Ovarian tissue cryopreservation in a patient with breast cancer during pregnancy: a case report

Abstract Background Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases, especially those needing chemo- or radiotherapy, is becoming routine in various Western countries. Our hospital is the first and until now the only centre in China to use this method. The question of whether treatment of breast cancer during pregnancy (PrBC) should be similar to non-pregnant young patients with breast cancer is controversial. To our knowledge, this is the first report worldwide to use OTC as fertility preservation for PrBC. Case presentation During the 29th week of pregnancy, a 24-year-old woman underwent needle aspiration cytology of a left breast tumour. Ultrasound and cytology revealed BI-RADS 4a grade. Oncologists recommended termination of the pregnancy. Caesarean section was performed at week 32, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were cryopreserved. It is estimated that 13,000 follicles were cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy was started within 1 week after diagnosis. After six courses of neoadjuvant chemotherapy, targeted drug therapy and goserelin acetate, left mastectomy and left axillary lymph node dissection were performed. In total, 23 doses of radiotherapy, eight trastuzumab targeted therapy treatments, and 17 pertuzumab + trastuzumab double targeted therapy treatments were performed after breast cancer surgery. Until now, more than 2 years after delivery, the ovarian function still is good, and no signs of a negative impact of OTC have been observed. Goserelin acetate injections, administered every 28 days, are planned to last for the next 5 years. In addition, endocrine therapy with anastrozole was started after breast cancer surgery and also is scheduled for 5 years. Conclusion OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy or chemotherapy, which is essential for effective treatment of breast cancer. We assess this method as a promising fertility preservation method which was used here for the first time worldwide in a patient who developed breast cancer during pregnancy.

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Ovarian Tissue Cryopreservation in a Patient with Breast Cancer During Pregnancy: A Case Report

10.21203/rs.3.rs-824318/v1 ◽

2021 ◽

Author(s):

Jiaojiao Cheng ◽

Xiangyan Ruan ◽

Juan Du ◽

Fengyu Jin ◽

Yanglu Li ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Targeted Therapy ◽

Neoadjuvant Chemotherapy ◽

Fertility Preservation ◽

Ovarian Tissue ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Ovarian Tissue Cryopreservation ◽

Tissue Cryopreservation

Abstract Background: Fertility preservation using ovarian tissue cryopreservation (OTC) in patients with certain diseases especially needing chemo- or radiotherapy is becoming a routine management in various Western countries. Our hospital is the first and until now the only center in China using this method. The question is controversial, if treatment of breast cancer during pregnancy (PrBC) should be similar like for non-pregnant young patients with breast cancer. To our knowledge this worldwide is the first report using OTC as fertility preservation for PrBC. Case presentation: During the 29th week of the pregnancy of a 24-year-old woman needle aspiration cytology of a left breast tumor showed cancer cells. The ultrasound revealed BI-RADS 4a grade. Oncologists recommended the termination of pregnancy. Cesarean section at week 32 was performed, and ovarian tissue samples were collected for OTC to preserve fertility and ovarian endocrine function. Twenty-three ovarian cortex slices were slowly programmed cryopreserved. It is estimated that 13000 follicles have been cryopreserved. Breast nodules and sentinel lymph node biopsy suggested invasive micropapillary carcinoma. Neoadjuvant chemotherapy within 1 week after diagnosis was started. After six courses of neoadjuvant chemotherapy, targeted drug therapy, and Goselin acetate, left mastectomy and left axillary lymph node dissection were performed. In total twenty-three times of radiotherapy, eight trastuzumab targeted therapy, and 17 pertuzumab + trastuzumab double targeted therapy was performed after breast cancer surgery. Until now, more than two years after delivery the ovarian function still is good. We do not see any signs of a negative impact of OTC. The injections of goserelin acetate, every 28 days, are planned to last for the next five years. In addition endocrine therapy with anastrozole, started after the breast cancer surgery, also is scheduled for five years. Conclusion: OTC for fertility preservation in patients with PrBC does not delay breast surgery, radiotherapy, or chemotherapy which is essential for an effective treatment of breast cancer. We assess this method as a promising fertility preservation method, worldwide for the first time now also used in a patient getting breast cancer in pregnancy.

