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Schallmoser A, Einenkel R, Färber C, Emrich N, John J, Sänger N. The effect of high-throughput vitrification of human ovarian cortex tissue on follicular viability: a promising alternative to conventional slow freezing? Arch Gynecol Obstet 2023; 307:591-599. [PMID: 36175682 PMCID: PMC9918590 DOI: 10.1007/s00404-022-06797-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/17/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The standard procedure most frequently used for ovarian tissue cryopreservation (OTC) is slow freezing, while vitrification has been proposed as promising alternative and has built an impressive catalog of success in fertility laboratories regarding cryopreservation of oocytes and embryos. METHODS We developed and evaluated a high-throughput protocol for vitrification of human ovarian tissue suitable for clinical processing. Follicular viability was assessed via calcein staining prior and after cryopreservation analyzing ovarian tissue of a cohort of 30 patients. RESULTS We found no significant differences regarding follicular viability between slow frozen and vitrified cortex tissue samples 24 h after thawing and rapid warming. Follicular viability of thawed and rapid warmed samples was not significantly different in comparison to fresh samples, indicating high proportions of follicular survival rates with both methods. CONCLUSIONS High-throughput vitrification is a promising option in a clinical setting. More research is required to determine the status of other tissue-specific quality indicators potentially influencing on autotransplantation.
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Affiliation(s)
- Andreas Schallmoser
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Rebekka Einenkel
- grid.15090.3d0000 0000 8786 803XDepartment of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Cara Färber
- grid.15090.3d0000 0000 8786 803XDepartment of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Norah Emrich
- grid.15090.3d0000 0000 8786 803XDepartment of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Julia John
- grid.15090.3d0000 0000 8786 803XDepartment of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
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Edimiris P, Krüssel JS. [Fertility preservation options before gonadotoxic antirheumatic treatment : A review]. Z Rheumatol 2021; 80:726-732. [PMID: 34550448 DOI: 10.1007/s00393-021-01075-3] [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] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
Cyclophosphamide is still clinically used in rheumatic diseases with severe disease courses. Cyclophosphamide has a pronounced gonadotoxic effect largely depending on the cumulative dose. The risk of amenorrhea is reported to be in the range of 12-54% and is dependent on the age of the patient at initiation of treatment. Every patient of reproductive age should therefore be offered counseling on options for fertility protection. There are 3 options for fertility protection: oocyte harvesting and cryopreservation after a hormonal stimulation of 10-14 days, ovarian wedge resection and cryopreservation and administration of a gonadotropin-releasing hormone (GnRH) agonist. The decision whether and, if so, which treatment should be performed is made in close consultation between the patient, rheumatologists and reproductive physicians and depends on the available treatment time window, the age of the patient and the severity of the underlying disease.
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Affiliation(s)
- Philippos Edimiris
- Universitäres Interdisziplinäres Kinderwunschzentrum Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Jan-Steffen Krüssel
- Universitäres Interdisziplinäres Kinderwunschzentrum Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Balcerek M, Schilling R, Byrne J, Dirksen U, Cario H, Fernandez-Gonzalez MJ, Kepak T, Korte E, Kruseova J, Kunstreich M, Lackner H, Langer T, Sawicka-Zukowska M, Stefanowicz J, Strauß G, Borgmann-Staudt A. Determinants of utilization of cryopreservation of germ cells in adolescent cancer patients in four European countries. Eur J Pediatr 2020; 179:51-60. [PMID: 31493021 DOI: 10.1007/s00431-019-03459-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/18/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
Infertility is a relevant late-effect following cancer treatment; yet, a large proportion of survivors cannot recall having been informed of this risk. In an intervention study, we examined if and how supportive patient information material on fertility/fertility-preserving measures influences utilization of cryopreservation in adolescent cancer patients. The control group, recruited 03/2014-01/2016, received the usual patient education at initial diagnosis. The intervention group, recruited 04/2016-10/2017, received patient education supported by a fertility flyer and brochure. Patients and parents were each asked questions on utilization of cryopreservation in a questionnaire 3 and 6 months after initial diagnosis. Patient core and therapy data were obtained from medical records. Overall, cryopreservation rates showed no significant difference between the control (32.7%, n = 37/113) and intervention group (36.6%, n = 37/101). In the control group, cryopreservation was associated with gender (OR 0.100, CI 0.023-0.427), age (OR 1.559, CI 1.077-2.258) and recalling information on fertility protection (OR 33.663, CI 2.100-539.574); in the intervention group, cryopreservation was related to gender (OR 0.093, CI 0.026-0.330) and the estimated infertility risk (OR 43.665, CI 2.157-883.974).Conclusion: Cryopreservation rates did not overall increase following the intervention; however, the individual risk seemed to be brought into attention more: Those at risk, including younger patients, cryopreserved at higher rates.What is Known:•Infertility is a relevant late-effect following adolescent cancer.•Guidelines recommend to offer fertility protection before cancer treatment.•A relevant proportion of adolescents with cancer are not aware of this risk.•Fertility protection seems under-used in cancer patients at risk for infertility.What is New:•Information material on fertility and protection in adolescents did not increase overall rates of cryopreservation.•Cryopreservation rates were improved according to individual risk for infertility.•Our flyers and brochures on fertility in cancer patients are available in various languages.
