemo on future fertility is of the utmost importance. This study evaluates the trends in AMH over time in women receiving different chemo regimens for breast cancer. Methods: This is an IRB approved prospective study of 164 women, < 45 years old with non-metastatic breast cancer who were enrolled at time of diagnosis. Patients received chemo and had prospective serum AMH measured at baseline,12, 18 & 24 mos post-chemo. Of those, 99/164 completed 2-yr follow up. Pts were divided according to their chemotherapy regimen: ddAC-T, CMF and other (e.g. TH). Results: Mean age in ddAC-T (n = 118), CMF (n = 22) and other (n = 23) chemo groups were 37.1±4.6, 41.1±3.2 and 37.6±4.3 yrs, respectively (p = 0.001). AMH sharply declined between baseline & 12 mos post-chemo in all groups (p = 0.005). There was no difference in rate of decline between the groups, after adjusting for age. Age was an important predictor of AMH. Older age at study entry was associated with lower AMH with a decrease of 9% per life year (p = 0.0005). AMH recovered from 12 to 18 mos post-chemo in all groups. 18 mos after chemo, AMH recovery was observed in 61%, 59% & 65% in ddAC-T, CMF & other groups, respectively. In the ddAC-T arm there was a 1.9 fold increase in AMH while there was a 1.4 and 3.3 fold increase in the CMF and other arms, respectively. At 2-yrs post-chemo, AMH recovery rate reached 67%, 69% & 77% in ddAC-T, CMF & other groups, respectively. However, 12% in ddAC-T and 23% in CMF had undetectable AMH. Baseline AMH was 1.59 fold higher in pts whose AMH increased compared to those whose AMH decreased between 12 & 18 mos (p = 0.035). AMH recovery was associated with higher baseline AMH. Age, BMI & chemo type did not correlate with AMH recovery and tamoxifen treatment did not impact AMH recovery. Conclusions: Our data show that anthracycline plus taxane, taxane-based and CMF chemo regimens compromise ovarian reserve in breast cancer patients in similar fashion. As surviving ovarian follicles resume production of AMH, most of ovarian reserve recovery occurs by 18 mos post-chemo with some minor recovery from 18-24 mos. Baseline AMH level is the most important predictor of AMH recovery. Hence in women undergoing gonadotoxic chemo, ovarian reserve should be assessed by AMH before and 12 months after treatment to determine extent of damage. The novel information provided in this study is valuable for counseling cancer pts about fertility preservation. Clinical trial information: NCT00823654 .
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Affiliation(s)
| | | | | | | | - Nadia Abdo
- Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
An increasing number of women in modern societies are delaying childbearing beyond the age of 35, and gynecologic cancers affect a significant proportion of reproductive age women who wish to preserve fertility for a future chance of childbearing. As a result, providing treatment options for fertility preservation in women with gynecologic cancer has become a crucial component of cancer survivorship care. In this review article, we discussed the current knowledge on fertility-sparing surgical approaches, as well as assisted reproductive technologies that can be utilized to preserve reproductive potential in women with cervical, endometrial, and ovarian cancer. A brief section on fertility preservation in pediatric gynecologic malignancies is also provided.
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Affiliation(s)
- Enes Taylan
- Women's Cancer Program at Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA; Innovation Institute for Fertility Preservation and IVF, New York, NY, USA; Ovarian Transplantation Program, NYU Winthrop Hospital, Mineola, NY, USA
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Oktay K, Taylan E, Rodriguez-Wallberg KA, Bedoschi G, Turan V, Pacheco F. Goserelin does not preserve ovarian function against chemotherapy-induced damage. Ann Oncol 2019; 29:512-513. [PMID: 29112733 DOI: 10.1093/annonc/mdx695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- K Oktay
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, USA.
| | - E Taylan
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, USA
| | - K A Rodriguez-Wallberg
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - G Bedoschi
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - V Turan
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics and Gynecology, GOP Hospital, Yeni Yuzyil University School of Medicine, Istanbul, Turkey
| | - F Pacheco
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Classiclínica, Porto Alegre, Brazil
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Turan V, Quinn MM, Dayioglu N, Rosen MP, Oktay K. The impact of malignancy on response to ovarian stimulation for fertility preservation: a meta-analysis. Fertil Steril 2019; 110:1347-1355. [PMID: 30503134 DOI: 10.1016/j.fertnstert.2018.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/13/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the impact of cancer diagnosis on response to ovarian stimulation for fertility preservation. DESIGN Meta-analysis. SETTING Not applicable. PATIENT(S) An electronic-based search was performed with the use of PubMed until May 2018 limited to English-language articles. In the final analysis, 10 case-controlled retrospective cohort studies were included, comparing ovarian response to stimulation between women with cancer and age-matched healthy women (control group). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of total oocytes retrieved, number of mature oocytes, fertilization rate and two pronuclei embryos obtained. RESULT(S) Ten studies that included a total of 713 women with cancer were analyzed in the cancer group (722 cycles), and 1,830 healthy women (1,835 cycles) qualified as controls for the meta-analysis. The pooled results showed no impact of cancer diagnosis on the mean number of total oocytes (P=.517; 95% CI -0.23 to 0.12), mature oocytes (P=.104; 95% CI -0.23 to 0.01), and two pronuclei embryos (P=.136; 95% CI -0.32 to 0.04) and fertilization rates (P=.273; 95% CI -0.29 to 0.183). When the analysis was limited to women with breast cancer diagnosis, there was also no difference in the mean number of total oocytes (P=.812; 95% CI -0.28 to 0.36) and mature oocytes (P=.993; 95% CI -0.16 to 0.16) between the two groups. CONCLUSION(S) This meta-analysis indicates that cancer diagnosis is not associated with reduced response to ovarian stimulation.
