Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study

Díaz-García, César; Domingo, Javier; Garcia-Velasco, Juan A.; Herraiz, Sonia; Mirabet, Vicente; Iniesta, Ignacio; Cobo, Ana; Remohı́, José; Pellicer, António

doi:10.1016/j.fertnstert.2017.11.018

Cited by 158 publications

(128 citation statements)

References 31 publications

(63 reference statements)

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“…In the present study, breast cancer and hematological malignancies constitute the most common oncological indications for fertility preservation, which is in accordance with the existing studies . A recent report on fertility preservation for adult women in Spain showed that breast cancer and hematological malignancies accounted for 60.3% and 21.4% of indications for oocyte cryopreservation, respectively, while accounted for 53.9% and 29.6% for ovarian tissue cryopreservation.…”

Section: Discussionsupporting

confidence: 91%

A Japanese nationwide survey on the cryopreservation of embryos, oocytes and ovarian tissue for cancer patients

Sanada

Harada

Kunitomi

et al. 2019

J of Obstet and Gynaecol

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Aim The survival rates of cancer patients have greatly improved owing to the advances in oncology. The preservation of fertility in cancer patients is an important task. To determine the reality of cryopreservation of embryos, oocytes and ovarian tissue in cancer patients, large‐scale survey analysis was performed in Japan. Methods We sent 613 Japan Society of Obstetrics and Gynecology‐certified assisted reproductive technology institutions a questionnaire about their experience of performing cryopreservation for cancer patients between January 2011 and December 2015. Subsequently, the institutions that conducted cryopreservation for cancer patients were sent a second questionnaire. Results We received replies from 481 (78.5%) institutions. Among them, 126 (26.2%) conducted cryopreservation for cancer patients. These 126 institutions were sent a second questionnaire. Of these, 108 (85.7%) institutions responded. At the 108 institutions, 1085 embryo or oocyte cryopreservation procedures and 122 ovarian tissue cryopreservation procedures were conducted for cancer patients. Cryopreservation was mainly performed for breast cancer patients (~70%), followed by patients with hematological malignancy. A total of 361 and 19 embryo transfer cycles were performed for patients whose embryos and oocytes were cryopreserved, respectively, and 42 and seven institutions reported pregnancy outcomes after embryo transfer in patients that underwent embryo and oocyte cryopreservation, respectively. However, pregnancy was not observed in the seven cases that underwent ovarian tissue transfer. Conclusion Indications, age limits and ovarian stimulation protocols for cryopreservation widely varied between the institutions. A national registration system for oncofertility must be established to evaluate the safety and efficacy of the current system.

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Section: Discussionsupporting

confidence: 91%

A Japanese nationwide survey on the cryopreservation of embryos, oocytes and ovarian tissue for cancer patients

Sanada

Harada

Kunitomi

et al. 2019

J of Obstet and Gynaecol

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“…The efficacy of re‐transplantation of ovarian tissue compared with the use of vitrified oocytes has been reported in a previous study . Although a trend toward higher pregnancy and live birth rate was observed in 49 women who thawed oocytes vs 44 women after re‐transplantation (risk ratio [RR] 1.31, 95% CI .90‐1.92; RR 1.39, 95% CI .95‐2.03, respectively), it did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 83%

A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

Rodriguez‐Wallberg

Marklund

Lundberg

et al. 2019

Acta Obstet Gynecol Scand

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Introduction In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary‐care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients’ choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications. Material and methods Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi‐square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications. Results Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre‐pubertal (n = 48) and 73% of post‐pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002). Conclusions Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications.

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“…However, in the vast majority of cancer patients, only 1 round of stimulation will be possible, and the number of oocytes retrieved has been found to be negatively correlated with age, but not with the type of cancer . Although oocyte/embryo vitrification is currently used routinely for young women requiring FP, the evidence regarding outcomes of IVF for cancer patients who have returned to use their stored oocytes, is scarce. The hitherto largest study, counting a cohort of 80 cancer patients, recently reported a cumulative live birth rate in young cancer patients (≤35 years) of only around 40%, whereas the percentage was markedly higher (around 70%) in the age‐matched group of elective freezers .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, oocyte vitrification is only now being implemented as a standard procedure in Danish fertility clinics, and cryopreservation of embryos is still considered the most established and reliable procedure in many centers. The superiority of oocyte vitrification also needs to be proven in the context of OTC, and so far, only 1 study by Diaz‐Garcia et al, have compared the efficacy of oocyte vitrification with that of OTC in a single‐center setting. Diaz‐Garcia et al found a trend toward higher clinical pregnancy rates and live birth rates after oocyte vitrification compared with OTC in breast cancer patients undergoing FP.…”

Section: Discussionmentioning

confidence: 99%

“…This difference has attracted little attention despite the fact that newly diagnosed women wanting FP often urgently needs gonadotoxic treatment. COS and oocyte aspiration are usually considered to take around 2 weeks, even with random‐start protocols, whereas ovarian tissue does not need any pretreatment and can be excised as soon as an operation can be scheduled . Most studies on FP, irrespective of whether focus is on freezing mature oocytes/embryos or ovarian tissue, state that the procedure was performed without delaying cancer treatment .…”

Section: Introductionmentioning

confidence: 99%

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Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility‐preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. Material and methods The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC‐referral to OTC. A literature search for “random start” protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. Results The time from OTC‐referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13‐17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13‐14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later. Conclusions It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

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Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study

Cited by 158 publications

References 31 publications

A Japanese nationwide survey on the cryopreservation of embryos, oocytes and ovarian tissue for cancer patients

A Japanese nationwide survey on the cryopreservation of embryos, oocytes and ovarian tissue for cancer patients

A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

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