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Ovarian Metastasis of Breast Cancer Found During Ovarian Tissue Cryopreservation for Fertility Preservation: A Case Report

Frontiers in Medical Case Reports ◽

10.47746/fmcr.2021.2205 ◽

2021 ◽

Vol 02 (02) ◽

Author(s):

Fabien KRIEF ◽

Charlotte SONIGO ◽

Michael GRYNBERG

Keyword(s):

Breast Cancer ◽

Case Report ◽

Fertility Preservation ◽

Ovarian Tissue ◽

Ovarian Metastasis ◽

Ovarian Tissue Cryopreservation ◽

Tissue Cryopreservation

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Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer

JCO Global Oncology ◽

10.1200/go.21.00153 ◽

2022 ◽

Author(s):

Shah Zeb Khan ◽

Luca Arecco ◽

Cynthia Villarreal-Garza ◽

Bhawna Sirohi ◽

Noam F. Ponde ◽

...

Keyword(s):

Breast Cancer ◽

Fertility Preservation ◽

Young Women ◽

Ovarian Tissue ◽

Ovarian Tissue Cryopreservation ◽

Middle Income ◽

Middle Income Countries ◽

Knowledge Practice ◽

Tissue Cryopreservation ◽

Low And Middle Income

PURPOSE Fertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues. METHODS A 19-item questionnaire adapted from an international survey exploring issues about fertility preservation and pregnancy after breast cancer was sent by e-mail between November 2019 and January 2020 to physicians from LMICs involved in breast cancer care. Descriptive analyses were performed. RESULTS A total of 288 physicians from Asia, Africa, America, and Europe completed the survey. Median age was 38 years. Responders were mainly medical oncologists (44.4%) working in an academic setting (46.9%). Among responders, 40.2% and 53.8% reported having never consulted the available international guidelines on fertility preservation and pregnancy after breast cancer, respectively. 25.0%, 19.1%, and 24.3% of responders answered to be not at all knowledgeable about embryo, oocyte, or ovarian tissue cryopreservation, respectively; 29.2%, 23.6%, and 31.3% declared that embryo, oocyte, and ovarian tissue cryopreservation were not available in their countries, respectively. 57.6% of responders disagreed or were neutral on the statement that controlled ovarian stimulation can be considered safe in patients with breast cancer. 49.7% and 58.6% of responders agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence overall or only in those with hormone receptor–positive disease, respectively. CONCLUSION This survey showed suboptimal knowledge, practice, and attitudes of physicians from LMICs on fertility preservation and pregnancy after treatment completion in young women with breast cancer. Increasing awareness and education on these aspects are needed to improve adherence to available guidelines and to promote patients' oncofertility counseling.

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Fertility Preservation

10.2310/obg.19100 ◽

2018 ◽

Author(s):

Chantae S Sullivan-Pyke ◽

Clarisa Gracia

Keyword(s):

Fertility Preservation ◽

Ovarian Tissue ◽

Testicular Tissue ◽

Mature Oocyte ◽

Gonadotropin Releasing Hormone ◽

Oocyte Cryopreservation ◽

Ovarian Tissue Cryopreservation ◽

Embryo Cryopreservation ◽

Gonadotropin Releasing Hormone Agonist ◽

Tissue Cryopreservation

Fertility preservation has becoming increasingly important for patients at risk for gonadal failure, including those needing treatment for cancer or autoimmune conditions, genetic conditions that predispose to gonadal insufficiency, and age-related fertility decline. Embryo cryopreservation and mature oocyte cryopreservation are the standards for fertility preservation in postpubertal women. Ovarian tissue cryopreservation and gonadotropin-releasing hormone agonist use for ovarian suppression are experimental methods that may be offered to patients for whom embryo and/or mature oocyte cryopreservation are not applicable. The cryopreservation of spermatozoa is the standard for fertility preservation in postpubertal males, but testicular tissue cryopreservation may be offered to prepubertal males. This review contains 10 figures, 6 tables and 53 references Key words: controlled ovarian stimulation, embryo cryopreservation, gonadotropin-releasing hormone agonist, in vitro maturation, oocyte cryopreservation, ovarian tissue cryopreservation, sperm extraction, testicular tissue cryopreservation

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Deliveries following fertility preservation by ovarian tissue cryopreservation without autotransplantation—what should be expected?

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-018-1341-z ◽

2018 ◽

Vol 36 (2) ◽

pp. 335-340 ◽

Cited By ~ 3

Author(s):

Daniel Lantsberg ◽

Adel Farhi ◽

Inna Zaslavsky-Paltiel ◽

Barbara G. Silverman ◽

Liat Lerner-Geva ◽

...