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Affiliation(s)
- Volkan Turan
- Yeni Yuzyil University School of Medicine, Department of Obstetrics and Gynecology, Division Reproductive Endocrinology and Infertility, Istanbul, Turkey
| | - Molly M Quinn
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Nurten Dayioglu
- Yeni Yuzyil University School of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Mitchell P Rosen
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Kutluk Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Innovation Fertility Preservation and IVF, New York, New York.
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Bhasin S, Kerr C, Oktay K, Racowsky C. The Implications of Reproductive Aging for the Health, Vitality and Economic Welfare of Human Societies. J Clin Endocrinol Metab 2019; 104:3821-3825. [PMID: 30990518 DOI: 10.1210/jc.2019-00315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/10/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Powerful demographic transitions towards aging of human populations, older age at first childbirth, and lower birth-rates will profoundly influence the health, vitality, and economies of human societies, and deserve greater attention in health policy and research. EVIDENCE ACQUISITION Information on birth-rates, fertility rates, and outcomes of assisted reproductive technologies were obtained from databases of government agencies (census data, Centers for Disease Control). EVIDENCE SYNTHESIS Fecundity declines with advancing age, especially in women >35 and in men >50. Advanced parental age adversely affects pregnancy outcomes for the mother and the offspring, and increases the offspring's risk of chromosomal disorders, neurodegenerative diseases and birth defects. Because of increased life expectancy, today, men and women can expect to spend a major portion of their life during a period of reproductive senescence; diseases associated with reproductive senescence will influence the health and wellbeing of middle-aged and older adults. Inversion of the population age pyramid would affect healthcare costs, retirement age, generational distribution of wealth, and the vitality of human societies.Several actions can be taken to mitigate the societal consequences of these trends. An educational campaign to inform young people about the trade-offs associated with postponement of childbirth will enable them to make informed choices. Some repositioning of research agenda and healthcare policy is needed to address the public health threat posed by reproductive aging. CONCLUSION The societal consequences of low fertility rates and delayed parenthood on nation's health, vitality, and economic growth should be considered in crafting research, health and economic policy.
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Affiliation(s)
- Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Candace Kerr
- Program Director, Aging Physiology Branch, Division of Aging Biology, National Institute on Aging, Bethesda MD
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, Yale University, New Haven, CT
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Abstract PD6-06: Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The BRCA1/2 genes are key members of the ataxia-telangiectasia mutated (ATM)-mediated DNA double strand break (DSB) repair pathway. Recent research showed that germline mutations in these genes result in DNA repair deficiency in oocytes, leading to accelerated ovarian aging as manifested by lower ovarian reserve and earlier age at natural menopause. Because we discovered that oocyte DNA repair is similarly critical in chemotherapy-induced ovarian follicle loss, we hypothesized that women with pathogenic mutations in BRCA1/2 genes may experience larger declines in ovarian reserve after chemotherapy. To gauge the degree of the chemotherapy-induced ovarian damage, we utilized serum anti-mullerian hormone (AMH), which is the most reliable current marker for assessing oocyte reserve.
Methods: Women with early stage breast cancer were enrolled before chemotherapy (Trial registration number: NCT00823654) between January 2009 and November 2017. Sera were obtained at baseline, before the initiation of treatment, and 18 to 24 months after the completion of chemotherapy. Stored sera were assayed at once for anti-mullerian hormone (AMH) and the results were adjusted for the women's age at sample collection. Of the 235 enrolled, 117 evaluable women were stratified into three groups, those never tested (based on NCCN Guidelines V 1.2018 ; n=38) and those negative (n=65) or positive (n=14) for a pathogenic BRCA mutation. Ovarian recovery was defined as the geometric mean of the post chemotherapy age-adjusted AMH levels compared to baseline.
Results: Compared to the lower risk (BRCA-untested) control group, AMH levels averaged 76% and 66% in those negative or positive for BRCA mutations (p=0.078). The geometric mean recoveries for the three groups (not tested, BRCA negative and BRCA positive) were 3.7%, 5.2% and 1.6%, respectively. The mean recovery in the BRCA mutation positive group was about one-third the 4.6% recovery in the other two groups combined (two group ANOVA, p=0.034, F=4.89). Given the potential of the ovarian recovery to be dependent on type of chemotherapy, the data were reanalyzed for all three BRCA groups after restriction to those treated with the AC-T (doxorubicin and cyclophosphamide followed by paclitaxel) regimen. Of the 108 women in the previous analysis, 83 (77%) were treated with AC-T; 25, 46 and 12 women in the three groups, respectively. The geometric mean AMH recoveries for these new groups were 3.2%, 4.7% and 1.3%. When the BRCA mutation positive group was compared with other two groups, the former had significantly worse recovery of serum AMH levels (ANOVA, p=0.044, F=4.2).
