Oncofertility - Revision history

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	{{ART Links}}		{{ART Links}}
			[[File:Ovary histology with chemotherapy.jpg\|thumb\|alt=Ovary histology with chemotherapy\|Ovary histology with chemotherapy<ref name=PMID26226487><pubmed>26226487</pubmed>\| [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133985 PLoS One.]</ref>]]
	==Some Recent Findings==		==Some Recent Findings==
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	* '''Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro'''<ref name=PMID26226487><pubmed>26226487</pubmed>\| [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133985 PLoS One.]</ref> "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. ~~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."		* '''Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro'''<ref name=PMID26226487><pubmed>26226487</pubmed>\| [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133985 PLoS One.]</ref> "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."
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	* <ref name=~~PMID25684703~~><pubmed>~~25684703~~</pubmed></ref>		* '''Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro'''<ref name=PMID26226487><pubmed>26226487</pubmed>\| [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133985 PLoS One.]</ref> "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. 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."
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	Search term: [http://www.ncbi.nlm.nih.gov/pubmed/?term=Oncofertility ''Oncofertility'']		Search term: [http://www.ncbi.nlm.nih.gov/pubmed/?term=Oncofertility ''Oncofertility'']

	<pubmed limit=5>~~Oncofertilityy~~</pubmed>		<pubmed limit=5>Oncofertility</pubmed>
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	==Trends in ART procedures==		==Trends in ART procedures==

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{{Header}}
{{Educational Warning}}
==Introduction==
[[File:IVF-Louise Brown.jpg|thumb|alt=Louise Brown, the first IVF baby as an adult|Louise Brown, the first IVF baby as an adult.]]

:''Draft page.''

{{ART Links}}

==Some Recent Findings==
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* <ref name=PMID25684703><pubmed>25684703</pubmed></ref>
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Search term: [http://www.ncbi.nlm.nih.gov/pubmed/?term=Oncofertility ''Oncofertility'']

<pubmed limit=5>Oncofertilityy</pubmed>
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==Trends in ART procedures==
[[File:Assisted reproductive technology in Australia and New Zealand 2010.jpg|thumb|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'''<ref name=ART2010>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. [http://www.aihw.gov.au/publication-detail/?id=10737423259 Online Summary] | [http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737423255 PDF] | [http://www.aihw.gov.au/publication-detail/?id=10737423259 26 Oct 2012]</ref>

==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.<ref><pubmed>20499073</pubmed></ref>

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.<ref><pubmed>20663793</pubmed></ref>

===Male===

A recent paper<ref name="PMID21873609"><pubmed>21873609</pubmed></ref> 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:''' [[Abnormal Development - Environmental|Environmental]] | [[Abnormal Development - Drugs|Drugs]] | [[Abnormal Development - Radiation|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.<ref><pubmed>19153092</pubmed></ref>

==Ovarian Follicle Growth in vitro==
[[File:Ovarian_follicle_growth_in_vitro.jpg|600px]]

2D and 3D methods of ovarian follicle growth in vitro.<ref><pubmed>20946661</pubmed>| [http://www.rbej.com/content/8/1/119 Reprod Biol Endocrinol.]</ref>

== 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.

<gallery>
File:Assisted reproductive technology in Australia and New Zealand 2012.jpg|2012
File:Assisted reproductive technology in Australia and New Zealand 2011.jpg|2011
File:Assisted reproductive technology in Australia and New Zealand 2010.jpg|2010
File:Assisted reproductive technology in Australia and New Zealand 2009.jpg|2009
</gallery>

:'''Links:''' [[Menstrual Cycle]] | [[Ovary Development]] | [[Oocyte Development]] | [[Endocrine_-_Pituitary_Development|Pituitary]]

==References==

<references/>

===Reviews===

===Articles===

<pubmed>20124287</pubmed>
<pubmed>19147504</pubmed>

===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:''' [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=in%20vitro%20fertilization in vitro fertilization] | [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=assisted%20reproduction%20technology assisted reproduction technology]

