Fertility preservation

In recent decades, ethicists have engaged with new developments in human reproductive technologies from a variety of angles. Yet there has been relatively little effort to problematize the concept of reproduction itself. In this paper, we examine the question of what reproduction is and its relationship with biology. We show that reproduction is commonly assumed to entail biological parenthood-an assumption that we term "the biological reproduction paradigm." Drawing on Sally Haslanger's analysis of the biological/ social division between sex and gender, we suggest that the concept of reproduction is socially constructed, despite its apparently biological nature. In turn, we argue that the supposed necessity of the relationship between reproduction and biological parenthood leads to a situation in which access to a variety of medical, legal, and social goods is constrained on the basis of spurious, inconsistent, and undertheorized assumptions. Finally, we note that, given the socially constructed nature of reproduction, we cannot take it for granted that the term "reproduction" signifies the same thing among different interlocutors and in different contexts.

INTRODUCTION: Robotic surgery has become the standard for surgical treatment of early cervical and endometrial carcinomas. The purpose was to determine if robotic cytoreduction estimates are accurate. METHODS: All patients with stage IIIc or IV ovarian carcinoma who presented for second opinions after primary surgery was performed robotically were offered a laparotomy and attempt at complete cytoreduction within 6 weeks of initial surgery. RESULTS: Nineteen patients met the inclusion criteria. The median age was 51 years (mean 51.4, 95% CI 47.3-55.5). Thirteen patients were said to have no residual disease while 6 patients were declared optimally cytoreduced after robotic debulking. Significant differences in cytoreduction were found in 15 of 19 patients at time of laparotomy (P=0.028). All 13 (complete cytoreduction) patients were found to have residual disease with 9 of them having disease greater than >1 cm and four of them with disease < 1 cm. Of the six patients optimally...

Fertility preservation methods for prepubertal women about to undergo gonadotoxic chemo and/or radiation therapy are limited. Therefore, the aim of this study was to investigate the feasibility to develop an alternative fertility preservation method based on an ex vivo perfusion platform for whole ewe ovaries. Thirteen ewe ovaries were divided into two groups (group 1 and 2) that were perfused in a bioreactor for up to 7 days. Group 1 (n = 3) were stimulated with human menopausal gonadotropin (hMG) administered in single daily dose, while group 2 (n = 10) were stimulated continuously for 24 h. The perfused ovaries in group 1 showed no significant differences in follicular density, sub-follicular morphology and oocyte quality after ischaemia and after ex vivo perfusion compared with non-perfused control ovaries. The perfused ovaries in group 2 showed a significant decrease in the follicular reserve and oocyte quality compared with the control group. In total, 16 GV–MI oocytes were re...

Some cases of male infertility are due to the destructive side-effects of anticancer treatment methods such as chemo and radiotherapies on germ cell lines. The increase in the survival rate of cancer patients who undergo treatment, especially children, has drawn attention to fertility preservation. The most common and effective technique in preserving male fertility is sperm freezing and its subsequent IVF. Children cannot efficiently produce sperm because of their spermatogonial immaturity. One of the strategies to maintain fertility in these patients is to preserve the testes or the germ cells by freezing them for their later maturation and production of fertile sperm, although the state in which the spermatogonia may not undergo maturation is one of the main obstacles faced in this method. Therefore, scientists have attempted to transplant cryopreserved testis tissues or produce in vitro-matured spermatozoa in this group of patients upon anticancer treatment. In this study we reviewed the germ cell biology, the side-effects of chemo and radiotherapies on germ cells and fertility preservation techniques in adults and children undergoing anticancer treatment.

Purpose In the accompanying article, “Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe,” we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions. Methods We provide data on the legalities of third-party assisted reproductive technologies and other family-building options in the 28 oncofertility-practicing countries surveyed. Results We found regional and country differences that will be important in the development of tailored resources for physicians and for patient brochures that are sensitive to these local restrictions and cultural norms. Conclusion Because many patients first consult Web-based materials, the forma...

Intramural pregnancy is a rare form of ectopic pregnancy, and little is known about its etiology, prevalence and natural history. There is no consensus regarding the ultrasound criteria necessary for the diagnosis of intramural pregnancy, and management strategies vary depending on the severity of clinical presentation, exact location of the pregnancy, viability and gestational age at diagnosis. We present four cases of intramural pregnancy diagnosed in a single institution that illustrate variability in their clinical presentation and difficulty in reaching the correct diagnosis. We also propose a set of ultrasound criteria to facilitate differential diagnosis between intramural and other types of uterine ectopic pregnancy.

Atypical endometrial hyperplasia,with fertility preserving management by hormonal IUS,and oral progesterone, natural conception three times,allowed for how many pregnancies before hysterectomy? To reduce the incidence of endometrial cancer.

Background: In the United States, >45,000 adolescent and young adult (AYA) women are diagnosed with cancer annually. Reproductive issues are critically important to AYA cancer survivors, but insufficient information is available to address their concerns. The AYA Horizon Study was initiated to contribute high-quality, contemporary evidence on reproductive outcomes for female cancer survivors in the United States. Methods: The study cohort includes women diagnosed with lymphoma, breast, melanoma, thyroid, or gynecologic cancer (the five most common cancers among women ages 15-39 years) at three study sites: the state of North Carolina and the Kaiser Permanente health systems in Northern and Southern California. Detailed information on cancer treatment, fertility procedures, and pregnancy (e.g., miscarriage, live birth) and birth (e.g., birth weight, gestational length) outcomes are leveraged from state cancer registries, health system databases and administrative insurance claims, national data on assisted reproductive technology procedures, vital records, and survey data. Results: We identified a cohort of 11,072 female AYA cancer survivors that includes >1,200 African American women, >1,400 Asian women, >1,600 Medicaid enrollees, and >2,500 Hispanic women using existing data sources. Active response to the survey component was low overall (N ¼ 1,679), and notably lower among minority groups compared with non-Hispanic white women. Conclusions: Passive data collection through linkage reduces participant burden and prevents systematic cohort attrition or potential selection biases that can occur with active participation requirements. Impact: The AYA Horizon study will inform survivorship planning as fertility and parenthood gain increasing recognition as key aspects of high-quality cancer care.

