Ethical Quandaries in Gamete-Embryo Cryopreservation Related to Oncofertility

2013 ◽  
Vol 41 (3) ◽  
pp. 711-719 ◽  
Author(s):  
Leslie Ayensu-Coker ◽  
Ellen Essig ◽  
Lesley L. Breech ◽  
Steven Lindheim
Keyword(s):  
Cancer Survivors ◽  
Fertility Preservation ◽  
Reproductive Potential ◽  
Reproductive Age ◽  
Embryo Cryopreservation ◽  
Fertility Awareness ◽  
Men And Women ◽  
Current Therapies ◽  
American Society ◽  
Prevalence Of Cancer

Cancer rates in men and women of reproductive age have continued to increase in recent years; however, therapy has dramatically decreased the mortality rates. Since 1990, the prevalence of cancer survivors in young adults increased from 1 in 1,000 to 1 in 250 patients due to more aggressive therapies. Current therapies may have profound toxic effects on gamete function with infertility as an expected consequence of cancer therapy. Depending on the site and stage of cancer, age of the patient, and the type of treatment, approximately 90% of men and women diagnosed with cancer may be at risk of permanent infertility.Fertility preservation has emerged as a discipline dedicated to improving the future reproductive potential of cancer survivors. Significant progress in the advancement of fertility preservation therapies and a heightened awareness of the availability of therapies has occurred in the past 10 years. The American Society of Clinical Oncology (ASCO) and the American Society of Reproductive Medicine (ASRM) have advanced these efforts by formally recognizing the importance of fertility awareness.

scholarly journals Established and Future Promising Fertility Preservation Options in Adolescence and Adults

2017 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Hossein Yazdekhasti ◽  
Zahra Rajabi
Keyword(s):  
Cancer Survivors ◽  
Fertility Preservation ◽  
Recent Progress ◽  
Cancer Prognosis ◽  
Oocyte Cryopreservation ◽  
Embryo Cryopreservation ◽  
Advantages And Disadvantages ◽  
The Past ◽  
Tissue Cryopreservation ◽  
Cancer Diseases

Over the past decades, due to a high number of cancer survivors, the demands for fertility preservation have been raised dramatically, and this might come from recent progress in the cancer prognosis and diagnosis procedures. For those who are involved in cancer diseases, there are multiple options regarding their fertility preservation which can be selected based on patient’s age, the risk of gonadal involvement, the time available and the type of cancer with different advantages and disadvantages. Among all possible options, embryo cryopreservation for females and semen freezing for males are the most applicable method, however other options such as gonadal tissue cryopreservation, and oocyte cryopreservation are other promising options which would be considered if the partner was not available. As conclusion, this is noteworthy that women with cancer must benefit from adequate consultations regarding their possible fertility preservation options and immediate correct consultations definitely can help families to make their mind to choose best available options.

scholarly journals Female Fertility Preservation through Stem Cell-based Ovarian Tissue Reconstitution In Vitro and Ovarian Regeneration In Vivo

2019 ◽  
Vol 13 ◽  
pp. 117955811984800 ◽  
Author(s):  
Taichi Akahori ◽  
Dori C Woods ◽  
Jonathan L Tilly
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Mammalian Species ◽  
Reproductive Age ◽  
Embryo Cryopreservation ◽  
Novel Approach ◽  
Future Fertility ◽  
Female Fertility Preservation

Historically, approaches designed to offer women diagnosed with cancer the prospects of having a genetically matched child after completion of their cytotoxic treatments focused on the existing oocyte population as the sole resource available for clinical management of infertility. In this regard, elective oocyte and embryo cryopreservation, as well as autologous ovarian cortical tissue grafting posttreatment, have gained widespread support as options for young girls and reproductive-age women who are faced with cancer to consider. In addition, the use of ovarian protective therapies, including gonadotropin-releasing hormone agonists and sphingosine-1-phosphate analogs, has been put forth as an alternative way to preserve fertility by shielding existing oocytes in the ovaries in vivo from the side-effect damage caused by radiotherapy and many chemotherapeutic regimens. This viewpoint changed with the publication of now numerous reports that adult ovaries of many mammalian species, including humans, contain a rare population of oocyte-producing germ cells—referred to as female germline or oogonial stem cells (OSCs). This new line of study has fueled research into the prospects of generating new oocytes, rather than working with existing oocytes, as a novel approach to sustain or restore fertility in female cancer survivors. Here, we overview the history of work from laboratories around the world focused on improving our understanding of the biology of OSCs and how these cells may be used to reconstitute “artificial” ovarian tissue in vitro or to regenerate damaged ovarian tissue in vivo as future fertility-preservation options.

Our act on fertility preservation for young breast cancer patients in our single institute.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 109-109 ◽  
Author(s):  
Yasuyuki Kojima ◽  
Kyoko Tsuchiya ◽  
Chie Nishijima ◽  
Nao Suzuki ◽  
Koichiro Tsugawa
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Reproductive Age ◽  
Ovarian Tissue Cryopreservation ◽  
Embryo Cryopreservation ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Er Positive ◽  
Young Breast Cancer

