Oncofertility

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Introduction

Louise Brown, the first IVF baby as an adult
Louise Brown, the first IVF baby as an adult.


Draft page.


ART Links: Assisted Reproductive Technology | In Vitro Fertilization | Oncofertility | Oocyte | Spermatozoa | Fertilization | Lecture - Fertilization | Lecture - Week 1 and 2 | Lecture - Genital Development | Robert Edwards | IVF Questions | ART Report 2013 | ART USA | ART Glossary | Category:ART
Ovary histology with chemotherapy
Ovary histology with chemotherapy[1]

Some Recent Findings

  • Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro[1] "Cryopreservation of ovarian tissue has been widely accepted as an option for fertility preservation among cancer patients. Some patients are exposed to chemotherapy prior to ovarian tissue cryopreservation. Consequently, assessment of the developmental capacity of human ovarian tissue after chemotherapy is of primary importance. ...Exposure to chemotherapy significantly impaired the survival and development of ovarian follicles in culture. After seven days, significantly higher densities of intermediary, primary and secondary follicles and lower densities of atretic follicles was detected in the samples collected before chemotherapy. Increasing dose of alkylating agents was identified by multivariate linear regression analysis as an independent predictor of a higher density of atretic follicles, whereas increasing age of the patient predicted a better outcome with less follicle atresia and a higher density of maturing follicles. This study provides quantitative in vitro evidence of the impact of chemotherapy on developmental capacity of cryopreserved human ovarian tissue. The results indicate that fertility preservation should be carried out, if possible, before initiation of alkylating agents in order to guarantee better in vitro survival of ovarian follicles. In addition, ovarian samples from younger girls show lower viability and fewer developing follicles in culture."
More recent papers 
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
  • References appear in this list based upon the date of the actual page viewing.

References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.

Links: References | Discussion Page | Pubmed Most Recent | Journal Searches


Search term: Oncofertility

V Lehmann, M C Keim, L Nahata, E L Shultz, J L Klosky, M A Tuinman, C A Gerhardt Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication. Hum. Reprod.: 2017;1-4 PubMed 29040512

Janella N Hudson, Nathanael B Stanley, Leena Nahata, Meghan Bowman-Curci, Gwendolyn P Quinn New Promising Strategies in Oncofertility. Expert Rev Qual Life Cancer Care: 2017, 2(2);67-78 PubMed 28959743

Dorit Barlevy, Bernice S Elger, Tenzin Wangmo, Vardit Ravitsky Adolescent oncofertility discussions: Recommendations from a systematic literature review. AJOB Empir Bioeth: 2017, 8(2);106-115 PubMed 28949840

Natalie K Bradford, Roderick Walker, Roslyn Henney, Po Inglis, Raymond J Chan Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol: 2017; PubMed 28934554

N Halászová, I Crha, M Huser, V Weinberger, J Žáková, M Ješeta, E Lousová, E Filipinská, P Ventruba [Fertility preserving methods in women with breast cancer before gonadotoxic therapy]. [Zachování fertility u žen s karcinomem prsu před gonadotoxickou léčbou.] Ceska Gynekol: 2017, 82(4);287-292 PubMed 28925272

Trends in ART procedures

Assisted reproductive technology in Australia and New Zealand 2010
  • In the last 5 years there has been a shift from day 2-3 embryo (cleavage stage) transfers to day 5-6 embryo (blastocyst) transfers.
  • The proportion of blastocyst transfers has increased from 27.1% in 2006 to 52.1% in 2010.
  • Increase in the transfer of vitrified (ultra-rapid frozen) embryos. Compared with 2009, the proportion has more than doubled from 18.3% to 38.2%.
  • reduction in the rate of multiple birth deliveries, with a decrease from 12% in 2006 to 7.9% in 2010.
  • shifting to single embryo transfer, the proportion of which increased from 56.9% in 2006 to almost 70% in 2009 and 2010.
  • decrease in the multiple delivery rate was achieved while clinical pregnancy rates remained stable at about 23% per cycle.

Data: Assisted reproductive technology in Australia and New Zealand 2010[2]

Gamete Banking

Both men and women undergoing clinical procedures of chemotherapy and/or radiotherapy (ionizing radiation) can have induced gametogenic failure.