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Affiliation(s)
- Magdalena Balcerek
- Charité - Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | - Uta Dirksen
- West German Cancer Centre, University Hospital Essen Paediatrics III, Essen, Germany.,German Cancer Research Centre (DKTK), Heidelberg, Germany
| | - Holger Cario
- Department of Paediatrics and Adolescent Medicine, University Medical Centre, Ulm, Germany
| | | | | | | | | | - Marina Kunstreich
- Department of Paediatric Oncology, Haematology and Immunology, Medical Faculty, Heinrich-Heine, University of, Düsseldorf, Germany
| | | | | | | | - Joanna Stefanowicz
- Klinika Pediatrii, Hematologii I Onkologii Gdanski Uniwersytet, Gdansk, Poland
| | - Gabriele Strauß
- Helios Kliniken Berlin-Buch, Klinik für Kinder- und Jungendmedizin, Berlin, Germany
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Jin F, Ruan X, Juan D, Li Y, Cheng J, Wang H, Mueck AO. Ovarian tissue cryopreservation: prospective randomized study on thawed ovarian tissue viability to estimate the maximum possible delivery time of tissue samples. Gynecol Endocrinol 2019; 35:591-594. [PMID: 30777495 DOI: 10.1080/09513590.2019.1572736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Ovarian tissue cryopreservation is one of the most important methods to protect female fertility, but we just recently established the first central laboratory in China, now building a network with other hospitals. The aim was to estimate the thawed ovarian tissue viability and to explore the feasibility of short-distance transportation. Fifteen samples were obtained from each of 11 patients, i.e. in total 165 samples. One fresh sample was used for follicle counts, 14 punches were cryopreserved, thawed, and randomly divided into seven groups depending on the time after thawing: 0, 20, 40, 60, 80, 100, 120 min. Follicle counts, steroid hormones, and lactate levels were assessed. No significant differences for the three parameters of tissue viability comparing the seven groups were seen. The time can last up to two hours for the delivery of tissue samples from the laboratory to the surgery room. To our knowledge, this question has been tested for the first time systematically within a prospective randomized comparative study.
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Affiliation(s)
- Fengyu Jin
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Xiangyan Ruan
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
- b Department of Women's Health , University Women's Hospital and Research Center for Women's Health, University of Tuebingen , Tuebingen , Germany
| | - Du Juan
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Yanglu Li
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Jiaojiao Cheng
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Husheng Wang
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Alfred O Mueck
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
- b Department of Women's Health , University Women's Hospital and Research Center for Women's Health, University of Tuebingen , Tuebingen , Germany
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Almeida-Santos T, Melo C, Macedo A, Moura-Ramos M. Are women and men well informed about fertility? Childbearing intentions, fertility knowledge and information-gathering sources in Portugal. Reprod Health 2017; 14:91. [PMID: 28778211 PMCID: PMC5545029 DOI: 10.1186/s12978-017-0352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The postponement of parenthood may increase the number of couples experiencing infertility and prolonged time to pregnancy. Previous research has revealed that childless people are not well informed regarding fertility, which may threat their childbearing intentions. This study aimed to examine fertility knowledge and childbearing intentions held by Portuguese people and their use and perceived usefulness of information sources on fertility. METHODS Participants were recruited using a random-route domiciliary approach. A total of 2404 individuals aged 18-45 were asked to complete a structured questionnaire evaluating socio-demographic characteristics, childbearing intentions, fertility knowledge and information-gathering sources regarding fertility. RESULTS In total, 95.5% of the participants indicated the desire to have children in the future, and 61.7% reported that having children would contribute to life satisfaction. Most of the participants expressed the desire to have two children in the future. The discrepancy between the numbers of planned and desired children was higher in men, in participants with lower education levels, in professionally active participants and in the unemployed participants. Relationship stability seemed to be more important in influencing childbearing decisions than financial stability or family support. Participants' knowledge regarding fertility was poor. Women, the participants who were older than 25, the participants with longer education and the participants with higher income exhibited the greatest levels of knowledge of fertility, although this knowledge was only slightly enhanced in these subgroups. Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques. Finally, the results revealed that websites were the main information sources used by the participants and only 18.0% of the participants had previously discussed fertility issues with their doctors. CONCLUSIONS Although Portuguese men and women reported the desire to have children in the future, their knowledge regarding fertility and infertility risk was poor. In addition, participants used more general sources of information, such as website, but not specialized sources, such as their doctors. There is a real need to work with general practitioners to empower them to provide adequate fertility information to every childless patient.
