Fertility considerations prior to conservative management of gynecologic cancers

2020 ◽  
pp. ijgc-2020-001783
Author(s):  
Katherine Stewart ◽  
Sukhkamal Campbell ◽  
Michael Frumovitz ◽  
Pedro T Ramirez ◽  
Laurie J McKenzie
Keyword(s):  
Assisted Reproductive Technologies ◽  
Early Stage ◽  
Standard Of Care ◽  
Reproductive Technologies ◽  
Success Rates ◽  
Gynecologic Cancers ◽  
Treatment Algorithms ◽  
Fertility Sparing ◽  
Fertility Potential ◽  
Oncologic Treatment

Fertility-sparing management of early-stage gynecologic cancers is becoming more prevalent as increasing evidence demonstrates acceptable oncologic and reproductive outcomes in appropriately selected patients. However, in the absence of randomized controlled trials, most of the commonly used treatment algorithms are based only on observational studies. As women are increasingly postponing childbearing, the need for evidence-based guidance on the optimal selection of appropriate candidates for fertility-sparing therapies is paramount. It is imperative to seriously consider the fertility potential of a given individual prior to making major oncologic treatment decisions that may deviate from the accepted standard of care. It is a disservice to patients to undergo a fertility-sparing procedure in hopes of ultimately achieving a live birth, only to determine later they have poor baseline fertility potential or other substantial barriers to conception including excess financial toxicity. Many women with oncologic diagnoses are of advanced maternal age and their obstetric and neonatal risks must be considered. In the era of advanced assisted reproductive technologies, patients should be provided realistic expectations regarding success rates while understanding the potential oncologic perils. A multidisciplinary approach to the conservative treatment of early-stage gynecologic cancers with early referral to reproductive specialists as well as maternal-fetal medicine specialists is warranted. In this review, we discuss the recommended fertility evaluation for patients with newly diagnosed, early-stage gynecologic cancers who are considering fertility-sparing management.

174 What Quality and Fertility Should We Expect When Using Semen Cryopreservation and AI with Livestock? a Comparison Across Species

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 113-113
Author(s):  
Phillip H Purdy
Keyword(s):  
Artificial Insemination ◽  
Germ Plasm ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Educational Opportunities ◽  
Success Rates ◽  
Agricultural Producers ◽  
Scientific Communities ◽  
Semen Cryopreservation ◽  
Agricultural Species

Abstract Assisted reproductive technologies (ART) can be used across most agricultural species and will result in some degree of fertility when employed correctly. Still, conversations with agricultural producers and scientists (corporate, academic, governmental) repeatedly reveal that they do not know what success rates they should anticipate when using some ARTs, specifically semen cryopreservation and artificial insemination, with agricultural species (beef and dairy cattle, goats, pigs, poultry, sheep). These perceptions hinder ART application within the agricultural and scientific communities. Understanding these expected results is a critical component that is used to guide the USDA National Animal Germplasm Program laboratory operations for collecting, freezing and using germ plasm (semen, eggs, embryos, DNA, tissues, organs, cells), has consequently resulted in growth of the national collection, and provided tools, technologies, and educational opportunities for agricultural producers with documented success. Therefore, the intent of this presentation is to provide an overview of what results should be expected when using semen cryopreservation and artificial insemination across livestock species, explain the factors that influence successful use of these ARTs, which should encourage a more broad acceptance of their use with all agricultural species, and discuss opportunities for research and optimization that will improve fertility when using these technologies.

scholarly journals Intrinsic and Extrinsic Factors Predicting the Cumulative Outcome of IVF / ICSI Treatment

2019 ◽  
Vol 9 (2S) ◽  
pp. 269-273 ◽  
Keyword(s):  
Assisted Reproductive Technologies ◽  
Sperm Quality ◽  
Reproductive Technologies ◽  
Process Time ◽  
Success Rates ◽  
Embryo Viability ◽  
Extrinsic Factors ◽  
Response Level ◽  
Female Population ◽  
Incident Cases