Female

Women undergoing clinical procedures of chemotherapy and/or radiotherapy (ionizing radiation) can have induced premature ovarian failure. Therefore a growing reproductive option has been the collecting of oocytes or ovarian tissue before commencing these procedures and storing ("banking") by cryopreservation for later use. One major issue is coordination of the two procedures, as most cancer therapies commence immediately, and most reproductive procedures require substantial preparation time. Currently the cryopreservation techniques required for ovarian tissue preservation are also improving all the time. In a number of clinics women with breast cancer and of reproductive age are being counselled about their reproductive options.[3]

Chemotherapy, alkylating and alkylating-like agents attach to the guanine base of DNA, cross-linking the DNA, preventing replication and cell division. Some examples include: busulfan, carboplatin, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, ifosfamide, thiotepa


A third potential option that may also in future be available is the transplanting (allografting) of ovarian cortex between individuals, this has recently been carried out between genetically non-identical sisters.[4]

Male

A recent paper[5] described the current practice of spermatozoa banking in the United Kingdom in relation to cancer patients. The UK Human Fertilization and Embryology Authority have now extended the period of storage permitted by their regulations to 55 years. They point to a lack of "national and international guidelines for the provision, organization, maintenance and management of the cryopreservation services."


Links: Environmental | Drugs | Radiation

Ovarian Reserve

Ovarian reserve is a term referring to the evaluation of ovary oocyte (egg) number and quality. A negative finding has been described as Diminished Ovarian Reserve, or an ovarian insufficiency or premature ovarian failure and may be seen in adult childhood cancer survivors and adult patients undergoing a number of therapies.

The anti-Müllerian hormone (AMH) level is currently the most sensitive marker of ovarian reserve.[6]

Ovarian Follicle Growth in vitro

Ovarian follicle growth in vitro.jpg

2D and 3D methods of ovarian follicle growth in vitro.[7]


Assisted Reproductive Technology (Australia and New Zealand)

  • Over 100,000 ART babies born over the last three decades in Australia and New Zealand.
  • ART children estimated as 3.3% and 2.0% of all children currently born in Australia and New Zealand respectively.


Links: Menstrual Cycle | Ovary Development | Oocyte Development | Pituitary

References

  1. 1.0 1.1 Babak Asadi Azarbaijani, Mona Sheikhi, Irma C Oskam, Mirja Nurmio, Tiina Laine, Helena Tinkanen, Sirpa Mäkinen, Tom G Tanbo, Outi Hovatta, Kirsi Jahnukainen Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro. PLoS ONE: 2015, 10(7);e0133985 PubMed 26226487 | PLoS One.
  2. AIHW, Macaldowie A, Wang YA, Chambers GM & Sullivan EA 2012. Assisted reproductive technology in Australia and New Zealand 2010. Assisted reproduction technology series. Cat. no. PER 55. Canberra: AIHW. Online Summary | PDF | 26 Oct 2012
  3. B Lawrenz, E Neunhoeffer, M Henes, S Lessmann-Bechle, B Krämer, Tanja Fehm Management of fertility preservation in young breast cancer patients in a large breast cancer centre. Arch. Gynecol. Obstet.: 2010, 282(5);547-51 PubMed 20499073
  4. Jacques Donnez, Jean Squifflet, Céline Pirard, Pascale Jadoul, Marie-Madeleine Dolmans Restoration of ovarian function after allografting of ovarian cortex between genetically non-identical sisters. Hum. Reprod.: 2010, 25(10);2489-95 PubMed 20663793
  5. Vinay Sharma Sperm storage for cancer patients in the UK: a review of current practice. Hum. Reprod.: 2011, 26(11);2935-43 PubMed 21873609
  6. S Lie Fong, J S E Laven, F G A J Hakvoort-Cammel, I Schipper, J A Visser, A P N Themmen, F H de Jong, M M van den Heuvel-Eibrink Assessment of ovarian reserve in adult childhood cancer survivors using anti-Müllerian hormone. Hum. Reprod.: 2009, 24(4);982-90 PubMed 19153092
  7. Nina Desai, Anastasia Alex, Faten AbdelHafez, Anthony Calabro, James Goldfarb, Aaron Fleischman, Tommaso Falcone Three-dimensional in vitro follicle growth: overview of culture models, biomaterials, design parameters and future directions. Reprod. Biol. Endocrinol.: 2010, 8;119 PubMed 20946661 | Reprod Biol Endocrinol.