Conclusions: These data show that women with breast cancer and pathogenic BRCA mutations have striking liability to chemotherapy-induced ovarian reserve loss and may have to be preferentially counselled on fertility preservation methods. In addition, taken together with the previous data showing that women with BRCA mutations may have accelerated ovarian aging, even unaffected reproductive age individuals may have to be proactive about family building or early preservation of their fertility (Supported by NIH R01HD053112).
Citation Format: Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-06.
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Affiliation(s)
- K Oktay
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - G Bedoschi
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - SB Goldfarb
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - E Taylan
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - S Titus
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - GE Palomaki
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - T Cigler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - M Robson
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - MN Dickler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
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Oktay K, Ozsoy KM, Dere UA, Cetinalp NE, Arslan M, Erman T, Guzel A. Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients. Niger J Clin Pract 2019; 22:1785-1789. [DOI: 10.4103/njcp.njcp_437_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Turan V, Bedoschi G, Rodriguez-Wallberg K, Sonmezer M, Pacheco FS, Oktem O, Taylor H, Oktay K. Utility of Gonadotropin-Releasing Hormone Agonists for Fertility Preservation: Lack of Biologic Basis and the Need to Prioritize Proven Methods. J Clin Oncol 2019; 37:84-86. [DOI: 10.1200/jco.18.00420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Volkan Turan
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Giuliano Bedoschi
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Kenny Rodriguez-Wallberg
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Murat Sonmezer
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Fernanda Silva Pacheco
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Ozgur Oktem
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Hugh Taylor
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Kutluk Oktay
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
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Oktay K, Harvey BE, Loren AW. Reply to M. von Wolff et al. J Clin Oncol 2018; 36:JCO1800717. [PMID: 30289733 DOI: 10.1200/jco.18.00717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; and Alison W. Loren, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Brittany E Harvey
- Kutluk Oktay, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; and Alison W. Loren, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Kutluk Oktay, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; and Alison W. Loren, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Oktay K, Bedoschi G, Goldfarb S, Titus S, Palomaki G, Dickler M. Increased chemotherapy-induced ovarian reserve loss in women with BRCA mutations: a prospective longitudinal study with mechanistic confirmation. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oktay K, Turan V, Palomaki G, Munne S, Sawarkar S, Escudero T. Comparison of embryo aneuploidy rates and patterns between brca mutation carriers and infertile women. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Taylan E, Sugishita Y, Kawahara T, Ursillo L, Oktay K. Feasibility and success of fertility preservation in children. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, Wallace WH, Wang ET, Loren AW. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2018; 36:1994-2001. [DOI: 10.1200/jco.2018.78.1914] [Citation(s) in RCA: 718] [Impact Index Per Article: 119.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose To provide current recommendations about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from January 2013 to March 2017 was completed using PubMed and the Cochrane Library. An Update Panel reviewed the identified publications. Results There were 61 publications identified and reviewed. None of these publications prompted a significant change in the 2013 recommendations. Recommendations Health care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible. Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm, oocyte, and embryo cryopreservation are considered standard practice and are widely available. There is conflicting evidence to recommend gonadotrophin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation. The Panel recognizes that, when proven fertility preservation methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. GnRHa should not be used in place of proven fertility preservation methods. The panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future. Additional information is available at www.asco.org/survivorship-guidelines .
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Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Brittany E. Harvey
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Ann H. Partridge
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Gwendolyn P. Quinn
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Joyce Reinecke
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Hugh S. Taylor
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - W. Hamish Wallace
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Erica T. Wang
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
| | - Alison W. Loren
- Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W
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Oktay K, Harvey BE, Loren AW. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update Summary. J Oncol Pract 2018; 14:381-385. [PMID: 29768110 DOI: 10.1200/jop.18.00160] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kutluk Oktay
- Yale University School of Medicine, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Brittany E Harvey
- Yale University School of Medicine, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Yale University School of Medicine, New Haven, CT; American Society of Clinical Oncology, Alexandria, VA; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
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Abstract
CONTEXT Recent clinical and laboratory studies suggested that women with BRCA mutations have lower ovarian reserve and their primordial follicle oocytes may be more prone to DNA damage; however, direct proof is lacking. OBJECTIVE To determine whether women with germline BRCA mutations have reduced primordial follicle reserve and increased oocyte DNA damage. DESIGN A comparative laboratory study of ovarian tissue obtained from unaffected BRCA mutation carriers (BMCs) vs age-matched organ donor cadavers. SETTING Two academic centers. PATIENTS OR OTHER PARTICIPANTS Of the 230 ovarian specimens from BMCs, 18 met the study inclusion criteria. Healthy ovaries from 12 organ donor cadavers served as controls. INTERVENTION Histology and immunohistochemical analysis on paraffin-embedded ovarian sections. MAIN OUTCOME MEASURE(S) Primordial follicle density and the percentage of DNA double-strand break (DSB)-positive primordial follicle oocytes. RESULTS Ovaries from BMCs had significantly lower primordial follicle densities than those of controls (11.2 ± 2.0 vs 44.2 ± 6.2 follicles/mm3; P = 0.0002). BRCA mutations were associated with increased DNA DSBs in primordial follicle oocytes (62% ± 5.2% vs 36% ± 3.4%; P = 0.0005). In subgroup analyses, both BRCA1 and BRCA2 mutations were associated with lower primordial follicle density (P = 0.0001 and 0.0030, respectively), and BRCA1 mutations were associated with higher DNA DSBs (P = 0.0003) than controls. The rates of follicle decline (R2 = 0.74; P = 0.0001) and DNA DSB accumulation (R2 = 0.70; P = 0.0001) appeared to be accelerated, particularly in primordial follicle oocytes of BMCs over age 30 years. CONCLUSIONS We provide direct evidence of diminished ovarian reserve as well as accelerated primordial follicle loss and oocyte DNA damage in women with BRCA mutations. These findings may further our understanding of ovarian aging, and be useful when counseling BMCs.