Infertility rates in India becoming increased in last decade principally due to the urbanization conditions and the lifestyle habits. It is giving alarm by continuously reporting the progress in incident cases of infertility amongst the young Indian adults of both male and female population. Among the various Assisted Reproductive Technologies (ART) available today in the treatment of infertility, In Vitro Fertilization (IVF) is found to be the most applicable treatment method of choice. This involves the administration of different hormones and drugs to treat infertility. In the present scenario technically IVF treatment process is tedious, laborious, high cost and most importantly success rates reported to be very low (20-30%). The prediction of IVF success rates is becoming an important scientific knowledge and practice, which helps both the doctor and the candidate couple to know about the conditions hence to take the right decision. The accurate prediction of the IVF success rate is really a challenging task in obstetrics and gynecology medicine. The success rates of the IVF depends on the various factors such as Intrinsic factors i.e, Genetic predisposition, Age, Body mass Index, Hormonal balance, Embryo viability, Sperm quality, Endometriosis and overall patient’s response level of the candidate couple and the Extrinsic factors such as Medical equipment technology, Treatment methods, Personal experiences of clinicians and embryologists, Process time, Stress due to the lifestyle etc.

Embryo Culture Conditions and the Epigenome

2018 ◽  
Vol 36 (03/04) ◽  
pp. 211-220 ◽  
Author(s):  
Sneha Mani ◽  
Monica Mainigi
Keyword(s):  
Embryo Culture ◽  
Assisted Reproductive Technologies ◽  
Culture Media ◽  
Reproductive Technologies ◽  
Common Mechanism ◽  
Success Rates ◽  
Blastocyst Development ◽  
Increased Risk ◽  
Modifiable Factors

AbstractAssisted reproductive technologies (ARTs) lead to an increased risk for pregnancy complications, congenital abnormalities, and specific imprinting disorders. Epigenetic dysfunction is thought to be one common mechanism which may be affecting these outcomes. The timing of multiple ART interventions overlaps with developmental time periods that are particularly vulnerable to epigenetic change. In vitro embryo culture is known to impact blastocyst development, in vitro fertilization (IVF) success rates, as well as neonatal outcomes. Embryo culture, in contrast to other procedures involved in ART, is obligatory, and has the highest potential for causing alterations in epigenetic reprograming. In this review, we summarize progress that has been made in exploring the effects of embryo culture, culture media, and oxygen tension on epigenetic regulation in the developing embryo. In humans, it is difficult to isolate the role of embryo culture on epigenetic perturbations. Therefore, additional well-controlled animal studies isolating individual exposures are necessary to minimize the epigenetic effects of modifiable factors utilized during ART. Findings from these studies will likely not only improve IVF success rates but also reduce the risk of adverse perinatal outcomes.

scholarly journals Follicular Metabolites-Assisted Clinical Evaluation of IVF/ICSI Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Bing Qu ◽  
Yunhe Xiong ◽  
Xiaofan Yu ◽  
Jinli Ding ◽  
Jing Weng ◽  
...  
Keyword(s):  
Assisted Reproductive Technologies ◽  
Sperm Quality ◽  
Public Health Problem ◽  
Decisive Role ◽  
Reproductive Technologies ◽  
Sperm Parameters ◽  
Success Rates ◽  
Vitro Fertilization ◽  
Icsi Outcomes