their bca diagnosis. In addition, we created a network of clinicians and researchers involved with delivery of bca care, providing infrastructure for health systems research and knowledge translation of findings into practice. This paper details the methods of the ruby cohort study to illustrate the feasibility of oncology research in the

Uterine Artery Embolization (UAE) is a minimally invasive procedure
that has emerged as a transformative option for managing uterine
leiomyomas (fibroids), postpartum hemorrhage, and other gynecological
conditions. While traditional surgical interventions like hysterectomy and
myomectomy remain standard, UAE offers a safer alternative for patients
seeking uterine preservation or fertility maintenance. This article examines
the efficacy, innovations, and challenges of UAE, with a focus on its
expanding applications and implications for patient care. Existing research
highlights high success rates of UAE, achieving significant symptom relief
in over 90% of cases by occluding uterine arterial blood supply with embolic
agents to induce localized ischemia and fibroid necrosis. Innovations in
embolic materials, such as hydrophobic injectable liquids, and procedural
techniques like transradial access have enhanced safety, reduced
complications, and improved patient outcomes. The effectiveness of UAE
in treating rarer conditions, including uterine arteriovenous malformations
and adenomyosis, demonstrates its versatility. However, questions remain
about its long-term reproductive impact, especially concerning fertility
outcomes and pregnancy rates, as conflicting data suggest potential risks.

Purpose To describe controlled ovarian stimulation (COS) in a population of women with GATA2 deficiency, a genetic bone marrow failure syndrome, prior to allogeneic hematopoietic stem cell transplant Methods This is a retrospective case series of nine women with GATA2 deficiency who underwent oocyte preservation at a research institution. Main outcomes measured include baseline fertility characteristics ((antimullerian hormone (AMH) and day 3 follicle-stimulating hormone (FSH) and estradiol (E2)) and total doses of FSH and human menopausal gonadotropins (HMG), E2 on day of trigger, and total number of metaphase II oocytes retrieved. The mean age was 24 years [16-32], mean AMH was 5.2 ng/mL [0.7-10], and day 3 mean FSH was 5.1 U/L [0.7-8.1], and E2 was 31.5 pg/mL [< 5-45]. The mean dose of FSH was 1774 IU [675-4035], and HMG was 1412 IU [375-2925] with a mean E2 of 2267 pg/mL [60.7-4030] on day of trigger. The mean total of metaphase II oocytes was 7.7 [0-15]. One patient was diagnosed with a deep vein thrombosis (DVT) with pulmonary embolism (PE) during COS. Conclusion This study is the first to analyze the outcomes of COS in women with GATA2 deficiency. The response to ovarian stimulation suggests that oocyte cryopreservation should be considered prior to gonadotoxic therapy. However, due to the risk of potentially life-threatening complications, it is prudent that patients are properly counseled of the risks and are evaluated by a multi-disciplinary medical team prior to COS.

The aim of our study was to evaluate the feasibility and e ciency of delayed ovarian stimulation and oocyte banking for fertility preservation after fertility-impairing treatment regardless of the initial disease. We conducted a cohort study based on population of women < 40 years of age with diminished ovarian reserve (n = 129). Three groups of women were compared according to the type of initial disease: hematological malignancies, solid tumors, and benign diseases. The endpoints were the number of metaphase II oocytes collected per woman, whether vitri ed or immediately used in in vitro fertilization and the cumulative live birth rate per stimulation cycle. We studied 245 delayed controlled ovarian stimulation cycles in 129 women: 201 for fertility preservation and 44 for in vitro fertilization and fresh embryo transfers. The number of metaphase II oocytes collected per woman after oocyte banking was similar in the three groups, with a mean of 10.7 ± 4.6, 12.3 ± 9.1 and 10.1 ± 7.6 oocytes (NS), respectively. The cumulative live birth rate was 38%, with 8 live births for the 21 women who wanted to conceive. After fertility-impairing treatment, practitioners should discuss a fertility preservation procedure for banking oocytes, even if a fertility preservation has already been performed.

Caring for young breast cancer patients is a challenge for different medical specialists. An introduction of more effective agents results in improved outcomes. At the same time, the quality of life after cancer becomes more important. The problems of young women who develop breast cancer differ from those that apply for older patients. It applies especially to fertility impairment due to systemic therapy. In recent years, new guidelines for the treatment and management of young breast cancer patients in certain specific situations have been developed. The article presents the comprehensive approach to care for young breast cancer patients. The current principles of treatment, recommended by scientific societies, were discussed. The following specific clinical issues were addressed: fertility after chemotherapy, the methods of fertility preservation, pregnancy and breastfeeding after breast cancer, breast cancer in pregnant women, and contraception.

Is random start ovarian stimulation associated with delays in initiation of neoadjuvant chemotherapy for breast cancer? SUMMARY ANSWER: Among women who complete fertility preservation (FP) consultation, random start ovarian stimulation is unlikely to delay time to initiation of neoadjuvant chemotherapy start.