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Affiliation(s)
- Wayne Lin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Shiny Titus
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510
| | - Fred Moy
- Department of Biostatistics, New York Medical College, Valhalla, New York 10595
| | - Elizabeth S. Ginsburg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510
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Turan V, Bedoschi G, Emirdar V, Moy F, Oktay K. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes. Reprod Sci 2017; 25:26-32. [PMID: 28874104 DOI: 10.1177/1933719117728800] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aromatase inhibitors (AI) have been introduced to reduce estrogen exposure in women with estrogen-sensitive cancer undergoing ovarian stimulation for oocyte/embryo cryopreservation. There have been questions regarding whether the addition of AI and the presence of BRCA mutations affect cycle outcomes. We sought to determine the impact of letrozole and BRCA mutations on fertility preservation (FP) cycle outcomes of patients undergoing ovarian stimulation with an antagonist protocol. METHODS The data were generated by the secondary analysis of a prospective database of all females diagnosed with cancer who underwent embryo or oocyte cryopreservation for FP. The final analysis included 145 patients stimulated with an antagonist protocol either using letrozole combined with recombinant follicle-stimulating hormone (rFSH; LF, n = 118) or rFSH alone (FA, n = 24). RESULTS The mean number of total (15.6 [7.9] vs 10.2 [7.8]; P = .004) and mature oocytes (10.4 [5.1] vs 7.8 [3.5]; P = .044) and embryos frozen (7.7 [5.3] vs 5.3 [2.7]; P = .043) were significantly higher after LF stimulation versus FA. In the LF group, women with BRCA mutations produced significantly fewer oocytes (11.0 [8.0] vs 16.4 [7.7], P = .015) and embryos (5.1 [4.4] vs 8.2 [4.7], P = .013), compared to those who were mutation negative. After adjusting for age, body mass index, baseline FSH level, and BRCA status, LF protocol still resulted in higher number of total oocytes (95% confidence interval [CI]: 1.9 to 3.6; P = .002) mature oocyte (95% CI: 0.3 to 1.4; P = .028), and embryo yield (95% CI: 0.7 to 1.4; P = .015). CONCLUSION In women with cancer undergoing FP, letrozole appears to enhance response to ovarian stimulation while the presence of BRCA mutations is associated with lower oocyte and embryo yield.
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Affiliation(s)
- Volkan Turan
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,2 Department of Obstetrics and Gynecology, GOP Hospital, Yeni Yuzyil University School of Medicine, Istanbul, Turkey
| | - Giuliano Bedoschi
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,3 Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Volkan Emirdar
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA
| | - Fred Moy
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA
| | - Kutluk Oktay
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,4 Laboratory of Molecular Reproduction and Fertility Preservation, Yale University School of Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, New Haven, CT, USA
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Oktay K, Taylan E, Sugishita Y, Goldberg GM. Robot-assisted Laparoscopic Transplantation of Frozen-thawed Ovarian Tissue. J Minim Invasive Gynecol 2017; 24:897-898. [DOI: 10.1016/j.jmig.2017.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 11/16/2022]
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Abstract
CONTEXT Ovarian cryopreservation followed by autotransplantation is still considered an experimental strategy for fertility preservation (FP) mainly because the success rates are unknown. OBJECTIVE To determine cohort epidemiologic characteristics and success rates of autologous ovarian tissue transplantation (OTT) with previously cryopreserved tissue. MATERIALS AND METHODS Literature review from 1999 to October 1, 2016. Additional cases were retrieved from meeting abstracts and own database. We selected studies that reported autologous OTT with previously banked tissue in humans. We did not include any cases involving fresh ovarian tissue transplantation or those performed to treat idiopathic premature ovarian failure/insufficiency. Both authors reviewed and selected studies for eligibility, which resulted in 59 full-text studies assessed for eligibility. Cases were extracted from original reports and reviews by the junior author, and the senior author reviewed and verified the extracted data. RESULTS Nineteen reports were included for qualitative synthesis. In 10 studies, detailed data were available to determine clinical and live birth + ongoing (LB + OG) pregnancy as well as endocrine restoration rates. Three hundred nine OTTs were performed with cryopreserved tissue, resulting in the birth of 84 children and 8 OG pregnancies. The cumulative clinical and LB + OG rates were 57.5% and 37.7%, respectively, and the endocrine restoration rate was 63.9%. CONCLUSION Success rates with cryopreserved OTT have reached promising levels. Given these recent data, ovarian tissue cryopreservation should be considered as a viable option for FP.
