scholarly journals Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

2019 ◽  
Vol 34 (8) ◽  
pp. 1462-1469 ◽  
Author(s):  
Claudia Massarotti ◽  
Paola Scaruffi ◽  
Matteo Lambertini ◽  
Fausta Sozzi ◽  
Valentino Remorgida ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Standard Of Care ◽  
Young Female ◽  
Cancer Relapse ◽  
Preservation Method

Abstract STUDY QUESTION Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit? SUMMARY ANSWER Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy. WHAT IS KNOWN ALREADY Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material. STUDY DESIGN, SIZE, DURATION We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18–40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any. PARTICIPANTS/MATERIALS, SETTING, METHODS Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit. LIMITATIONS, REASONS FOR CAUTION These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard. WIDER IMPLICATION OF THE FINDINGS The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N.A.

scholarly journals Addressing decisional conflict about fertility preservation: helping young female cancer survivors’ family planning decisions

2017 ◽  
Vol 44 (3) ◽  
pp. 175-180 ◽  
Author(s):  
Madleina Müller ◽  
Corinne Urech ◽  
Jacky Boivin ◽  
Verena Ehrbar ◽  
Rebecca Moffat ◽  
...  
Keyword(s):  
Family Planning ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Decisional Conflict ◽  
Young Female ◽  
University Education ◽  
Time Interval ◽  
Related Factors ◽  
Female Cancer Patients

BackgroundHealth professionals are challenged by a growing number of young long-term cancer survivors with their specific needs with regard to family planning. This study aimed at assessing decisional conflict (DC) in young female cancer patients regarding fertility preservation, identifying demographic, fertility and fertility preservation related factors, which may affect DC, and assessing the helpfulness of various decision-supports.MethodsA retrospective, cross-sectional, web-based survey via an online questionnaire available in three languages with specific items concerning cancer, fertility, fertility preservation and the validated Decisional Conflict Scale targeted at current or former female cancer patients aged 18–45 years, with cancer types or treatment potentially affecting reproductive function.ResultsThe 155 participating women showed considerable DC, especially with regard to missing information and support. DC was significantly lower in patients when the risk of infertility was discussed with a health professional, when they had undergone any procedure to preserve fertility, and when they had a university education. A longer time interval since cancer diagnosis was associated with higher DC. The most helpful decision-support tools were specialised websites and leaflets.ConclusionsYoung female cancer patients’ DC with regard to fertility preservation is very high. Information and support seem to be deficient. More information through standardised information tools might be an effective strategy to lower their DC at the time when treatment decisions need to be taken, and to improve their reproductive health after they have overcome cancer in the future.

P–433 Pregnancy and livebirth after fertility preservation in cancer patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Arab ◽  
E Suarthana ◽  
W Buckett
Keyword(s):  
Cohort Study ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Anti Cancer ◽  
Reproductive Material

Abstract Study question What do we know about pregnancy and livebirth after IVF- fertility preservation treatment in women with cancer? Summary answer Most women conceived spontaneously (60%) and more than 50% of those who returned to use their cryopreserved reproductive material have delivered at least one child. What is known already Diminishing ovarian reserve and declining future reproductive potential are important issues in cancer survivors after anti-cancer treatment exposure. Publications on pregnancy and livebirth after fertility preservation in women with cancer are sparse. Studies report most cancer patient who underwent fertility preservation do not come back and use their frozen reproductive material. The purpose of this study was to investigate the fertility preservation outcome among cancer survivors. Study design, size, duration A retrospective cohort study was conducted at a single academic fertility center from including 336 cancer patients who underwent IVF-fertility preservation from January 2009 to June 2020. Participants/materials, setting, methods We included all women with cancer aged ≤40 years old who were referred for fertility preservation treatment prior to chemotherapy. Primary outcome: Number of pregnancies and livebirths after spontaneous conception and/or using their stored frozen material. Secondary outcomes: We also evaluated the utilization rate of the stored reproductive material and mortality rate among those with follow up data. Main results and the role of chance Of 336 patients who underwent IVF-fertility preservation, 214 (63.69%) elected oocyte cryopreservation, 86 (25.5%) underwent both embryo and oocyte cryopreservation and 36 (10.7`%) underwent embryo cryopreservation. Follow up data were available in 198 (58.9%) patients with a mean follow up of 3.2 years. Of 198, 16 (8%) patients died, 40 (20%) became pregnant. Of those pregnant patients, 24 (60%) became spontaneously pregnant and 16 (40%) became pregnant after frozen oocyte or frozen embryo treatment cycles. Almost a quarter (72.5%) of the pregnancies resulted in livebirths. In total, only 23 (7%) patients had returned for frozen oocyte or frozen embryo treatment cycle, of which 16 (70%) achieved a pregnancy and 10 (63%) achieved at least one live birth. Of 142 patients who were still alive at follow up but did not get pregnant, 51 (39%) were in remission from their cancer but had not chosen to use their stored reproductive material; 44 (31%) were still on anti-cancer treatment and had not started trying yet; 13 (9%) were suffering from the end-stage cancer disease; and 7 (5%) had used their stored reproductive material but failed and stopped trying to get pregnant. Limitations, reasons for caution The main limitation was the retrospective cohort study design which could introduce unidentified selection biases. Wider implications of the findings: Of women who underwent IVF-fertility preservation for cancer, most did not come back for treatment for a variety of reasons. Of those who became pregnant, 60% conceived spontaneously. Of those who used their cryopreserved reproductive material, 63% delivered at least one child. Trial registration number 2021/6935