== External Links ==
{{External Links}}

* '''Australia''' [http://www.npsu.unsw.edu.au/art8high.htm Assisted reproductive technology in Australia and New Zealand 2002 Report - Highlights] Has links to the full report online. | [http://www.npsu.unsw.edu.au/ (Australian) National Perinatal Statistics Unit] | (Australian) National Perinatal Statistics Unit [http://www.npsu.unsw.edu.au/NPSUweb.nsf/page/Assisted+Reproduction+Technology+Reports Assisted Reproduction Technology Reports] | [http://www.nor.com.au/community/aisg/ The Australian Infertility Support Group]
** Victorian Assisted Reproductive Treatment Authority ([http://www.varta.org.au VARTA]) This group provides public education and resources for professionals and the community on fertility and issues related to assisted reproductive treatment, including IVF, surrogacy and donor-conception.
* '''USA''' [http://www.cdc.gov/ART/ CDC - Assisted Reproductive Technology]
** [http://www.cdc.gov/art/reports/2012/national-summary.html 2012 Assisted Reproductive Technology National Summary Report]
** [http://www.sart.org Society for Assisted Reproductive Technology] The Society for Assisted Reproductive Technology (SART) promotes and advances the standards for the practice of assisted reproductive technology to the benefit of patients, members and society at large.
** [http://www.asrm.org The American Society for Reproductive Medicine] (ASRM) is a multidisciplinary organization for the advancement of information, education, advocacy and standards in the field of reproductive medicine.
** [http://www.theafa.org American Fertility Association] (AFA) is a national consumer organization that offers support for men and women dealing with infertility. Their purpose is to educate the public about reproductive disease and support families during struggles with infertility and adoption.
** [http://www.resolve.org RESOLVE: The National Infertility Association] is a national consumer organization that offers support for men and women dealing with infertility. Their purpose is to provide timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.
* '''UK''' | [http://www.hfea.gov.uk/Home Human Fertilisation and Embryology Authority (UK)] | [http://www.hfea.gov.uk/ForPatients/YourGuidetoInfertility Your Guide to Infertility] | [http://www.hfea.gov.uk/ForPatients/PatientsGuidetoDI Patients' Guide to Donor Insemination (DI)] | [http://www.hfea.gov.uk/ForPatients/PatientsFAQs Patients FAQs] | [http://www.hfea.gov.uk/ForPatients/PatientsGuidetoIVFClinics Patients Guide to IVF Clinics (UK)]
* [http://www.ivf-worldwide.com IVF Directory]
* '''The Merck Manual''' | [http://www.merck.com/mmhe/sec22/ch254/ch254a.html?qt=infertility&alt=sh The Merck Manual- Infertility | ][http://www.merck.com/mmhe/sec22/ch257/ch257a.html?qt=pregnancy&alt=sh The Merck Manual- Pregnancy] | [http://www.merck.com/mmhe/search.html?qt=infertility&qp=%2Bsite%3Awww.merck.com+%2Burl%3A%2Fmmhe+-url%3Aprint%2F+-url%3Aindex%2F+-url%3Aresources%2Fpronunciations+-url%3Amultimedia%2F&charset=utf8&la=en&start=0 Search The Merck Manual "Infertility"] | [http://www.merck.com/mmhe/search.html?qt=pregnancy&qp=%2Bsite%3Awww.merck.com+%2Burl%3A%2Fmmhe+-url%3Aprint%2F+-url%3Aindex%2F+-url%3Aresources%2Fpronunciations+-url%3Amultimedia%2F&charset=utf8&la=en&start=0 Search The Merck Manual "Pregnancy"]
* '''Sydney Commercial IVF Sites''' [http://www.sivf.com.au/ Sydney IVF] | [http://www.ivf.com.au/ Citywest IVF] | [http://www.ivfsouth.com.au/ IVF South] | [http://www.nsart.com.au/ North Shore Fertility Pty Ltd]
* '''National Conference of State Legislatures (USA)''' [http://www.ncsl.org/issues-research/health/embryo-and-gamete-disposition-laws.aspx Embryo and Gamete Disposition Laws] Updated July 2007

==Terms==

For a full list of terms see [[Assisted_Reproductive_Technology_-_Glossary|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 hormon'''e - (FSH, gonadotropin) A glycoprotein hormone secreted by [[A#anterior pituitary|anterior pituitary]] (adenohypophysis gonadotrophs, a subgroup of basophilic cells) and acts on [[G#gametogenesis|gametogenesis]] and other systems in both males and females. In females, FSH acts on the [[O#ovary|ovary]] to stimulate [[F#follicle|follicle]] development. Negative feedback by inhibin from the developing [[F#follicle|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 [[A#antral_follicle|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 [[C#conceptus|conceptus]] during week two, supporting the ovarian [[C#corpus luteum|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 [[T#teratogen|teratogenic]] to fetal gonadal tissues.
* '''human menopausal gonadotropin''' - (HMG) A clinical [[H#hormone|hormone]] preparation used in [[A#assisted reproductive technology|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 [[O#ovulation|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 [[A#assisted reproductive technology|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? [http://www.ncbi.nlm.nih.gov/pubmed/18284880 PMID18284880] | [http://www.ncbi.nlm.nih.gov/pubmed/20079896 PMID20079896])

{{Glossary}}

{{Footer}}

[[Category:Human Embryo]] [[Category:Week 1]] [[Category:Fertilization]] [[Category:Oocyte]] [[Category:Spermatozoa]][[Category:In Vitro Fertilization]] [[Category:Assisted Reproductive Technology]]