Purpose To determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcome. The main purpose and research question of the study is to determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes. Methods Prospective study: 67 breast cancer patients between 18 and 40 years old, undergoing a fertility preservation by means of oocyte storage were considered. Inclusions criteria for the study were age between 18 and 40 years old, BMI between 18 and 28, breast cancer neoplasm stage I and II according to American Joint Committee on Cancer classification (2017) and no metastasis. Exclusion criteria: age over 40 years old, BMI < 18 and > 28, breast cancer neoplasm stage III and IV and do not performed the BRCA test. A total of 21 patients had not performed the test and were excluded. Patients were divided into four groups: Group A was composed by 11 breast cancer patients with BRCA 1 mutations, Group B was composed by 11 breast cancer patients with BRCA 2 mutations, Group C was composed by 24 women with breast cancer without BRCA mutations, and Group D (control) was composed by 181 normal women. Results Group A showed significant lower AMH levels compared to Group C and D (1.2 ± 1.1 vs 4.5 ± 4.1 p < 0.05 and 1.2 ± 1.1 vs 3.8 ± 2.5 p < 0.05). BRCA1 mutated patients showed a significant lower rate of mature oocytes (MII) compared to Group C (3.1 ± 2.3 vs 7.2 ± 4.4 p < 0,05) and Group D (3.1 ± 2.3 vs 7.3 ± 3.4; p < 0,05). Breast cancer patients needed a higher dose of gonadotropins compared to controls (Group A 2206 ± 1392 Group B2047.5 ± 829.9 Group C 2106 ± 1336 Group D 1597 ± 709 p < 0,05). No significant differences were found among the groups considering basal FSH levels, duration of stimulation, number of developed follicles, and number of total retrieved oocytes. Regarding BRCA2 mutation, no effect on fertility was shown in this study. Conclusions The study showed that BRCA1 patients had a higher risk of premature ovarian insufficiency (POI) confirmed by a diminished ovarian reserve and a lower number of mature oocytes suitable for cryopreservation.

Background Resumption of elective surgery during the current coronavirus disease 2019 pandemic crisis has been debated widely and largely discouraged. The aim of this prospective cohort study was to assess the feasibility of resuming elective operations during the current and possible future peaks of this coronavirus disease 2019 pandemic. Methods We collected data during the peak of the current pandemic in the United Kingdom on adult patients who underwent elective surgery in a “COVID-19-free” hospital from April 8 to May 29, 2020. The study included patients from various surgical specialties. Nonelective and pediatric cases were excluded. The primary outcome was 30-day mortality postoperatively. Secondary outcomes were the rate of coronavirus disease 2019 infections, new onset of pulmonary symptoms after hospitalization, and requirement for admission to the intensive care unit. Results A total of 309 consecutive adult patients were included in this study. No patients died nor required intensive care unit admission. Operations graded “Intermediate” were the most performed procedure representing 91% of the total number. One patient was diagnosed with a coronavirus disease 2019 infection after being transferred to the nearest local emergency hospital for management of postoperative pain secondary to common bile duct stone and was successfully treated conservatively on the ward. No patient developed pulmonary complications. Three patients were admitted for greater than 23 hours. Twenty-seven patients (8.7%) developed complications. Complications graded as 2 and 3 according to the Clavien-Dindo classification occurred in 14 and 2 patients, respectively. Conclusion This prospective study shows that, despite the severity and high transmissibility of novel coronavirus 2 disease, COVID-19-free hospitals can represent a safe setting to resume many types of elective surgery during the peak of a pandemic.

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breast cancer are frequently referred for fertility preservation treatment (FPT) consultation. Our objective was to identify predictive factors for FPT and fertility outcomes in breast cancer patients. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We analyzed 126 breast cancer patients, ages 18-42 years old, seen for FPT consultation at an academic fertility center from 2001-2017. We calculated proportions for patient diagnosis, demographics, type of FPT chosen, planned treatment, and in vitro fertilization (IVF) outcomes. Pearson chi-squared and Fisher's exact tests were performed to test for associations. RESULTS: Our cohort included 126 patients with a mean age of 33.6 + 4.9 years. Breast cancer stage, known in 106 patients, included 34.9% (n¼37) Stage 1, 50.0% (n¼53) Stage 2, 8.5% (n¼9) Stage 3, 6.6% (n¼7) Stage 4. At the time of consult, 15.1% (19/126) had prior chemotherapy and 12.7% (16/126) had prior radiation, while 79.4% (100/126) and 64.3% (81/126) had planned to receive chemotherapy and radiation, respectively. After counseling, 61.1% (77/126) underwent FPT. Treatment modalities included embryo cryopreservation 61.0% (47/77), oocyte cryopreservation 29.9% (23/ 77) and half embryo/half oocyte cryopreservation 9.1% (7/77). No patients underwent ovarian tissue cryopreservaton. Mean number of oocytes retrieved was 14.7 + 9.0. Significantly fewer oocytes were retrieved from patients with prior chemotherapy (avg. 5.9 + 6.2 with vs. 15.3 + 9.1 without, p<0.001) or prior radiation (avg. 9.5 + 7.8 with vs. 15.2 + 9.0 without, p<0.001). After FPT, 16.8% (13/77) of women subsequently attempted pregnancy with frozen embryos and no patients returned to utilize their frozen oocytes thus far. The clinical pregnancy rate was 21.7% (5/23) with a live birth rate of 17.9% (4/23) per transfer. Overall, 11 women had a clinical pregnancy (conceived naturally, with intrauterine insemination, or after embryo transfer) and 10 women had live births. Of patients that underwent FPT, 6.5% (5/77) died from breast cancer and did not utilize their frozen eggs or embryos. CONCLUSIONS: In our analysis of breast cancer patients seen for FPT consultation, over half underwent either embryo or oocyte cryopreservation. However, over the 16-year period, less than 20% returned to attempt pregnancy with frozen eggs or embryos and of those there was a less than 20% live birth rate. Further research is needed regarding utilization of FPT services in this group.

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OBJECTIVE: To demonstrate our technique of uterus transplantation into a living recipient using a deceased donor model. METHODOLOGY: We report the case of a recent successful uterus transplant from a deceased multi-organ donor. This video uses live action footage from surgery and detailed diagrams to review the process of enrollment into our research trial and the techniques used in the re-implantation procedure. Main outcome measures include warm and cold ischemia time, onset of menstrual cycling, ultrasound and MRI imaging, and histology from cervical biopsies.CONCLUSIONS: Uterine transplantation is a rapidly evolving surgical treatment for uterine factor infertility. Extensive coordination and planning is required for a successful outcome. In addition to the many live births already reported following uterus transplant, many more are anticipated in the coming months, as research efforts accelerate worldwide.

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