Reviews

Articles

J Smitz, M M Dolmans, J Donnez, J E Fortune, O Hovatta, K Jewgenow, H M Picton, C Plancha, L D Shea, R L Stouffer, E E Telfer, T K Woodruff, M B Zelinski Current achievements and future research directions in ovarian tissue culture, in vitro follicle development and transplantation: implications for fertility preservation. Hum. Reprod. Update: 2010, 16(4);395-414 PubMed 20124287

Marius Meintjes, Samuel J Chantilis, David C Ward, James D Douglas, Alfred J Rodriguez, Ali R Guerami, David M Bookout, Brian D Barnett, James D Madden A randomized controlled study of human serum albumin and serum substitute supplement as protein supplements for IVF culture and the effect on live birth rates. Hum. Reprod.: 2009, 24(4);782-9 PubMed 19147504


Search Pubmed

July 2010 "Assisted Reproductive Technology" All (45041) Review (5016) Free Full Text (8551)

"in vitro fertilization" All (29785) Review (3172) Free Full Text (6189)

Search Pubmed Now: in vitro fertilization | assisted reproduction technology


External Links

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Terms

For a full list of terms see ART Glossary

  • empty follicle syndrome - (EFS) Term used to describe a condition in which no oocytes are recovered/obtained after an apparently successful ovarian stimulation.
  • follicle stimulating hormone - (FSH, gonadotropin) A glycoprotein hormone secreted by anterior pituitary (adenohypophysis gonadotrophs, a subgroup of basophilic cells) and acts on gametogenesis and other systems in both males and females. In females, FSH acts on the ovary to stimulate follicle development. Negative feedback by inhibin from the developing follicle decreases FSH secretion. In males, acts on the testis Sertoli cells to increase androgen-binding protein (ABP) that binds androgens and has a role in spermatogenesis. FSH-defficiency in females results in infertile (block in folliculogenesis prior to antral follicle formation) and in males does not affect fertility (have small testes but are fertile). FSH protein has a molecular weight 30 kDa and a 3-4 hour half-life in circulation. Gonadotrophins have been used clinically in humans for the treatment of infertility.
  • human chorionic gonadotropin - (hCG, human chorionic gonadotrophin) Placental hormone initially secreted by cells (syncitiotrophoblasts) from the implanting conceptus during week two, supporting the ovarian corpus luteum, which in turn supports the endometrial lining and therefore maintains pregnancy. Hormone can be detected in maternal blood and urine and is the basis of many pregnancy tests. Hormone also stimulates the onset of fetal gonadal steroidogenesis, high levels are teratogenic to fetal gonadal tissues.
  • human menopausal gonadotropin - (HMG) A clinical hormone preparation used in assisted reproductive technologies (ART). This hormone is collected from the urine of menopausal women and has similar biological activity to that of follicle stimulating hormone (FSH). This is used in an injectable form along with human chorionic gonadotropin (hCG) to induce ovulation. Some commercial product names include Menogon or Organon.
  • triptorelin acetate - A gonadotropin-releasing hormone (GnRH) agonist used clinically in an acetate or pamoate form inreproduction for assisted reproductive technologies (ART, in vitro fertilization, IVF). This decapeptide (pGlu-His-Trp-Ser-Tyr-D-Trp-Leu-Arg-Pro-Gly-NH2) agonist stimulates the pituitary to decrease secretion of gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH). Also used for other clinical conditions.
  • zona pellucida birefringence - (ZPB) Optical property of the zona pellucida using polarization imaging when viewed microscopically. Used to qualitatively predict the developmental potential of a in vitro matured metaphase-II (MII) oocytes. High birefringence has been associated with oocytes contributing to conception cycles when compared with those of nonconception cycles and higher implantation, pregnancy, and live birth rates from transferred oocytes. (More? PMID18284880 | PMID20079896)


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Cite this page: Hill, M.A. 2017 Embryology Oncofertility. Retrieved October 22, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/Oncofertility

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© Dr Mark Hill 2017, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G