Current advances in cancer therapy have increased survival, emphasizing the need for life quality improvement. Fertility loss is common post-chemotherapy. Current guidelines establish embryo and oocyte cryopreservation to address premature ovarian insufficiency (POI). Ovarian tissue cryopreservation has also recently become an acceptable option for fertility preservation, particularly as it is the only option for pre-pubertal patients. Few definitions for optimum fertility outcomes, and few systematic reviews comparing embryo, oocyte, and ovarian tissue cryopreservation as a means of fertility preservation (FP) in pre-and post-pubertal female cancer patients exist. This systematic review aims to improve understanding of gonadotoxic effects of chemoradiation therapy in cancer patients, to analyze the different fertility preservation techniques and procedures available to women with chemoradiation induced ovarian insufficiency, and to compare and recognize the benefits of each technique in restoring fertility, sexual hormone function, and quality of life. Searches were conducted electronically on PubMed, Cochrane, and EBSCOHost, including clinical trials, prospective, and retrospective studies of female cancer patients undergoing anti-cancer therapy, with predefined MeSH terminology. Data were collected, analyzed, and compared. Non-randomized clinical studies were evaluated for risk bias through the Newcastle-Ottawa Scale. In total, 23 studies were included. From there, 647 patients opted for oocyte cryopreservation, 267 for embryo cryopreservation, and 1382 for ovarian tissue cryopreservation (OTC). A total of 175, 18, and 121 live births resulted respectively from oocyte, embryo, and OTC, respectively. Studies without live births discussed other fertility markers as indicators of improvement in sexual hormone function and fertility. The gonadotoxic effects of chemotherapy call for FP intervention. Oocyte and embryo cryopreservation/implantation are well-established procedures. With changing trends and life quality consideration, OTC is a promising interventional method for pre-pubertal patients facing the prospect of fertility loss.

Purpose Germline mutations in BRCA genes are associated with breast and ovarian cancer susceptibility. Because infertility is associated with breast and ovarian cancer risks, we hypothesized that the mutations in the BRCA gene may be associated with low response to fertility treatments. Methods We performed ovarian stimulation in 126 women with breast cancer by using letrozole and gonadotropins for the purpose of fertility preservation by embryo or oocyte cryopreservation. As surrogates of ovarian reserve, the oocyte yield and the incidence of low response were compared with ovarian stimulation according to BRCA mutation status. Results Of the 82 women who met the inclusion criteria, 47 women (57%) had undergone BRCA testing, and 14 had a mutation in BRCA genes, of which two were of clinically undetermined significance. In BRCA mutation–positive patients, low ovarian response rate was significantly higher compared with BRCA mutation–negative patients (33.3 v 3.3%; P = .014) and with...

A pre-established Day 5 algorithm can significantly improve the probability of predicting the viability of an individual blastocyst. The blinded prediction of the Day 5 media samples indicates that the viability score can be used as a successful, non-invasive addition to blastocyst morphology to aid in the prediction of pregnancy.

Fertility issues have become critical in the management and counseling of BRCA mutation carriers. In this setting four points deserve consideration. (1) Women in general lose their ability to conceive at a mean age of 41 years, thus the suggested policy of prophylactic bilateral salpingo-oophorectomy at age 40 for BRCA mutation carriers does not affect the chances of natural pregnancy. Conversely, if the procedure is chosen at 35 years old, oocyte cryopreservation prior to surgery should be considered. (2) Some evidence suggests that ovarian reserve may actually be partly reduced in BRCA mutations carriers and that the mutation may affect ovarian responsiveness to stimulation. However, these findings are still controversial. (3) Breast cancer is not rare before the age of 40 and fertility preservation after diagnosis can be requested in a significant proportion of BRCA mutation carriers. Thus, a policy of oocyte cryopreservation in young healthy carriers deserves consideration. The procedure could be considered at a young age and in an elective setting, when ovarian stimulation may yield more oocytes of better quality. (4) Preimplantation genetic diagnosis (PGD) could be considered in BRCA mutations carriers, particularly when good quality oocytes have been stored at a young age. Based on the current knowledge, a univocal approach cannot be recommended; in depth patient counseling is warranted.

The increasing confidence with the techniques of oocyte and ovarian cortex freezing has prompted their potential use for patient categories other than those at risk of early menopause due to cancer treatments. Women affected by every iatrogenic or pathologic condition known to compromise ovarian function severely have been considered as potential candidates for fertility preservation. Among them, women with endometriosis may represent a particularly suitable group since they are at increased risk of premature ovarian exhaustion and about half of them will experience infertility. Based on the currently available notions on the intricate relationships between endometriosis, infertility and damage to the ovarian reserve, we speculate that fertility preservation may be of interest for women with endometriosis, in particular for those with bilateral unoperated endometriomas and for those who previously had excision of unilateral endometriomas and require surgery for a contralateral recurrence. Young age at diagnosis may be an independent but pivotal additional factor to be taken into consideration in the balance of the pros and cons of fertility preservation. On the other hand, we argue against the introduction of fertility preservation for endometriosis in routine clinical practice. To date, only few cases have been reported and there are insufficient data for robust cost-utility analyses. It is noteworthy that endometriosis is a relatively common disease and systematically including affected women in a fertility preservation program would have profound clinical, logistic and financial effects. More clinical data and in-depth economic analysis are imperative prior to recommending its routine use.

