Progress in Fertility Preservation Strategies in Turner Syndrome

Abstract

Growth retardation and gonadal dysgenesis are two of the most important clinical manifestations of Turner syndrome (TS). As premature ovarian failure generally occurs early in life in women with TS, these patients should be counseled and evaluated as early as possible for discussion of optimal and individualized fertility preservation strategies. Infertility seriously affects the quality of life of women with TS. For those who have ovarian reserve, the theoretical options for future fertility in TS patients include cryopreservation of oocytes, ovarian tissues, and embryos. For those who have already lost their ovarian reserve, oocyte or embryo donation, gestational surrogacy, and adoption are strategies that allow fulfillment of desire for parenting. This review describes the etiologies of infertility and reviews the fertility preservation strategies for women with TS.

Questions concerning fertility preservation during transition in girls with Turner syndrome: review of the literature

“…Finally, oocyte retrieval is performed transvaginally under general anaesthesia. Transabdominal retrieval is feasible, but not recommended (50). In vitro maturation (IVM) is used to increase the yield of mature oocytes.…”

“…Vitrified oocytes show similar fertilization and pregnancy rates comparing to fresh oocytes (51). Due to small yields in TS women, additional stimulations cycles are often required for a minimal number of 10 mature oocytes (50).…”

“…Additionally, as the cryopreservation of the ovarian cortex only preserves the primordial and primary follicles, integrated oocyte aspiration from antral follicles followed by IVM and OC should be used as a supplementary FP technique (43,62,63). Finally, to mitigate the oocyte loss connected with hypoxia during transplantation, vasculogenic factors, like S-1-P, VEGF or stromal cell enriched in CD34, could prove useful, although their clinical applicability is still being tested (50,64,65).…”

Adolescent Fertility Preservation: Where Do We Stand Now

“…While the exact mechanism of follicular depletion is unknown, it is believed to be due to accelerated apoptosis of germ cells in the intrauterine growth period. 43 When evaluating the number of ovarian follicles in human fetuses with 45,X karyotype, studies revealed that while there are normal numbers of germ cells in the early gestational period, by midgestation their numbers were decreased significantly. 44,45 This is in part due to the high incidence of follicle apoptosis.…”

“…49,62 Additionally, adolescents may not be able to tolerate ovarian stimulation or transvaginal oocyte retrieval and transabdominal oocyte retrieval is generally not recommended. 43 Due to the challenges of oocyte cryopreservation, some have advocated for in vitro matured oocyte cryopreservation. But there has only been one case report of a TS patient undergoing in vitro oocyte cryopreservation and the pregnancy potential of in vitro matured oocytes has not been shown in women with TS; so, the potential benefit to this approach is unknown.…”