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Affiliation(s)
- Fernanda Pacheco
- 1 Innovation Fertility Preservation & IVF, New York, NY, USA.,2 Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.,3 Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kutluk Oktay
- 1 Innovation Fertility Preservation & IVF, New York, NY, USA.,2 Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Abstract
In tissue engineering, decellularized scaffolds have been proved to have remarkable capacity to promote regeneration in various organs such as kidney, heart, lung, and liver. Marrying the field of cryobiology and reproductive medicine resulted in considerable progress and breakthroughs, which led to the emergence of ovarian tissue cryopreservation and transplantation as a promising option for fertility preservation. Here we describe an innovative application of decellularized tissue scaffolds as a regenerative platform for reconstruction of ovarian grafts for auto-transplantation.
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Affiliation(s)
- Enes Taylan
- Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, NY, USA
| | - Kutluk Oktay
- Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, NY, USA. .,Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.
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Oktay K, Baltaci V, Sonmezer M, Turan V, Unsal E, Baltaci A, Aktuna S, Moy F. Oogonial Precursor Cell-Derived Autologous Mitochondria Injection to Improve Outcomes in Women With Multiple IVF Failures Due to Low Oocyte Quality: A Clinical Translation. Reprod Sci 2016; 22:1612-7. [PMID: 26567266 DOI: 10.1177/1933719115612137] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mitochondrial dysfunction has been suggested as a major cause of age-induced decline in oocyte quality. In the past, donor oocyte cytoplasmic transfer showed some success but was abandoned due to the concerns with heteroplasmy. Recent studies indicated presence of oogonial precursor cells (OPCs) in the human ovary, which could be an autologous source of "healthy mitochondria." We sought to investigate the clinical efficacy of OPC-derived autologous mitochondrial injection (AMI) to improve oocyte quality in women with multiple in vitro fertilization (IVF) failures. METHODS The OPCs were isolated from laparoscopically obtained ovarian cortical pieces by cell sorting using a monoclonal anti-vasa homolog (anti-DDX) antibody. They were then disrupted and mitochondria were isolated. Reconstituted mitochondria were injected into each oocyte during intracytoplasmic sperm injection. Paired comparisons were made between the first failed cycles and the post-AMI cycles. RESULTS Of the 15 women undergoing ovarian stimulation, 2 were canceled and 3 decided to pool oocytes for later AMI. In remaining 10 (mean age 34.7 ± 4.1), AMI significantly improved fertilization rates (49.7 ± 31.3 vs 78.3 ± 18.9; P = .03) with a trend for better embryo grades (2.3 ± 0.3 vs 3.1 ± 0.7; P = .08). Four of 10 women conceived after single frozen embryo transfer and 3 after confirmation of diploidy via array comparative genomic hybridization (aCGH) (clinical pregnancy/embryo transfer = 4/10). CONCLUSION These data show encouraging results for AMI in comparison to previous failed IVF cycles.
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Affiliation(s)
- Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Innovation Institute for Fertility Preservation and IVF, New York, NY, USA GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Volkan Baltaci
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Murat Sonmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Turan
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Innovation Institute for Fertility Preservation and IVF, New York, NY, USA
| | - Evrim Unsal
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Aysun Baltaci
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Suleyman Aktuna
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Fred Moy
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Deparment of Pathology, New York Medical College, Valhalla, NY, USA
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Sugishita Y, Oktay K. Recent advances in vitrification of human ovarian tissue and tandem IVM oocytes. Cryobiology 2016. [DOI: 10.1016/j.cryobiol.2016.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oktay K, Turan V, Bedoschi G. Reply to M. Lambertini et al. J Clin Oncol 2016; 35:807-809. [PMID: 27893322 DOI: 10.1200/jco.2016.70.6101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
| | - Volkan Turan
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
| | - Giuliano Bedoschi
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
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34
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Oktay K, Bedoschi G, Berkowitz K, Bronson R, Kashani B, McGovern P, Pal L, Quinn G, Rubin K. Fertility Preservation in Women with Turner Syndrome: A Comprehensive Review and Practical Guidelines. J Pediatr Adolesc Gynecol 2016; 29:409-416. [PMID: 26485320 PMCID: PMC5015771 DOI: 10.1016/j.jpag.2015.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 12/31/2022]
Abstract
In this article we review the existing fertility preservation options for women diagnosed with Turner syndrome and provide practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in women, occurring in approximately 1 in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency and infertility. Although approximately 70%-80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder might possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood because the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, and cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remains investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 years of age and ovarian tissue cryopreservation in affected prepubertal children. However, current efficacy of these approaches is unknown in this cohort. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of the desire for parenting. For those with Turner syndrome-related cardiac contraindications to pregnancy, use of gestational surrogacy allows the possibility of biological parenting using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.
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Affiliation(s)
- Kutluk Oktay
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York; Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, New York.