The increasing confidence with the techniques of oocyte and ovarian cortex freezing has prompted their potential use for patient categories other than those at risk of early menopause due to cancer treatments. Women affected by every iatrogenic or pathologic condition known to compromise ovarian function severely have been considered as potential candidates for fertility preservation. Among them, women with endometriosis may represent a particularly suitable group since they are at increased risk of premature ovarian exhaustion and about half of them will experience infertility. Based on the currently available notions on the intricate relationships between endometriosis, infertility and damage to the ovarian reserve, we speculate that fertility preservation may be of interest for women with endometriosis, in particular for those with bilateral unoperated endometriomas and for those who previously had excision of unilateral endometriomas and require surgery for a contralateral recur...

Adolescence is a time of rapid change encompassing both the physical and emotional realm. Young people may be overwhelmed with conflicting and confusing feelings regarding changes in their body habitus, sexuality, as well as their place among family, friends, and society. Most adolescents have few serious medical or psychological problems while passing from childhood to adulthood. For some, however, it may be a dangerous time of experimentation with high-risk behaviors while lacking the maturity to make sound, safe decisions. This may also be a time where underlying mental illness or past traumas may come to the surface in overt behavior. The 1992 Youth Risk Behavior Survey found that at least 25% of 12 to 13 year olds engaged in at least one health-risk behavior, such as failure to always wear seat belts, physical fighting, and tobacco or alcohol use.' O Early initiation of these behaviors can lead to significant morbidity and mortality throughout adolescence. In addition, the attitudes and behaviors developed during this time can affect the future lifestyles and health habits of adolescents. Injury and violence account for 75% of all deaths during adolescence.16, 29 Accidents are the leading cause of death among adolescents. More than 3 out of 10 adolescents who die are killed in a of which 50% involve alcohol.30 Homicide and suicide make up the second and third leading causes of death during adolescen~e.~~ The homicide rate has dou-From the

Infertility by the inability to achieve a clinical pregnancy after 12 months of consistent, unprotected sexual intercourse or due to an individual's diminished capacity to reproduce independently or with a partneris characterized. This paper aims to comprehensively explore infertility treatments, emphasizing the potential role of stem cells in offering effective and safe solutions. Additionally, it delves into the legal and regulatory challenges associated with stem cell research, focusing on the legislative frameworks in six major European countries. For individuals who do not benefit from traditional assisted reproductive technologies (ART), stem cell-based treatments present a promising alternative. However, ethical dilemmas and unresolved immunological concerns continue to pose significant barriers, necessitating further robust research to facilitate widespread adoption of these therapies. The ethical controversy surrounding the use of human embryonic stem cells (ESCs) arises from the requirement to destroy human embryonic tissue during their extraction. Despite these challenges, stem cell research has paved the way for significant advancements in infertility treatment. Addressing the intricate ethical and legal questions linked to these therapies will require the development of standardized, evidence-based guidelines and best practices, ensuring that patients' reproductive rights while adhering to the foundational principles of medical ethicsare upheld.

Does chemotherapy exposure (with or without alkylating agents) or primary diagnosis affect spermatogonial quantity in human prepubertal testicular tissue? SUMMARY ANSWER: Spermatogonial quantity is significantly reduced in testes of prepubertal boys treated with alkylating agent therapies or with hydroxyurea for sickle cell disease. WHAT IS KNOWN ALREADY: Cryopreservation of spermatogonial stem cells, followed by transplantation into the testis after treatment, is a proposed clinical option for fertility restoration in children. The key clinical consideration behind this approach is a sufficient quantity of healthy cryopreserved spermatogonia. However, since most boys with malignancies start therapy with agents that are not potentially sterilizing, they will have already received some chemotherapy before testicular tissue cryopreservation is considered.

For patients with early breast cancer undergoing breast conserving surgery, radiotherapy is given either as a post-operative course of External-Beam RadioTherapy (EBRT), given daily for over a number of days and often weeks, or with TARGeted Intrabeam Intraoperative radioTherapy (TARGIT-IORT), which is delivered, during surgery under the same anaesthetic. Several studies have reported the quantitative Quality-of-Life (QoL) benefits of TARGIT-IORT over EBRT. This qualitative study was designed to gather a deep understanding of the benefits and impacts of receiving EBRT or TARGIT-IORT as perceived by patients. It also captured how differently the treatments affected the lived experience of the patient and their care partner through their treatment journey. A patient-led Working Group was established to guide study design, delivery and to help validate findings. Patients with experience of receiving EBRT or TARGIT-IORT were first purposively sampled by Hampshire Hospitals NHS Foundation Trust after which a randomiser was applied to ensure the final selection process was free from bias. In February and March 2023, 29 semi-structured interviews (15 EBRT, 14 TARGIT-IORT) were conducted virtually via Zoom. Thematic analysis of verbatim interview transcripts was then carried out by two coders generating 11 themes related to either EBRT or TARGIT-IORT. A number of procedural grievances were noted among EBRT patients. EBRT was perceived as being disruptive to a range of normal routines (work, home-life, and the burden of travel), and dissatisfying due to discomfort of side effects. TARGIT-IORT was perceived by patients and care partners as being efficient (given while they are asleep during surgery and without additional hospital visits) with minimal if any disruptions to QoL and

We describe an original perfusion system for the culture of whole ovine ovaries for up to 4 days. A total of 33 ovaries were divided into six groups: control (n = 6), not perfused and fixed; Groups SM72 and SM72-FSH (n = 6 each), perfused with a simple medium for 72 h with or without FSH; Groups CM96 and CM96-FSH (n = 6 each), perfused with a complex medium for 96 h with or without FSH; Group CM96-FSH-cryo, (n = 3) cryopreserved and perfused for 96 h with Group CM96-FSH medium. Depending on the medium used, morphological parameters of cultured ovaries differed from fresh organs after 72 (SM72, SM72-FSH) or 96 (CM96, CM96-FSH) h of perfusion. Oestradiol and progesterone were secreted in all groups but FSH had an effect only on Group CM96-FSH, stimulating continued oestradiol secretion 10 times higher than in all other groups. Morphological parameters and hormone secretion of cryopreserved ovaries were not different from fresh controls. This method enables the culture of whole ovaries...