109 Background: Along with increasing number of newly diagnosed Japanese breast cancer patients, the number of breast cancer survivors in reproductive age is also increasing. Among newly diagnosed Japanese breast cancer patients, 3182(6.6%) are under age 40 in 2011, which was 1610 in 2006. In our institute, we have been cooperating with gynecologists and providing fertility preservation program since 2010. Our aim is to access our team management, clinical impact and outcome of fertility preservation among young breast cancer patients in our institute. Methods: A patient, 1)without distant metastasis, 2)systemic chemotherapy and/or hormonal therapy planned, 3)within reproductive age and 4)willing to preserve fertility, will be referred to oncofertility clinic. Chart review was done retrospectively. Results: Ninety-five patients had consultation to the oncofertility clinic between April 2010 and April 2015. The average age at consultation was 34.1(range 22-44). Almost all patient had invasive cancer; cStage0:4%, cStageI:31%, cStageII:53%, cStageIII:11%. Fifty-five percent had estrogen receptor (ER) positive/HER2 negative, 31% had ER positive/HER2positive, 2% had ER negative/HER2 positive and 12% had ER negative/HER2 negative breast cancer. Forty-five had counseling without any procedure, 22 underwent ovarian tissue cryopreservation, 17 underwent embryo cryopreservation and 8 underwent oocyte cryopreservation. Because observation period is still short, we haven’t had any case that got pregnant or delivered, yet. Conclusions: The number of patient who choose to underwent fertility preservation is increasing. We have actually started facing proposition, when we shall lay aside adjuvant therapy and let them plan to be conceived. Taking risk into account, we are now evaluating the safety of cancer treatment and outcome of each procedure which undergone multidisciplinary deliberate decision-making process.

Fertility Preservation in Adolescents and Young Adults With Cancer

2010 ◽  
Vol 28 (32) ◽  
pp. 4831-4841 ◽  
Author(s):  
Jennifer Levine ◽  
Andrea Canada ◽  
Catharyn J. Stern
Keyword(s):  
At Risk ◽  
Fertility Preservation ◽  
Ethical Issues ◽  
Reproductive Potential ◽  
Adolescent And Young Adult ◽  
Embryo Cryopreservation ◽  
Premature Menopause ◽  
High Dose ◽  
Vitro Fertilization

Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.

scholarly journals Fertility preservation in young patients with cancer

2015 ◽  
Vol 04 (03) ◽  
pp. 134-139 ◽  
Author(s):  
Virender Suhag ◽  
B. S. Sunita ◽  
Arti Sarin ◽  
A. K. Singh ◽  
Dashottar S.
Keyword(s):  
At Risk ◽  
Fertility Preservation ◽  
Ovarian Follicle ◽  
Reproductive Potential ◽  
Young Patients ◽  
Embryo Cryopreservation ◽  
Premature Menopause ◽  
High Dose ◽  
Future Fertility

AbstractInfertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

Communication and cancer-related infertility

2017 ◽  
Author(s):  
Zeev Rosberger ◽  
Sylvie Aubin ◽  
Barry D. Bultz ◽  
Peter Chan
Keyword(s):  
Decision Making ◽  
Fertility Preservation ◽  
Healthcare Providers ◽  
Treatment Completion ◽  
Embryo Cryopreservation ◽  
Cancer Therapies ◽  
Sperm Cryopreservation ◽  
Men And Women ◽  
The Right ◽  
The Continuum

Cancer and cancer therapies (e.g. surgery, chemotherapy, radiation) may have a significant impact on fertility for both young men and women, resulting in distress regarding future parenting options. Fertility preservation (FP) is available through sperm cryopreservation and for women through oocyte or embryo cryopreservation. While normal fertility will occur after treatment for many patients in the survivorship phase, assisted reproductive therapy (ART) may be the only option for some. Because of this uncertainty, healthcare providers must discuss this challenge immediately after diagnosis to facilitate decision-making regarding FP, and at all points along the continuum with patients and their families to ensure that the right information and choices are clearly shared. Research has shown that timely communication can result in successful outcomes for patients wishing to have children after treatment completion.

scholarly journals Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

2013 ◽  
Vol 31 (19) ◽  
pp. 2500-2510 ◽  
Author(s):  
Alison W. Loren ◽  
Pamela B. Mangu ◽  
Lindsay Nohr Beck ◽  
Lawrence Brennan ◽  
Anthony J. Magdalinski ◽  
...  
Keyword(s):  
Health Care ◽  
Fertility Preservation ◽  
Clinical Oncology ◽  
Health Care Providers ◽  
Randomized Clinical Trials ◽  
Case Series ◽  
Cochrane Collaboration ◽  
Embryo Cryopreservation ◽  
Care Providers ◽  
American Society

Purpose To update guidance for health care providers about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. Results There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. Recommendations As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.

American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients

2006 ◽  
Vol 24 (18) ◽  
pp. 2917-2931 ◽  
Author(s):  
Stephanie J. Lee ◽  
Leslie R. Schover ◽  
Ann H. Partridge ◽  
Pasquale Patrizio ◽  
W. Hamish Wallace ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Expert Panel ◽  
Case Reports ◽  
Full Range ◽  
Case Series ◽  
Embryo Cryopreservation ◽  
Preservation Methods ◽  
Online Databases ◽  
American Society ◽  
Clinician Judgment

Purpose To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. Methods An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. Results The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. Recommendations As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. Conclusion Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.

Features of the ovarian reserve of women of reproductive age suffering from autoimmune diseases

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 27-30
Author(s):  
Elena N. Andreeva ◽  
Olga R. Grigoryan ◽  
Yulia S. Absatarova ◽  
Irina S. Yarovaya ◽  
Robert K. Mikheev
Keyword(s):  
Type 1 Diabetes ◽  
Thyroid Gland ◽  
Autoimmune Diseases ◽  
Ovarian Reserve ◽  
Reproductive Potential ◽  
Reproductive Age ◽  
Control Group ◽  
Antithyroid Antibodies ◽  
Healthy Women

The reproductive potential of a woman depends on indicators of the ovarian reserve, such as the anti-Muller hormone (AMH) and the number of antral follicles (NAF). Autoimmune diseases have a significant effect on fertility and contribute to the development of premature ovarian failure. Aim.To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women. Materials and methods.In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women. Results.In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found. Conclusion.The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.

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