Keyword(s):

Fertility Preservation ◽

Ovarian Tissue ◽

Ovarian Tissue Cryopreservation ◽

Tissue Cryopreservation

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P–466 Fertility preservation for medical reasons: International and intra-national variation in provision and the gap between guideline and practice

Human Reproduction ◽

10.1093/humrep/deab130.465 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

E Yasmin ◽

S Latif ◽

C Dia. Garcia ◽

S. Martin. D Silva

Keyword(s):

Northern Ireland ◽

Fertility Preservation ◽

Ovarian Tissue ◽

National Policy ◽

Cytotoxic Agents ◽

Ovarian Tissue Cryopreservation ◽

The Uk ◽

And Storage ◽

Tissue Cryopreservation ◽

Health Boards

Abstract Study question What is the gap between guidance and practice of fertility preservation between countries and within countries with common clinical guidelines? Summary answer Substantial variation in provision of FP exists between countries and within individual countries with gaps between national and international guidelines and policies governing provision. What is known already A robust guideline on female FP was published by ESHRE in 2020, advising the application of FP in cancer and other conditions where treatment with cytotoxic agents or surgery will compromise reproductive function. Across Europe, in 13 countries (43.3%) FP is funded for all available FP procedures, in 13 countries (43.3%) no FP funding is available, and in 4 countries (13.3%) at least one FP option is funded. Variation in state provision of fertility care in different countries in Europe was highlighted in the ESHRE guidance. It did not specifically examine individual national policies or whether a national policy exists. Study design, size, duration Five clinicians performing FP in Europe were contacted to collect current FP provision data. Policies retrieved from the internet were not included as they could not be verified. Finally, FP funding policies for 135 Clinical Commissioning Groups (CCGs) in England, 14 Health Boards in Scotland, 7 Health Boards in Wales and 5 Trusts in Northern Ireland and 17 policies for regional heath services in Spain were included were included. Participants/materials, setting, methods Policies on FP for the UK and Spain were reviewed (n = 178), including policies from the 161 regions from the four nations of the UK and policies of 17 autonomous bodies in Spain. Information on funded procedures, type of conditions included for funding and duration of storage were extracted. The provision of FP was compared to the current European Society of Human Reproduction and Embryology (ESHRE) and National Institute for Health and Care Excellence (NICE) guidelines. Main results and the role of chance In England, 127/128 (99%) CCGs fund cryopreservation of oocytes, sperm and embryos. Cancer is the exclusive indication in 11%. Provision of FP for transgender individuals is specified in 28%, ovarian tissue cryopreservation is funded in 8% and storage funding varies from five to ten years. In Scotland, a national policy is applied. All 14 health boards equitably fund cryopreservation of oocytes, sperm, embryos and ovarian and testicular tissue. Funding is provided for cancer, medical conditions which may impair fertility and transgender individuals. Storage funding is based on a five yearly review until age 43 in women and 60 in men. In Wales and Northern Ireland, cryopreservation of oocytes, sperm and embryos is funded for people undergoing medical or surgical treatment that is likely to make them infertile, provision for transgender individuals is not specified and ovarian tissue cryopreservation is not funded. In Spain, all 17 Health Services fund cryopreservation of oocytes, sperm and embryos for patients whose fertility is at risk due to gonadotoxic treatments or other pathological processes. Ovarian tissue cryopreservation is funded in 94%, provision for transgender individuals is specified in 12%, and storage funding is available until the age of 50 in women and 55 in men. Limitations, reasons for caution Inability to retrieve fertility preservation policies for every country in Europe is a limitation, for which ongoing collaboration is sought. The variable nature of FP provision is likely to be multi-factorial; a lag in publication of guidelines and updated policies, ethical considerations and resource distribution may govern health policies. Wider implications of the findings: The study highlights that provision of FP not only varies between countries but is also inconsistent within the same country. It is clear that there is a gap between ideal, evidence-based practice and actual provision. Variation in policies limits uniform access to care for patients. Trial registration number Not applicable.

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O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

Human Reproduction ◽

10.1093/humrep/deab127.081 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Sellami ◽

M Grynberg ◽

A Benoit ◽

C Sifer ◽

A Mayeur ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Fertility Preservation ◽

Cancer Diagnosis ◽

Ovarian Tissue ◽

Young Patients ◽

Oocyte Retrieval ◽

Breast Cancer Patients ◽

Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

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