While Denmark is widely known as a global exporter of cryopreserved sperm, Danish women's eggs face a very different fate. This paper combines legal and rhetorical analyses with the concept of sociotechnical imaginaries. In establishing the genealogy of the sociotechnical imaginaries that shaped Danish regulation of the cryopreservation of eggs, we analyse the relevant Acts, Bills, preparatory work, and readings in Parliament, along with the concurrent public and ethical debates that over time relaxed the legal limit for the cryopreservation of eggs to the current five years and today continue to ignite discussions on elective egg freezing. We rely on welfare-state perspectives to discuss why reproduction, in the Danish context, is seen as a legitimate and appropriate sphere to regulate, and we turn to feminist theorizing to discuss the gendered implications captured in the sociotechnical imaginaries of the "Moral State", "technologies to be tamed", "the nuclear family", and "technology as equality and hope". We end by discussing how an interdisciplinary approach enriches our understanding of the legal, cultural, and political entanglements related to putting eggs on ice.

In Denmark, female patients who undergo chemo-and radiation therapy are, prior to treatment, increasingly offered fertility preservation in the form of ovarian tissue freezing. In the cryotank, the frozen ovarian tissue awaits the recovery of the patient, after which it can be thawed and implanted into the remaining ovary or the abdominal wall. Here it potentially restores the ovarian function and enables women to become pregnant and experience genetic motherhood. Promising reproductive futures, the biomedical imaginary of ovarian tissue preservation is entangled with visions of possibilities and risk management as well as gendered understandings of reproduction and the 'good life.' From the get-go, ovarian tissue freezing has been informed by an optimistic imaginary of scientific progress. Not only were freezing programs established before clinical evidence testified to the success of the technique in humans; the envisioning of improvements and new applications also anticipates future scientific breakthroughs, such as in vitro maturation of eggs. In the imaginary of hopefulness and reproductive futurity, frozen ovarian tissue becomes an object of vitality which (re)installs the cancer patient as a reproductive citizen. Moreover, ovarian tissue is imagined as a bountiful material with different potentiality than egg freezing. In Denmark, the biomedical imaginary romanticizes the restoration of 'natural' fertility and spontaneous pregnancies. Thus, the potentiality of ovarian tissue freezing is imagined within a normative framework privileging 'natural' conception, yet simultaneously destabilizing the very notion of the agespan of 'natural fertility.'

What is semen quality and fertility like in Non-Hodgkin Lymphoma (NHL) survivors? Summary answer: Most NHL subjects are normozoospermic before cancer treatment, and the semen parameters of the survivors are comparable to the baseline 18 months after standard first-line treatments. Salvage therapy followed by hematopoietic stem cell transplant had the worst impact, with 66% azoospermic subjects in the long term. Overall, most patients can achieve fatherhood posttreatment through natural fertility or assisted reproductive technology. What is known already: Testicular function has been widely investigated in relation to the most common malignancies in reproductive age, such as testicular cancer and Hodgkin lymphoma, but NHL has been somewhat under-investigated. The available reports generally show a post-treatment worsening of semen parameters in NHL survivors, but the only papers to have focused on the subject have non-comparable results from small caseloads or from a subgroup of broader caseloads. Study design, size, duration: We conducted a retrospective analysis of 222 subjects who attended the Laboratory of Seminology -"Loredana Gandini" Sperm Bank of the Department of Experimental Medicine -"Sapienza" University of Rome between 2002-2017 for sperm cryopreservation after a diagnosis of NHL. Participants/materials, setting, methods: We retrospectively selected 222 NHL patients who underwent sperm cryopreservation before any antineoplastic treatment between 2002 and 2017. Subjects with any comorbidity and/or other conditions interfering with sperm parameters were excluded. All patients underwent a careful medical history and physical examination at the time of sperm cryopreservation (T0) and had at least one follow-up visit at 6 (T6), 12 (T12), 18 (T18) and/or 24 months (T24) or more than 24 months (T>24), with a median follow-up of 47.5 months (range 28-140 months). Fertility information was collected through the administration of a questionnaire. Pre-treatment evaluation -More than 80% of NHL patients were previously normozoospermic and in 16% of cases had already fathered a child. Aggressive lymphomas were associated with worse baseline semen volume and total sperm number compared to indolent subtypes (p <0.05). Post-treatment evaluation -Total sperm number worsened at T6 and returned to near-baseline values only after a median of 47.5 months (T>24), although the mean value was still below the T0 mean value (T0: 209.2 ± 190.5 vs. T>24: 160.5 ± 137.8, p = 0.118). The percentage of progressive motility and of abnormal forms significantly worsened at T6 compared to 2 baseline (p <0.001), returning to near-baseline at T12. Two years post-treatment, 25.5% of NHL survivors showed persistent oligozoospermia and 14.1% azoospermia. Subgroup analyses showed that standard first-line treatments had a more favourable outcome for semen parameters, with total sperm number returning to near-baseline values at 18 months ( T0: 195.0 ± 189.8 vs. T18: 113.4 ± 103.1, p = 0.278), and a lower prevalence of azoospermia at two years (7.7%). In this subgroup, radiotherapy of the pelvis vs. other "high" sites (mediastinum, laterocervical and axillary lymph nodes, etc.) was associated with an increased risk of developing post-treatment azoospermia (OR 4.29, 95% CI 1.81-10.14; p = 0.001). Two-thirds of subjects who had relapsed or had disease progression after first-line treatment and then underwent salvage treatment ± hematopoietic stem cell transplant became azoospermic. Fertility questionnaire -Fertility data was available for 176 patients: 15.9% already had at least one child prior to the NHL diagnosis and 12.5% (22 patients) desired children after treatment. Of these, 14 achieved fatherhood through natural fertility (2 patients) or ART (12 patients). The main limitations of the study are the unavailability of blood hormones for evaluation of testicular function as a whole and the non-compliance of several patients in undergoing follow-up visits at all time points, resulting in a reduced sample size for treatment subgroup analyses. Furthermore, despite a good fertility questionnaire response rate (>80%), the low number of NHL survivors actively seeking fatherhood limits the generalization of results. The increased survival of NHL patients of reproductive age makes it essential to focus on the testicular toxicity of its treatment. Sperm cryopreservation must be suggested before any treatment. It is expected that up to 30% of subjects will require treatment intensification, which could result in permanent testicular damage; in such cases the use of banked semen might represent the patient's best chance for future fertility.

