Hot Topics on Fertility Preservation for Women and Girls—Current Research, Knowledge Gaps, and Future Possibilities

Abstract

Fertility preservation is a novel clinical discipline aiming to protect the fertility potential of young adults and children at risk of infertility. The field is evolving quickly, enriched by advances in assisted reproductive technologies and cryopreservation methods, in addition to surgical developments. The best-characterized target group for fertility preservation is the patient population diagnosed with cancer at a young age since the bulk of the data indicates that the gonadotoxicity inherent to most cancer treatments induces iatrogenic infertility. Since improvements in cancer therapy have resulted in increasing numbers of long-term survivors, survivorship issues and the negative impact of infertility on the quality of life have come to the front line. These facts are reflected in an increasing number of scientific publications referring to clinical medicine and research in the field of fertility preservation. Cryopreservation of gametes, embryos, and gonadal tissue has achieved quality standards for clinical use, with the retrieval of gonadal tissue for cryopreservation being currently the only method feasible in prepubertal children. Additionally, the indications for fertility preservation beyond cancer are also increasing since a number of benign diseases and chronic conditions either require gonadotoxic treatments or are associated with premature follicle depletion. There are many remaining challenges, and current research encompasses clinical health care and caring sciences, ethics, societal, epidemiological, experimental studies, etc.

Fertility-Sparing Surgery for Ovarian Cancer

“…Moreover, FSS can improve sexual function and the psychological wellbeing of patients, both of which are negatively impacted after cancer diagnosis and treatment [ 1 ]. Cryopreservation may also be an option prior to surgery if the risk of gonadal damage is high [ 2 ].…”

Restructuring healthcare services, routines and procedures on reproductive medicine based on respect for differences

“…Considering that the LGBT population approaching medical care has been growing, there is an increasing need for research aiming to specialize health care according to their specific needs ( Rodriguez-Wallberg et al ., 2021 ). In this sense the increasingly seeking to access reproductive services shed light on the optimal way to provide effective care to these patients ( Leung et al ., 2019 ).…”

“…Considering the transgender women, semen analysis is the most important tool for assessing sperm quality and help detect infertility-related problems. We know that the transition hormonal therapy with estrogens can impair fertility causing sperm alterations, such as lower sperm quality, which could complicate and limit the efficiency of reproductive procedures ( Sermondade et al ., 2021 ; Rodriguez-Wallberg et al ., 2021 ). Lower sperm quality in individuals that began gender affirming hormonal therapy presented high rates of sperm abnormalities, lower total sperm count and sperm concentration ( Rodriguez-Wallberg et al ., 2021 ).…”

“…We know that the transition hormonal therapy with estrogens can impair fertility causing sperm alterations, such as lower sperm quality, which could complicate and limit the efficiency of reproductive procedures ( Sermondade et al ., 2021 ; Rodriguez-Wallberg et al ., 2021 ). Lower sperm quality in individuals that began gender affirming hormonal therapy presented high rates of sperm abnormalities, lower total sperm count and sperm concentration ( Rodriguez-Wallberg et al ., 2021 ). However, some studies demonstrated that even before the introduction of hormonal therapy, transwomen sperm parameters seemed slightly altered compared to those from healthy sperm donors ( Rodriguez-Wallberg et al ., 2021 ; Sermondade et al ., 2021 ).…”

Fertility Preservation: How to Preserve Ovarian Function in Children, Adolescents and Adults

“…The goal of obtaining mature metaphase II (MII) oocytes following COS is not always achieved. Studies have been conducted to assess whether oocytes that have been retrieved at immature stages (germinal vesicle (GV) or metaphase I (MI)) can be matured in the IVF laboratory [26]. This process is known as in vitro maturation and has been shown to enhance oocyte and embryo yields in breast cancer patients undergoing COS for fertility preservation purposes [27].…”