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Affiliation(s)
- Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,Centro Hospitalar Universitário de Coimbra, Av. Bissaya Barreto e Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Cláudia Melo
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Ana Macedo
- KeyPoint, Edifício Miraflores Premium, Al. Fernão Lopes, n°16, 6° Andar, 1495-190, Miraflores, Portugal
| | - Mariana Moura-Ramos
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal.
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Abstract
Ovarian tissue cryopreservation is gaining much interest since the publication of the first live birth after retransplantation of frozen-thawed tissue in 2004 (Donnez et al., Lancet 364:1405-1410, 2004). In contrast to cryopreservation of gametes and embryos, ovarian tissue freezing is a complex requiring a proper approach in order to make this a viable option for fertility preservation of cancer patients. Due to the need in terms of laboratory space, equipment, personnel, and adequate logistics, an ovarian tissue cryobank is most economic if managed as a centralized service unit that interacts with numerous clinics covering the surgical part. Transportation of ovarian tissue under appropriate conditions from the surgical unit to the cryobank for subsequent preparation and freezing has been shown to have no impact on cryo-survival (Schmidt et al., Hum Reprod 18:2654-2659, 2003; Isachenko et al., Fertil Steril 91:1556-1559, 2009). Several children have been born after retransplantation of such tissue that was derived from the cryobank in Bonn, Germany (Homepage FertiPROTEKT. http://www.fertiprotekt.de ). This cryobank is one of the largest in the world with more than 1300 tissue samples that were frozen from 2003 until today. It is integrated in the network FertiPROTEKT (Homepage FertiPROTEKT. http://www.fertiprotekt.de ) and is served by 108 surgical centers that are located all over Germany. The concept of this cryobank is a blueprint for success and has recently been used for another regionally centralized cryobank in Beijing, China. In this chapter the most important topics that need to be considered while creating a centralized cryobank within a national or regional network are highlighted.
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Affiliation(s)
- Jana Liebenthron
- Cryobank at the Department of Gynecological Endocrinology and Reproductive Medicine, University Clinic of Bonn, Sigmund-Freud-Str. 25, 53125, Bonn, Germany
| | - Markus Montag
- ilabcomm GmbH, Eisenachstr. 34, 53757, St. Augustin, Germany.
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Codacci-Pisanelli G, Del Pup L, Del Grande M, Peccatori FA. Mechanisms of chemotherapy-induced ovarian damage in breast cancer patients. Crit Rev Oncol Hematol 2017; 113:90-96. [PMID: 28427528 DOI: 10.1016/j.critrevonc.2017.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 07/11/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 01/25/2023] Open
Abstract
Fertility preservation in breast cancer patients is an increasingly relevant topic. In the present paper we review available data on the mechanism of ovarian damage caused by anticancer agents currently used for the treatment of breast cancer. We also describe current methods to preserve fertility including oocytes or ovarian tissue freezing and administration of LH-RHa during chemotherapy. The aim of the paper is to provide clinical oncologists with an adequate knowledge of the subject to enable them to give a correct counselling to young women that must receive chemotherapy and want to increase their possibilities of maintaining fertility.
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Affiliation(s)
- Giovanni Codacci-Pisanelli
- University of Rome "la Sapienza", Department of Medical and Surgical Sciences and Biotechnology, Corso della Repubblica, 79 Latina, 04100, Italy.
| | - Lino Del Pup
- Department of Gynaecological Oncology, National Cancer Institute, Via Franco Gallini, 2, Aviano (Pordenone) 33170 Italy.
| | - Maria Del Grande
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Ospedale, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
| | - Fedro A Peccatori
- Department of Gynaecological Oncology, European Institute of Oncology, Via Ripamonti, 435 Milano 20141, Italy.
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