STUDY QUESTIONHow is semen quality affected by treatment in survivors of non-Hodgkin lymphoma (NHL)?SUMMARY ANSWERBefore cancer treatment, most NHL subjects were normozoospermic and, while standard first-line treatments seemed compatible with post-treatment recovery after 18 months, salvage therapy followed by haematopoietic stem cell transplant caused permanent damage to spermatogenesis in many cases, with 66% azoospermic subjects in the long term.WHAT IS KNOWN ALREADYTesticular function has been widely investigated in relation to the most common malignancies in men of reproductive age, such as testicular cancer and Hodgkin lymphoma, but NHL has been somewhat under-investigated. The available reports generally show a post-treatment worsening of semen parameters in NHL survivors, but they involved small caseloads or a subgroup of broader caseloads, and their results are not comparable.STUDY DESIGN, SIZE, DURATIONWe conducted a retrospective analysis of 222 subjects who attended our ...

Cervical myomas are rare and account for &lt;1% of uterine leiomyomas. Clinical complications include bulk-related symptoms of pelvic pain, abnormal bleeding and infertility. While hysterectomies may be readily performed for postmenopausal women; the management of women with cervical myomas of childbearing age remains a challenge.Traditionally described fertility-preserving procedures such as myomectomy, endometrial ablation or myolysis may only be applied to leiomyomas within the uterine corpus. Little is known about the surgical management of its cervical counterpart.Radical abdominal trachelectomy has been described as a potential fertility-preserving procedure in the management of women with early cervical cancer. As such, we present a case of a giant cervical myoma that was treated with an abdominal trachelectomy in an attempt to preserve fertility.

Current practices in counselling of female cancer patients with respect to fertility issues need considerable improvement, particularly given the general underuse of fertility preservation options and the negative impact that infertility can have on quality of life. We investigated the relationship between physicians&#39; and physician-related factors and the frequency of physicians discussing fertility issues and referring to a reproductive specialist. We invited 1,832 physicians in the Netherlands who had treated at least five reproductive-age female cancer patients within the past year to complete a questionnaire. Of the 748 respondents, 406 met our inclusion criteria, and 280 participated. Analysis revealed that 79% of the participants usually or always discuss fertility issues. Specialty, confidence in knowledge regarding fertility issues and a lack of reproductive specialists in their region contributed independently to the variance in the frequency of discussing fertility iss...

Addressing fertility is a key aspect of oncology care for young adult female cancer survivors (YAFCS) who receive gonadotoxic treatment. Fertility preservation (FP) may help to mitigate infertility risks (e.g., egg or embryo freezing), but most women do not preserve their fertility before treatment . After treatment, lowered ovarian reserve leads to a shortened reproductive time window. For survivors hoping to have children in the future but are not yet ready to start family-building, FP after treatment may be appropriate to mitigate the risks of premature ovarian failure . Reproductive health counseling is often missing or inadequate in post-treatment survivorship care , and lack of information, misconceptions, anxiety, and distress about fertility are common among this population . Understanding the ways in which fertility and family-building concerns impact broader quality of life (QOL) domains is important to address this critical issue in young adult survivorship.

Cancer treatment may lead to premature menopause and infertility. Young adult female cancer survivors (YAFCS) are often concerned about their fertility and future family-building options, but research is limited on how concerns may affect more general quality of life (QOL) domains. This study examined how fertility factors relate to QOL among YAFCS who received gonadotoxic therapy. A national sample of YAFCS completed an online, anonymous survey. The survey included investigator-designed questions about perceived fertility information needs (five items; Cronbach&#39;s α = .83) and general QOL (four items; α = .89), the Reproductive Concerns after Cancer Scale (RCACS) and Decisional Conflict Scale (DCS). Analyses included Pearson&#39;s correlation, t tests, and stepwise regression. Participants (N = 314) were an average of 30 years old (SD = 4.1) and 5 years (SD = 5.4) post-treatment; 31% reported being infertile and 19% had undergone fertility preservation (FP). Overall, QOL was rel...

