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Cite this page: Hill, M.A. (2021, January 21) Embryology Oncofertility. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Oncofertility
Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro
PLoS One. 2015 Jul 30;10(7):e0133985. doi: 10.1371/journal.pone.0133985. eCollection 2015.
Asadi Azarbaijani B1, Sheikhi M2, Oskam IC3, Nurmio M4, Laine T5, Tinkanen H6, Mäkinen S7, Tanbo TG1, Hovatta O8, Jahnukainen K9.
BACKGROUND: 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. MATERIALS: In order to study the impact of previous chemotherapy on in vitro development and viability of ovarian follicles, quality control samples from 34 female cancer patients at median age of 15 years (range 1‒35), cryopreserved for fertility preservation before (n = 14) or after (n = 20) initiation of chemotherapy, were thawed and cultured for 7 days. The morphology and developmental stages of ovarian follicles were studied by light microscopy before and after culture. Possible associations between follicular densities, age and exposure to alkylating agents, expressed as cyclophosphamide equivalent dose (CED) were tested. RESULTS: 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. CONCLUSION: 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.
Fertility preservation in reproductive-age women facing gonadotoxic treatments
Curr Oncol. 2015 Aug;22(4):e294-304. doi: 10.3747/co.22.2334.
Roberts J1, Ronn R2, Tallon N1, Holzer H3.
BACKGROUND: Advancements in the treatments for cancer and autoimmune and other hematologic conditions continue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical reproductive technologies has helped to offset the reproductive consequences of the use of gonadotoxic therapies, and allows for future fertility and normal pregnancy. METHODS: A review of the literature was performed to outline the pathophysiology of gonadotoxicity from various treatments. The success of fertility preservation, fertility sparing, and cryopreservation options are reviewed. Barriers and facilitators to referral and oncofertility treatment in Canada are also outlined. RESULTS: According to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies. CONCLUSIONS: To ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral. KEYWORDS: Oncofertility; adolescents; cryopreservation; fertility preservation; gonadotoxicity; young adults