Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process

Abstract

International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP.

Feasibility and efficiency of delayed ovarian stimulation and oocyte banking for fertility preservation after fertility-impairing treatment

“…An increasing number of authors are focusing their research on FP for nonmalignant diseases [2]. Legrand et al reported that oocyte banking in women treated for benign ovarian tumors is an e cient strategy, with a mean of 7.0 (± 5.23 SD) cryopreserved oocytes per woman, irrespective of the histological type of tumor [13].…”

“…The secondary endpoints were as follows: (1) the total number of COS cycles performed per woman; (2) the COS cycle cancellation rate for no ovarian response; (3) the oocyte retrieval failure rate; and (4) the CLBR per stimulation cycle with fertilized oocyte, including fresh and frozen embryo transfers.…”

“…Since ovarian reserve diminishes progressively throughout the reproductive life span until menopause, any iatrogenic damage to the ovarian reserve may lead to premature ovarian insu ciency (POI) and infertility [1]. Emergency fertility preservation (FP) of germinal tissue or oocytes should be proposed when benign or malignant disease or therapy is likely to impair ovarian reserve [2]. Since the development of vitri cation, oocyte cryopreservation is the method advised for most women undergoing FP for medical indications [3].…”

Oocyte Cryopreservation in Patients with Endometriosis: Current Knowledge and Number Needed to Treat

“…If an OMA is accidentally punctured, the needle should be immediately withdrawn and flushed with media and the collecting tube should be changed [ 32 ]. According to the French recommendations, drainage—with a technique such as sclerotherapy—rather than cystectomy should be performed in first line if OMAs are too bulky and/or if they prevent easy access to the ovaries for retrieval [ 13 ].…”

“…They recommend offering FP for bilateral OMA > 3 cm or an OMA on a single ovary. They also suggest doing so before cystectomy if the ovaries are easily accessible for retrieval, in order to increase the number of oocytes cryopreserved [ 13 ].…”