Ovarian tissue cryopreservation is a female fertility preservation technique that presents major challenges for the maintenance of follicular viability after transplantation. The aim of this study was to evaluate and compare the application of L-Mesitran Soft®, a product containing 40% medical grade honey (MGH), with other strategies to improve ovarian grafts’ viability. For this purpose, bovine ovarian tissue was vitrified, warmed and randomly assigned to culture groups: (1) control, (2) MGH 0.2% in vitro, (3) MGH in vivo (direct application in the xenotransplantation), (4) vascular endothelial growth factor (VEGF 50 ng/mL) and (5) vitamin D (100 Nm), during a 48 h period. A sixth group (6) of fragments was thawed on transplantation day and was not cultured. The tissue was xenotransplanted into immunodeficient (Rowett nude homozygous) ovariectomized rats. Grafts were analyzed 48 h after culture, and 7 and 28 days after transplantation. The tissue was subjected to histological and i...

Purpose Most guidelines about fertility preservation are predominantly focused on scientific evidence, but are less practically orientated. Therefore, practically oriented recommendations are needed to support the clinician in daily practice. Methods A selective literature search was performed based on the clinical and scientific experience of the authors, focussing on the most relevant diseases and gynaecological cancers. This article (Part I) provides information on topics that are essential for the fertility preservation indication, such as disease prognosis, disease therapy and its associated risks to fertility, recommending disease-specific fertility preservation measures. Part II specifically focusses on fertility preservation techniques. In breast cancer patients, fertility preservation such as ovarian tissue and oocyte cryopreservation is especially recommended in low-stage cancer and in women < 35 years of age. In Hodgkin's lymphoma, the indication is mainly based on the chemotherapy regime as some therapies have very low, others very high gonadotoxicity. In borderline ovarian tumours, preservation of fertility usually is achieved through fertility sparing surgery, ovarian stimulation may also be considered. In cervical cancer, endometrial cancer, rheumatic diseases and other malignancies such as Ewing sarcoma, colorectal carcinoma, non-Hodgkin lymphoma, leukaemia etc., several other factors must be considered to enable an individual, stage-dependent decision. The decision for or against fertility preservation depends on the prognosis, the risks to fertility and individual factors such as prospective family planning.

Fertility preservation has become an integral part of standard treatment for young patients with planned gonadotoxic therapy. The decision-making process is an interdisciplinary challenge to both oncologists and radiotherapists involved in the process of diagnosis and treatment. Nevertheless, even today, not every patient receives adequate counselling about fertility preserving techniques. Current data on the options of fertility preservation for women, including cryopreservation of oocytes, embryos, ovarian tissue, transposition of ovaries and medical treatment, are summarized in this review.

Purpose The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation. Methods This prospective observational pilot study was set in an urban, public hospital. Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation. As the intervention, these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months. Blood samples were also collected at the same time intervals. The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) level changes throughout treatment and post-treatment period. Results Two patients were pregnant at study initiation. They received obstetric consultations, opted to continue pregnancies, and postpone treatment; both delivered at term without complications. One woman desired future childbearing and received fertility preservation counseling. All women received family planning consultations and received/continued effective contraceptive methods. Seventy-three percent used longterm contraception, 18 % remained abstinent, and 9 % used condoms. During chemotherapy, FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 %. While 82 % of women experienced amenorrhea, 44 % of these women resumed menstruation after chemotherapy. Conclusions The assessment and algorithm were useful in m a n ag i n g pa t i e n t s' r e p r o du c t i v e he a l t h n ee d s . Chemotherapy-induced endocrine disruption impacted reproductive health.

The purpose of this study was to pilot a survey instrument and to develop descriptive data about the reproductive goals of reproductive-aged women (15-44 years) with cancer. STUDY DESIGN: This was a cross-sectional pilot survey study of 20 women who were diagnosed with various types of cancers at the oncology clinic of Stroger Hospital of Cook County, Chicago, from January-July 2006. Of the 20 patients whose cases were surveyed, the mean age was 36.6 years, and 90% of the women had breast cancer. Ten percent of patients would continue pregnancy, if they became pregnant while receiving treatment. Contraception was used by 55% of patients (n ϭ 11), of whom 55% of the women (n ϭ 6) were using abstinence. The result of this pilot study demonstrates the need for reproductive health counseling in women with cancer; the range of discussion must include fertility interest, contraception, and fertility preservation.

The purpose of this study was to pilot a survey instrument and to develop descriptive data about the reproductive goals of reproductive-aged women (15-44 years) with cancer. STUDY DESIGN: This was a cross-sectional pilot survey study of 20 women who were diagnosed with various types of cancers at the oncology clinic of Stroger Hospital of Cook County, Chicago, from January-July 2006. Of the 20 patients whose cases were surveyed, the mean age was 36.6 years, and 90% of the women had breast cancer. Ten percent of patients would continue pregnancy, if they became pregnant while receiving treatment. Contraception was used by 55% of patients (n ϭ 11), of whom 55% of the women (n ϭ 6) were using abstinence. The result of this pilot study demonstrates the need for reproductive health counseling in women with cancer; the range of discussion must include fertility interest, contraception, and fertility preservation.

Background: Steroidogenic factor 1 (SF-1), encoded by the nuclear receptor subfamily 5 group A member 1 (NR5A1) gene, is a transcriptional factor crucial for adrenal and gonadal organogenesis. Pathogenic variants of NR5A1 are responsible for a wide spectrum of phenotypes with autosomal dominant inheritance including disorders of sex development and oligospermiaazoospermia in 46,XY adults. Preservation of fertility remains challenging in these patients. Objective: The aim was to offer fertility preservation at the end of puberty in an NR5A1 mutated patient. Case report: The patient was born of non-consanguineous parents, with a disorder of sex development, a small genital bud, perineal hypospadias, and gonads in the left labioscrotal fold and the right inguinal region. Neither uterus nor vagina was detected. The karyotype was 46,XY. Anti-Müllerian hormone (AMH) and testosterone levels were low, indicating testicular dysgenesis. The child was raised as a boy. At 9 years old, he presented with precocious puberty treated by triptorelin. At puberty, follicle-stimulating hormone (FSH), luteinising hormone (LH), and testosterone levels increased, whereas AMH, inhibin B, and Frontiers in Endocrinology frontiersin.org 01