As infertility became a significant public health problem, assisted reproductive technologies (ARTs) were introduced. However, the fertilization rate of in vitro fertilization (IVF) per cycle varied, and patients needed to repeat IVF or change to intracytoplasmic sperm injection (ICSI). Here, 75 couples suffering from female fallopian tubal blockage (tubal group) and 42 spouses beset by male abnormal sperm status (dysspermia group) were recruited. We comprehensively explored the relationship among couples’ clinical factors, follicular metabolites, and IVF/ICSI stepwise outcomes. IVF/ICSI outcomes were affected by follicular metabolites and physical status in both women and men, regardless of which side infertility came from. Particularly, in the tubal group, the energy supporting pathways—glycolysis and pyruvate metabolism—were most essential in follicles, and IVF/ICSI outcomes were also related to sperm parameters. However, in the dysspermia group, in addition to sperm conditions, oocyte quality acted as a compensation for poor sperm quality, for which aminoacyl-tRNA biosynthesis and the related supporting metabolism were critical in the follicular environment, and ultimately played a decisive role in IVF/ICSI outcomes. The respective logistic regression models in combination with selective male sperm parameters, estradiol (E2), follicular alanine, glutamine, glycoprotein, lipid, and acetic acid, were constructed to predict IVF or ICSI outcomes. No matter which sex infertility comes from, factors from both men and women should be considered. The current study provides a feasible option for pre-IVF evaluation, as well as guidance for follow-up clinical intervention to improve IVF/ICSI success rates.

scholarly journals Cross-Sectional Survey Of Fertility Knowledge In Obstetrics And Gynecology Residents

2020 ◽  
Author(s):  
Leah May Roberts ◽  
Rashmi Kudesia ◽  
Huaqing Zhao ◽  
Shaliz Dolan ◽  
Marisa Rose
Keyword(s):  
Online Survey ◽  
Assisted Reproductive Technologies ◽  
Knowledge Score ◽  
The United States ◽  
Reproductive Technologies ◽  
Obstetrics And Gynecology ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Of Training

Abstract PURPOSE: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).METHODS: OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform.RESULTS: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all four years of training. Mean FIT-KS score was 21.2 (73% correct). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. CONCLUSIONS: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%)(1, 2).

scholarly journals A Cross-Sectional Survey Of Fertility Knowledge In Obstetrics And Gynecology Residents

2020 ◽  
Author(s):  
Leah May Roberts ◽  
Rashmi Kudesia ◽  
Huaqing Zhao ◽  
Shaliz Dolan ◽  
Marisa Rose
Keyword(s):  
Online Survey ◽  
Assisted Reproductive Technologies ◽  
Knowledge Score ◽  
The United States ◽  
Reproductive Technologies ◽  
Obstetrics And Gynecology ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Of Training

Abstract BACKGROUND: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).METHODS: OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5,000 OB-GYN residents in the country, 177 responded. RESULTS: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all four years of training. Mean FIT-KS score was 21.2 (73% correct; range 17-26). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. CONCLUSIONS: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%)(1, 2).

scholarly journals Use of an oncology sperm bank: a Canadian experience

2013 ◽  
Vol 3 (3) ◽  
pp. 219 ◽  
Author(s):  
Amanda Selk ◽  
Timea Belej-Rak ◽  
Heather Shapiro ◽  
Ellen Greenblatt
Keyword(s):  
Assisted Reproductive Technologies ◽  
Intrauterine Insemination ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Reproductive Technologies ◽  
Success Rates ◽  
Oncology Patients ◽  
Vitro Fertilization ◽  
Sperm Bank

Background: We performed a retrospective chart review in 2006to review oncology patients’ use of banked semen samples infertility treatments at a tertiary care centre.Methods: From 2002 to 2005, 367 oncology patients bankedsemen. During the same period, 31 patients used banked samplesin 48 treatment cycles. Samples were used for intrauterine insemination(IUI) in 28 cycles and for in vitro fertilization (IVF) withor without intracytoplasmic sperm injection (ICSI) in 20 cycles.Results: Pregnancy rates per cycle were 21% for IUI and 50%for IVF with or without ICSI. Overall, 16 of the 31 couples achieveda pregnancy with assisted reproductive technologies (52%).Conclusion: This data indicates high pregnancy success rates withthe use of banked semen samples from men with cancer.Contexte : Une revue rétrospective de dossiers a été effectuée afind’examiner le recours à des échantillons de sperme provenantde patients cancéreux pour le traitement de l’infertilité dans uncentre de soins tertiaires.Méthodes : Entre 2002 et 2005, des échantillons de spermeprovenant d’un total de 367 patients atteints de cancer ont été misen banque. Durant la même période, 31 patientes ont utilisé ceséchantillons au cours de 48 cycles de traitement. Les échantillonsont été utilisés pour insémination intra-utérine (IIU) lors de28 cycles et pour fertilisation in vitro (FIV) avec ou sans injectionintracytoplasmique de sperme (ICSI) lors de 20 cycles.Résultats : Le taux de grossesse par cycle était de 21 % avecl’IIU et de 50 % pour la FIV avec ou sans ICSI. Au total, 16 des31 patientes sont devenues enceintes (52 %).Conclusion : Ces données montrent des taux élevés de grossesseobtenus par l’utilisation d’échantillons de sperme provenantd’hommes atteints de cancer.