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York; Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, New York
| | - Karen Berkowitz
- Department of Biochemistry and Molecular Biology and Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Richard Bronson
- Department of Obstetrics and Gynecology and Pathology, Division of Reproductive Endocrinology, Stony Brook University Medical Center, Stony Brook, New York
| | - Banafsheh Kashani
- Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter McGovern
- Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gwendolyn Quinn
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Karen Rubin
- Department of Pediatrics, Division of Pediatric Endocrinology, Connecticut Children's Medical Center, Hartford, Connecticut and University of Connecticut School of Medicine, Farmington, Connecticut
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Abstract
Extracellular matrix plays a key role in cell growth, survival, and differentiation in a wide array of tissue types through integrin-mediated signaling pathways and its interaction with growth factors. This study investigates the role of extracellular matrix and its interaction with activin-A on in vitro growth and survival of mouse preantral follicles. Preantral follicles isolated from 14-day-old immature mouse ovaries were cultured either 3 dimensionally using basement membrane matrix (growth factor - reduced matrigel) or 2 dimensionally on cover slips coated with a single component of extracellular matrix (fibronectin, collagen, or laminin), on polylysine (negative control), or in standard culture plates in a serum-free culture medium with or without activin-A for 7 days. Follicles cultured in matrigel maintained well their 3-dimensional structure compared to those cultured conventionally. This observation was confirmed by analyzing 3-dimensional images of follicles cultured in matrigel and standard culture plate using confocal microscopy. Furthermore, follicles displayed higher growth and survival rates and exhibited antral space formation as early as day 5 of culture when activin-A was added to matrigel; in contrast, the addition of activin-A had no effect on the growth and survival of follicles cultured on individual extracellular matrix components after 7 days of culture. These data may suggest that 3-dimensional culture with extracellular matrix and activin-A provides a better milieu for in vitro growth and survival of preantral follicles in immature mice.
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Affiliation(s)
- Ozgur Oktem
- Center for Reproductive Medicine and Infertility, Weill Medical College of Cornell University, New York, New York 10021, USA
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36
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Demeestere I, Turan V, Oktay K. Pregnancy Rate and Preservation of Cyclic Ovarian Function With Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy--Reply. JAMA Oncol 2016; 2:546-7. [PMID: 27077899 DOI: 10.1001/jamaoncol.2015.5743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Isabelle Demeestere
- Erasme Hospital, Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla3Innovation Institute for Fertility Preservation and In Vitro Fertilization, Ne
| | - Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla3Innovation Institute for Fertility Preservation and In Vitro Fertilization, Ne
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Abstract
Cancer is a major public health problem around the world. Currently, about 5% of women diagnosed with cancer are of reproductive age. These young survivors may face compromised fertility. The effects of chemotherapeutic agents on ovarian reserve and its clinical consequences are generally inferred from a variety of surrogate markers of ovarian reserve, all aiming to provide prognostic information on fertility or the likelihood of success of infertility treatment. Until recently, the mechanisms that are responsible for chemotherapy-induced ovarian damage were not fully elucidated. The understanding of these mechanisms may lead to targeted treatments to preserve fertility. In this manuscript, we will review the current knowledge on the mechanism of ovarian damage and clinical impact of chemotherapy agents on fertility.
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Affiliation(s)
- Giuliano Bedoschi
- Innovation Institute for Fertility Preservation & In vitro Fertilization, New York, NY, USA.,Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA.,Division of Reproductive Medicine, Department of Gynecology & Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Paula Andrea Navarro
- Division of Reproductive Medicine, Department of Gynecology & Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Kutluk Oktay
- Innovation Institute for Fertility Preservation & In vitro Fertilization, New York, NY, USA.,Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA
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Oktay K, Turan V. Failure of Ovarian Suppression With Gonadotropin-Releasing Hormone Analogs to Preserve Fertility: An Assessment Based on the Quality of Evidence. JAMA Oncol 2016; 2:74-5. [PMID: 26426406 DOI: 10.1001/jamaoncol.2015.3252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla2Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla2Innovation Institute for Fertility Preservation and IVF, New York, New York
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Oktay K, Bedoschi G. Appraising the Biological Evidence for and Against the Utility of GnRHa for Preservation of Fertility in Patients With Cancer. J Clin Oncol 2016; 34:2563-5. [PMID: 27217452 DOI: 10.1200/jco.2016.67.1693] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kutluk Oktay
- New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
| | - Giuliano Bedoschi
- New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
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40
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Abstract
CONTEXT AND OBJECTIVE There has been increased attention to the issue of fertility preservation (FP). We aimed to investigate the long-term safety of FP via controlled ovarian stimulation with letrozole supplementation (COSTLES) prior to breast cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, nonrandomized, controlled study conducted between the years 2002 and 2014. A total of 337 women diagnosed with stage 3 or less invasive breast cancer were enrolled during a FP consultation before chemotherapy. Of those, 120 elected to undergo COSTLES for FP prior to chemotherapy (FP group). The remaining 217 patients did not undergo any FP procedure and served as the controls. MAIN OUTCOME MEASURE The primary end point was cancer recurrence defined as the detection of locoregional tumor (chest wall, regional nodal disease), distant metastases, or contralateral invasive breast cancer. RESULTS The baseline characteristics at enrollment were similar between the FP and control groups except for the less frequent lymph node involvement (P = .02) in the former. The mean follow-up after diagnosis was 5.0 years in the FP group and 6.9 years in the control group. In the FP group, the hazard ratio for recurrence after ovarian stimulation was 0.77 (95% confidence interval 0.28–2.13), and the survival was not compromised compared with controls (P = .61). Neither BRCA gene mutation status (P = .57) nor undergoing FP before or after breast surgery (P = .44) affected survival outcomes in the FP group. Likewise, none of the tumor characteristics including the estrogen receptor status affected the survival rates after the COSTLES. CONCLUSIONS COSTLES is unlikely to cause a substantially increased recurrence risk in breast cancer during the 5 years after diagnosis.