Systemic therapies have been shown to effectively improve prognosis in patients with breast cancer. However, such therapies also become increasingly harmful as their duration increases, and they have adverse effects on fertility and ovarian function. Fertility preservation (FP) is important in young adult cancer survivors who may wish to have children. In Japan, some cancer societies recommend that the potentially serious effects of systemic therapy on ovarian function should be explained to women with cancer, and they should be encouraged to undergo FP prior to commencing treatment. Still, as there are no official guidelines, many oncologists lack the required knowledge and mind-set to advise young breast cancer patients on fertility issues. Counseling of patients and their families might improve their understanding about the influence of such treatment on fertility and ensure effective FP. There are several FP methods that can be selected before beginning treatment, and these methods have both advantages and disadvantages. Young adults with breast cancer who want to bear children in the future must be provided with FP counseling, in addition to advice about breast cancer treatment and prognosis.

OBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990–2019 with terms “cervical cancer” and “(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy.” Grey literature and unpublished data were omitted. METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. TABULATION, INTEGRATION, AND RESULTS: Va...

BACKGROUND: In female cancer survivors, the accelerated loss of primordial follicles as a result of gonadal damage may lead to premature ovarian failure (POF). However, the extent of the damage is unpredictable. Anti-Mu ¨llerian hormone (AMH) constitutes a sensitive marker of ovarian reserve. Serum AMH levels were measured to assess sub-clinical ovarian damage in patients treated with gonadotoxic therapy. METHODS: In 25 patients with haematological malignancies, serum AMH concentrations were measured prior to and after cancer therapy and were compared with normo-ovulatory controls. RESULTS: In all patients, AMH concentrations were lower than controls prior to treatment. Thirteen patients were treated with multi-drug chemotherapy. Although in most patients treated with chemotherapy menstrual cyclicity was restored, median serum AMH levels were lower than in controls. Twelve patients had stem cell transplantation (SCT) after total body irradiation. They all developed POF and their serum AMH concentrations were undetectable. CONCLUSIONS: Female cancer survivors treated with SCT all developed POF. Hence, in these patients fertility preservation should be considered. In patients treated with chemotherapy, ovarian reserve seems to be compromised as well.

Background: Endometrial stromal sarcomas (ESSs) are rare, indolent tumors with high recurrence rates. Management includes surgery and hormonal therapy given high estrogen and progesterone receptor (ER/PR) expression. Case: A pre-menopausal patient with stage II ESSs (ER+/PR+) underwent primary surgery followed by adjuvant megestrol. Recurrence in the bladder/upper vagina (ER+/PR-) was diagnosed one year later and treated with anterior pelvic exenteration and adjuvant letrozole. Two years later she recurred and was treated with radical surgery and adjuvant exemestane therapy (tumor ER strongly +/PR+). The patient then had a five-year disease free interval before being diagnosed with her third recurrence (ER+). Conclusion: Exemestane treatment for ESSs can lead to a prolonged response, even in the setting of progression after prior aromatase inhibitor treatment.

Objective: To evaluate the association between carriage of BRCA1/2 mutations and ovarian performance, as demonstrated by in vitro fertilization (IVF) outcomes. Design: Retrospective cohort study. Setting: Two tertiary IVF centers. Patient(s): BRCA mutation carriers undergoing IVF for preimplantation genetic diagnosis (PGD) or fertility preservation were compared with non-BRCA PGD or fertility preservation patients, matched by age, IVF protocol, IVF center, and cancer disease status. Intervention(s): In vitro fertilization cycles for PGD and fertility preservation. Main Outcome Measure(s): Outcome of IVF: oocyte yield, poor response rate, number of zygotes, pregnancy rates. Result(s): A total of 62 BRCA mutation carriers and 62 matched noncarriers were included; 42 were fertility preservation breast cancer patients, and 82 were PGD non-cancer patients. Mean (AESD) age of patients was 32 AE 3.58 years. Number of stimulation days and total stimulation dose were comparable between carriers and noncarriers. Their cycles resulted in comparable oocyte yield (13.75 vs. 14.75) and low response rates (8.06% vs. 6.45%). Number of zygotes, fertilization rates, and conception rates were also comparable. Conclusion(s): Both healthy and cancer-affected BRCA mutation carriers demonstrated normal ovarian response in IVF cycles. (Fertil Steril Ò 2015;104:1162-7. Ó2015 by American Society for Reproductive Medicine.

Almost every female classic galactosemia patient develops primary ovarian insufficiency (POI) as a diet-independent complication of the disease. This is a major concern for patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The unique pathophysiology of classic galactosemia with a severely reduced follicle pool at an early age requires an adjusted approach. In this article recommendations for physicians based on current knowledge concerning galactosemia and fertility preservation are made. Fertility preservation is only likely to be successful in very young prepubertal patients. In this group, cryopreservation of ovarian tissue is currently the only available technique. However, this technique is not ready for clinical application, it is considered experimental and reduces the ovarian reserve. Fertility preservation at an early age also raises ethical questions that should be taken into account. In addition, spontaneous conception despite POI is well described in classic galactosemia. The uncertainty surrounding fertility preservation and the significant chance of spontaneous pregnancy warrant counseling towards conservative application of these techniques. We propose that fertility preservation should only be offered with appropriate institutional research ethics approval to classic galactosemia girls at a young prepubertal age.