scholarly journals Endometriosis-Related Infertility: The Role of the Assisted Reproductive Technologies

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Eric S. Surrey
Keyword(s):  
Assisted Reproductive Technologies ◽  
Large Body ◽  
Ovarian Response ◽  
Reproductive Technologies ◽  
Invasive Disease ◽  
Definitive Treatment ◽  
Success Rates ◽  
Vitro Fertilization ◽  
Ovarian Endometriomas

The assisted reproductive technologies, particularly in vitro fertilization (IVF), represent the most efficient and successful means of overcoming infertility associated with endometriosis. Although older studies suggest that IVF outcomes are compromised in endometriosis patients, more contemporary reports show no differences compared to controls. The exception may be evidence of poorer outcomes and diminished ovarian response in women with advanced disease, particularly those with significant ovarian involvement or prior ovarian surgery. Prolonged pre-IVF cycle suppressive medical therapy, particularly gonadotropin releasing hormone agonists, appears to improve success rates in a subset of endometriosis patients. However, as of yet, there is no diagnostic marker to specifically identify those who would most benefit from this approach. Pre-IVF cycle surgical resection of nonovarian disease has not been consistently shown to improve outcomes with the possible exception of resection of deeply invasive disease, although the data is limited. Precycle resection of ovarian endometriomas does not have benefit and should only be performed for gynecologic indications. Indeed, there is a large body of evidence to suggest that this procedure may have a deleterious impact on ovarian reserve and response. A dearth of appropriately designed trials makes development of definitive treatment paradigms challenging.

scholarly journals Fertility preservation in reproductive-age women facing gonadotoxic treatments

2015 ◽  
Vol 22 (4) ◽  
pp. 294 ◽  
Author(s):  
J. Roberts ◽  
R. Ronn ◽  
N. Tallon ◽  
H. Holzer
Keyword(s):  
Fertility Preservation ◽  
Multidisciplinary Approach ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Future Fertility ◽  
Fertility Sparing ◽  
Cure Rates ◽  
Reproductive Consequences

BackgroundAdvancements in the treatments for cancer and autoimmune and other hematologic conditionscontinue 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.ResultsAccording to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies.ConclusionsTo ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral. 

scholarly journals A Cross-Sectional Survey of Fertility Knowledge in Obstetrics and Gynecology Residents

2020 ◽  
Author(s):  
Leah May Roberts ◽  
Rashmi Kudesia ◽  
Huaqing Zhao ◽  
Shaliz Dolan ◽  
Marisa Rose
Keyword(s):  
Online Survey ◽  
Assisted Reproductive Technologies ◽  
Knowledge Score ◽  
The United States ◽  
Reproductive Technologies ◽  
Obstetrics And Gynecology ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Of Training

Abstract PURPOSE: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).METHODS: OB-GYN residents in the United States were recruited through an email to all residency directors nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5,000 OB-GYN residents in the country, 177 responded. RESULTS: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all four years of training. Mean FIT-KS score was 21.2 (73% correct; range 17-26). No statistically significant differences were noted across the level of training (p=0.23). Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however, overestimated their success rates per cycle. CONCLUSIONS: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%)(1, 2).

Sign in / Sign up

Export Citation Format

Share Document