scholarly journals Exploring the Potential Role of the Gut Microbiome in Chemotherapy-Induced Neurocognitive Disorders and Cardiovascular Toxicity

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 782
Author(s):  
Sona Ciernikova ◽  
Michal Mego ◽  
Michal Chovanec
Keyword(s):  
Cardiovascular Diseases ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Gut Microbiome ◽  
Late Effects ◽  
Fecal Microbiota Transplantation ◽  
Experimental Models ◽  
Neurocognitive Disorders ◽  
Cardiovascular Toxicity

Chemotherapy, targeting not only malignant but also healthy cells, causes many undesirable side effects in cancer patients. Due to this fact, long-term cancer survivors often suffer from late effects, including cognitive impairment and cardiovascular toxicity. Chemotherapy damages the intestinal mucosa and heavily disrupts the gut ecosystem, leading to gastrointestinal toxicity. Animal models and clinical studies have revealed the associations between intestinal dysbiosis and depression, anxiety, pain, impaired cognitive functions, and cardiovascular diseases. Recently, a possible link between chemotherapy-induced gut microbiota disruption and late effects in cancer survivors has been proposed. In this review, we summarize the current understanding of preclinical and clinical findings regarding the emerging role of the microbiome and the microbiota–gut–brain axis in chemotherapy-related late effects affecting the central nervous system (CNS) and heart functions. Importantly, we provide an overview of clinical trials evaluating the relationship between the gut microbiome and cancer survivorship. Moreover, the beneficial effects of probiotics in experimental models and non-cancer patients with neurocognitive disorders and cardiovascular diseases as well as several studies on microbiota modulations via probiotics or fecal microbiota transplantation in cancer patients are discussed.

P–449 Evaluation of ovarian reserve in female children and adolescents with non-iatrogenic primary ovarian insufficiency to establish criteria for ovarian tissue cryopreservation

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Volodarsky-Perel ◽  
M Zajicek ◽  
D Shai ◽  
H Raanani ◽  
N Gruber ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Predictive Value ◽  
Ovarian Function ◽  
Ovarian Tissue ◽  
Antral Follicle ◽  
Ovarian Tissue Cryopreservation ◽  
Positive Parameter ◽  
Primordial Follicles

