Efficacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases

Jadoul, Pascale; Guilmain, Apolline; Squifflet, Jean-Luc; Luyckx, Mathieu; Votino, Raffaella; Wyns, Christine; Dolmans, Marie-Madeleine

doi:10.1093/humrep/dex040

Cited by 174 publications

(126 citation statements)

References 42 publications

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“…Although this number seems quite low, it reflects that these are good‐prognosis patients without disseminated disease, so their 5‐year survival rate is better than in the general cancer population. This is also in accordance with observations from other groups performing OTC . Those most likely to die from their disease were individuals with upper gastrointestinal cancers, neuroblastomas and sarcomas with a 100% risk, 33% risk and 31% risk, respectively.…”

Section: Discussionsupporting

confidence: 91%

Prevalence of deaths in a cohort of girls and women with cryopreserved ovarian tissue

Macklon

2019

Acta Obstet Gynecol Scand

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Introduction Ovarian tissue cryopreservation (OTC) is increasingly offered to women in need of fertility preservation. However, little is known about the risk of these women dying before they use the preserved material. Material and methods From 1999 to 2016, 927 girls and women underwent OTC in our center, before receiving gonadotoxic treatment. All patients were without disseminated disease and with an estimated chance of survival after 5 years of >50%. For each patient the specific indication for OTC was noted, and through a national registry linked to a personal identification number, we were able to identify those who had died and the date and cause of death. Results By December 2017, 124/927 patients had died from their disease (13%). The highest relative prevalence of death was seen in patients with liver cancer (2/2; 100%), gall bladder cancer (2/2; 100%), stomach cancer (1/1; 100%), hemophagocytic lymphohistiocytosis (2/3; 66%), scleroderma (1/2; 50%), and sarcoma (24/78; 31%). The lowest risk of dying was seen in the group of individuals with non‐Hodgkin lymphoma (3/30; 10%) and breast cancer (31/313; 10%). The shortest time from OTC to death was seen in those with hemophagocytic lymphohistiocytosis (mean interval 0.25 years), gall bladder cancer, non‐Hodgkin disease and acute myeloid leukemia (mean interval 0.7 years) and the longest time from OTC to death was in women with breast cancer (mean interval 3.4 years). Of those who died, 34 had received chemotherapy at some point before OTC, indicating a relapse or non‐responsiveness to the initial treatment. Conclusions Patients with upper gastrointestinal cancers and sarcoma had the highest risk of dying from their disease. Breast cancer patients had the lowest risk. This knowledge may guide clinicians in their decisions on whether to offer OTC to girls and younger women with a life‐threatening disease.

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Section: Discussionsupporting

confidence: 91%

Prevalence of deaths in a cohort of girls and women with cryopreserved ovarian tissue

Macklon

2019

Acta Obstet Gynecol Scand

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“…If we take into account only living patients who are currently 18 years of age or older, the utilization rate is 2.2% (3/149) of the population. This utilization rate is lower than that estimated by Jadoul et al which was 3.9%, but those patients had an average age of 22.3 ± 8.8 years at the time of OTC.…”

Section: Discussioncontrasting

confidence: 63%

Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center

Poirot

Brugières

Yakouben

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The preservation of fertility is an integral part of care of children requiring gonadotoxic treatments for cancer or non‐malignant diseases. In France, the cryopreservation of ovarian tissue has been considered and has been offered as a clinical treatment since its inception. The aim of this study is to review 20 years of activity in fertility preservation by ovarian tissue cryopreservation (OTC) for children and the feasibility of oocyte isolation and cryopreservation from the ovarian tissue at a single center. Material and methods Retrospective study including patients aged 15 years or younger who underwent OTC, combined for some with oocyte cryopreservation of isolated oocytes, before a highly gonadotoxic treatment for malignant or non‐malignant disease was initiated. We describe the evolution of activities in our program for fertility preservation and patient characteristics at the time of OTC and follow up. Results From April 1998 to December 2018, 418 girls and adolescents younger than 15 years of age underwent OTC, representing 40.5% of all females who have had ovarian tissue cryopreserved at our center. In all, 313 patients had malignant diseases and 105 had benign conditions. Between November 2009 and July 2013, oocytes were isolated and also cryopreserved in 50 cases. The mean age of patients was 6.9 years (range 0.3‐15). The most frequent diagnoses in this cohort included neuroblastoma, acute leukemia and hemoglobinopathies; neuroblastoma being the most common diagnosis in very young patients. During follow up, three patients requested the use of their cryopreserved ovarian tissue. All had undergone ovarian tissue transplantation, one for puberty induction and the two others for restoring fertility. So far, no pregnancies have been achieved. Eighty‐four patients who had OTC died. Conclusions Ovarian tissue cryopreservation is the only available technique for preserving fertility of girls. To our knowledge this is the largest series of girls and adolescents younger than 15 years so far reported on procedures of OTC before highly gonadotoxic treatment in a single center.

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“…Although the overall efficiency of fertility restoration following ovarian tissue preservation and transplantation is unknown, recent evidence from defined cohorts of patients suggests a ~30% live birth rate after autotransplantation of slow frozen-thawed ovarian cortex, (Jadoul et al, 2017;Keden et al, 2018). When fertility preservation strategies require the removal of the whole ovary and it is age appropriate to do so, ovarian cortex harvest and cryopreservation can be most effectively combined with methods for in vitro maturation and vitrification of MII oocytes to maximize the likelihood of a future successful pregnancy outcome for the patient.…”

Section: Ovarian Tissue Preservationmentioning

confidence: 99%

Preservation of female fertility in humans and animal species

Picton¹

2018

Anim Reprod

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A detailed understanding of the cryobiology of gametes and complex tissues has led to the development of methods that facilitate the successful low temperature banking of isolated mature human oocytes, or immature oocytes in situ within fragments of human ovarian cortex. Although many outstanding research challenges remain to be addressed, the successful development of new treatments to preserve female fertility for a range of clinical indications has largely been underpinned by the conduct of extensive, fundamental research on oocytes and ovarian tissues from a number of laboratory and commercially important farm species. Indeed, the most recent evidence from large animals suggests that it is also possible to cryopreserve intact whole ovaries along with their supporting vasculature for later autotransplantation and restoration of natural fertility. This review will explore how the methods developed to preserve human oocytes and ovarian tissues can now be used strategically to support the development of conservation strategies aimed at safeguarding the genetic diversity of commercially important domestic animals and also of preserving the female germplasm for wild animals and endangered species.

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Efficacy of ovarian tissue cryopreservation for fertility preservation: lessons learned from 545 cases

Abstract: ClinicalTrials.gov Registration ID: CRYOFONOV01.

Cited by 174 publications

References 42 publications

Prevalence of deaths in a cohort of girls and women with cryopreserved ovarian tissue

Prevalence of deaths in a cohort of girls and women with cryopreserved ovarian tissue

Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center

Preservation of female fertility in humans and animal species

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