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Affiliation(s)
- Jayeon Kim
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Volkan Turan
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Kutluk Oktay
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
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Oktay K, Bedoschi G, Pacheco F, Turan V, Emirdar V. First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. Am J Obstet Gynecol 2016; 214:94.e1-9. [PMID: 26601616 DOI: 10.1016/j.ajog.2015.10.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ovarian tissue cryopreservation is an experimental fertility preservation method and the transplantation techniques are still evolving. OBJECTIVE We attempted to improve the technique with the utility of a human decellularized extracellular tissue matrix (ECTM) scaffold, robot-assisted minimally invasive surgery, and perioperative pharmacological support. STUDY DESIGN We prospectively studied 2 subjects with hemophagocytic lymphohistiocytosis (patient A) and non-Hodgkin lymphoma (patient B) who underwent ovarian tissue cryopreservation at the age of 23 years, before receiving preconditioning chemotherapy for hematopoietic stem cell transplantation. Both experienced ovarian failure postchemotherapy and we transplanted ovarian cortical tissues to the contralateral menopausal ovary 7 and 12 years later, using a human ECTM scaffold and robotic assistance. The ECTM scaffold tissue compatibility was shown in preclinical studies. Patients also received estrogen supplementation and baby aspirin preoperatively to aid in the revascularization process. RESULTS Ovarian follicle development was observed approximately 10 (patient A) and 8 (patient B) weeks after ovarian tissue transplantation. Following 8 and 7 cycles of in vitro fertilization, 9 and 10 day-3 embryos were cryopreserved (patients A and B, respectively). While the baseline follicle-stimulating hormone (range 3.6-15.4 mIU/mL) levels near normalized by 7 months and remained steady postovarian transplantation in patient A, patient B showed improved but elevated follicle-stimulating hormone levels throughout (range 21-31 mIU/mL). Highest follicle yield was achieved 14 (8 follicles; patient A) and 11 (6 follicles; patient B) months postintervention. Patient A experienced a chemical pregnancy after the third frozen embryo transfer attempt. She then conceived following her first fresh in vitro fertilization embryo transfer and the pregnancy is currently ongoing. Patient B conceived after the first frozen embryo transfer attempt and delivered a healthy girl at term. CONCLUSION We report the first pregnancies after the minimally invasive transplantation of previously cryopreserved ovarian tissue with an ECTM scaffold. This approach seems to be associated with steady ovarian function after a follow-up of up to 2 years.
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Affiliation(s)
- Kutluk Oktay
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - Giuliano Bedoschi
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Faculdade de Medicina de Ribeirao Preto-Universidade de Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernanda Pacheco
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Classiclinica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Volkan Turan
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Volkan Emirdar
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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Rodriguez-Wallberg K, Turan V, Munster P, Oktay K. Can ovarian suppression with gonadotropin-releasing hormone analogs (GnRHa) preserve fertility in cancer patients? Ann Oncol 2015; 27:357. [PMID: 26609009 DOI: 10.1093/annonc/mdv554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - V Turan
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla Innovation Institute for Fertility Preservation and IVF, New York
| | - P Munster
- Helen Diller Cancer Center, University of California, San Francisco
| | - K Oktay
- Innovation Institute for Fertility Preservation and IVF, New York Laboratory of Molecular Reproduction and Fertility Preservation, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, USA
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Affiliation(s)
- Shiny Titus
- Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York
| | - Robert Stobezki
- Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York
| | - Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York
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Abstract
Oocyte aging has a significant impact on reproductive outcomes both quantitatively and qualitatively. However, the molecular mechanisms underlying the age-related decline in reproductive success have not been fully addressed. BRCA is known to be involved in homologous DNA recombination and plays an essential role in double-strand DNA break repair. Given the growing body of laboratory and clinical evidence, we performed a systematic review on the current understanding of the role of DNA repair in human reproduction. We find that BRCA mutations negatively affect ovarian reserve based on convincing evidence from in vitro and in vivo results and prospective studies. Because decline in the function of the intact gene occurs at an earlier age, women with BRCA1 mutations exhibit accelerated ovarian aging, unlike those with BRCA2 mutations. However, because of the still robust function of the intact allele in younger women and because of the masking of most severe cases by prophylactic oophorectomy or cancer, it is less likely one would see an effect of BRCA mutations on fertility until later in reproductive age. The impact of BRCA2 mutations on reproductive function may be less visible because of the delayed decline in the function of normal BRCA2 allele. BRCA1 function and ataxia-telangiectasia-mutated (ATM)-mediated DNA repair may also be important in the pathogenesis of age-induced increase in aneuploidy. BRCA1 is required for meiotic spindle assembly, and cohesion function between sister chromatids is also regulated by ATM family member proteins. Taken together, these findings strongly suggest the implication of BRCA and DNA repair malfunction in ovarian aging.