Abstract Study question What is the predictive value of ovarian reserve evaluation in patients with non-iatrogenic primary ovarian insufficiency (NIPOI) for follicle detection in ovarian tissue harvested for cryopreservation? Summary answer Ovarian tissue cryopreservation (OTCP) should be considered if patients present at least one of the following parameters: detectable AMH, FSH≤20mIU/ml, detection of ≥ 1 antral follicle. What is known already In pre-pubertal girls suffering from NIPOI, which majorly has a genetic etiology, fertility preservation using OTCP is commonly practiced. When OTCP was performed in an unselected group of children and adolescents with NIPOI, only 26% of them had follicles in ovarian tissue while 74% did not benefit from the surgery. The role of preoperative evaluation of anti-müllerian hormone (AMH) serum level, follicular stimulating hormone (FSH) serum level, and trans-abdominal ultrasound for the antral follicle count to predict the detection of primordial follicles in the harvested ovarian tissue is unclear. Study design, size, duration We conducted a retrospective analysis of all patients ≤ 18 years old who were referred for fertility preservation counseling due to NIPOI at a single tertiary hospital between 2010 and 2020. If initial evaluation suggested a diminished ovarian reserve and at least one positive parameter indicating a follicular activity (AMH > 0.16ng/ml, FSH ≤ 20mIU/ml, detection of ≥ 1 antral follicle by transabdominal sonography), OTCP was offered. Patients with 46XY gonadal dysgenesis were excluded. Participants/materials, setting, methods OTCP was performed laparoscopically in all cases. A fresh sample of cortical tissue was fixed in buffered formaldehyde for histological analysis. The rest of the ovarian tissue was cut into small cuboidal slices 1–2 mm in thickness and cryopreserved. After the serial sections, the histological slides were evaluated for the presence of follicles by a certified pathologist. Follicles were counted and categorized as primordial, primary, and secondary. Main results and the role of chance During the study period, 39 patients with suspected NIPOI were referred to the fertility preservation center. Thirty-seven patients included in the study were diagnosed with Turner’s syndrome (n = 28), Galactosemia (n = 3), Blepharophimosis-Ptosis-Epicanthus Inversus syndrome (n = 1), and idiopathic NIPOI (n = 6). Of 28 patients with Turner’s syndrome, 6 had 45X monosomy, 15 had mosaicism and 7 had structural anomalies in X-chromosome. One patient with gonadal dysgenesis and one with the presence of Y-chromosome in 20% of somatic cells were excluded from the study. OTCP was conducted in 14 patients with at least one positive parameter suggesting ovarian function. No complications of the surgical procedure or the anesthesia were observed. Primordial follicles were found in all patients with two or three positive parameters (100%) and in three of six cases with one positive parameter (50%). In total, of the 14 patients who underwent OTCP with at least one positive parameter, 11 (79%) had primordial follicles at biopsy (mean 23.9, range 2–47). This study demonstrates a positive predictive value of 79% for the detection of primordial follicles in patients who had at least one positive parameter of ovarian reserve evaluation. If two or three parameters were positive, the positive predictive value increased to 100%. Limitations, reasons for caution This study did not examine the negative predictive value of our protocol as OTCP was not recommended in the absence of positive parameters. The future fertility potential of cryopreserved tissue in the population with NIPOI is unclear and should be discovered in further studies. Wider implications of the findings: We suggest the evaluation of ovarian reserve by antral follicles count, AMH, and FSH serum levels prior to OTCP in patients with NIPOI. By recommendation of OTCP only if ≥ 1 parameter suggesting the ovarian function is positive, unnecessary procedures can be avoided. Trial registration number Not applicable

scholarly journals Self-collected dried blood spots as a tool for measuring ovarian reserve in young female cancer survivors

2016 ◽  
Vol 31 (7) ◽  
pp. 1570-1578 ◽  
Author(s):  
S.C. Roberts ◽  
S.M. Seav ◽  
T.W. McDade ◽  
S.A. Dominick ◽  
J.R. Gorman ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Ovarian Reserve ◽  
Dried Blood Spots ◽  
Young Female ◽  
Blood Spots ◽  
Female Cancer Survivors

Current State of Fertility Preservation in Cancer Patients—What is Established and What is Still Controversial?

2016 ◽  
Vol 12 (01) ◽  
pp. 33
Author(s):  
Kutluk Oktay ◽  
Giuliano Bedoschi ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Care ◽  
Testicular Tissue ◽  
Semen Cryopreservation ◽  
Young Females ◽  
Current State ◽  
Preservation Method ◽  
Prepubertal Boys ◽  
Straightforward Approach

Fertility Preservation is an essential part of cancer care when treating young females and men. While semen cryopreservation is a straightforward approach for postpubertal men and there is the option of experimental testicular tissue freezing for prepubertal boys, the options for females are more tumultuous. The last 17 years brought us established approaches such the embryo and oocyte cryopreservation and the ovarian cryopreservation is ready to join the list. However, there still is no proven medical fertility preservation method and the controversy around the utility of GnRHa continues.

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