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Affiliation(s)
- Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Shiny Titus
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Robert Stobezki
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Lin Liu
- Department of Cell Biology and Genetics, College of Life Sciences, Nankai University, Tianjin, China
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Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer. J Clin Oncol 2015; 33:2424-9. [PMID: 26101247 DOI: 10.1200/jco.2014.59.3723] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We have previously reported an approach to ovarian stimulation for the purpose of fertility preservation (FP) in women with breast cancer via embryo freezing with the concurrent use of letrozole. The aim of this study was to provide the pregnancy and FP outcomes when embryos generated with the same protocol are used. PATIENTS AND METHODS In all, 131 women with stage ≤ 3 breast cancer underwent ovarian stimulation and received concurrent letrozole 5 mg per day before receiving adjuvant chemotherapy and cryopreserving embryos. RESULTS Thirty-three of the 131 women underwent 40 attempts to transfer embryos to their own uterus (n = 18) or via the use of a gestational carrier (n = 22) at a mean age of 41.5 ± 4.3 years with a median 5.25 years after embryo cryopreservation. The overall live birth rate per embryo transfer was similar to the US national mean among infertile women of a similar age undergoing in vitro fertilization-embryo transfer (45.0 v 38.2; P = .2). Seven (38.8%) of the 18 pregnancies were twins with no higher-order pregnancies being encountered. No fetal anomalies or malformations were reported in 25 children after a mean follow-up of 40.4 ± 26.4 months. Seventeen of the 33 women attempting pregnancy had at least one child, translating into an FP rate of 51.5% per attempting woman. CONCLUSION Embryo cryopreservation after ovarian stimulation with the letrozole and follicle-stimulating hormone protocol preserves fertility in women with breast cancer and results in pregnancy rates comparable to those expected in a noncancer population undergoing in vitro fertilization.
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Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY.
| | - Volkan Turan
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Giuliano Bedoschi
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Fernanda S Pacheco
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Fred Moy
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
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Oktay K, Turan V, Kim J. Long-term safety of fertility preservation by ovarian stimulation and concurrent aromatase inhibitor treatment in women with breast cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kutluk Oktay
- Institute for Fertility Preservation and New York Medical College, New York, NY
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48
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Goldfarb SB, Bedoschi G, Grunblatt E, Goswami S, Cigler T, Quistorff J, Pacheco F, Stobezki R, Robson ME, Moy F, Hudis CA, Patil S, Dickler MN, Oktay K. The impact of adjuvant breast cancer (BC) chemotherapy on ovarian reserve and menses. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Fernanda Pacheco
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | - Robert Stobezki
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | | | - Fred Moy
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kutluk Oktay
- Institute for Fertility Preservation and New York Medical College, New York, NY
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Oktay K, Bedoschi G. Oocyte cryopreservation for fertility preservation in postpubertal female children at risk for premature ovarian failure due to accelerated follicle loss in Turner syndrome or cancer treatments. J Pediatr Adolesc Gynecol 2014; 27:342-6. [PMID: 25214440 PMCID: PMC4252563 DOI: 10.1016/j.jpag.2014.01.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To preliminarily study the feasibility of oocyte cryopreservation in postpubertal girls aged between 13 and 15 years who were at risk for premature ovarian failure due to the accelerated follicle loss associated with Turner syndrome or cancer treatments. DESIGN Retrospective cohort and review of literature. SETTING Academic fertility preservation unit. PARTICIPANTS Three girls diagnosed with Turner syndrome, 1 girl diagnosed with germ-cell tumor. and 1 girl diagnosed with lymphoblastic leukemia. INTERVENTIONS Assessment of ovarian reserve, ovarian stimulation, oocyte retrieval, in vitro maturation, and mature oocyte cryopreservation. MAIN OUTCOME MEASURE Response to ovarian stimulation, number of mature oocytes cryopreserved and complications, if any. RESULTS Mean anti-müllerian hormone, baseline follical stimulating hormone, estradiol, and antral follicle counts were 1.30 ± 0.39, 6.08 ± 2.63, 41.39 ± 24.68, 8.0 ± 3.2; respectively. In Turner girls the ovarian reserve assessment indicated already diminished ovarian reserve. Ovarian stimulation and oocyte cryopreservation was successfully performed in all female children referred for fertility preservation. A range of 4-11 mature oocytes (mean 8.1 ± 3.4) was cryopreserved without any complications. All girls tolerated the procedure well. CONCLUSIONS Oocyte cryopreservation is a feasible technique in selected female children at risk for premature ovarian failure. Further studies would be beneficial to test the success of oocyte cryopreservation in young girls.
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Affiliation(s)
- K Oktay
- Innovation Institute for Fertility Preservation and IVF, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - G Bedoschi
- Innovation Institute for Fertility Preservation and IVF, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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Kim J, Turan V, Bedoschi G, Oktay K. Efficacy of serum follicle-stimulating hormone level monitoring during letrozole-gonadotropin ovarian stimulation cycles. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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