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Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study.
Hum Reprod. 2020 Nov 01; 35(11):2524-2536.HR

Abstract

STUDY QUESTION

What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)?

SUMMARY ANSWER

In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising.

WHAT IS KNOWN ALREADY

FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future.

STUDY DESIGN, SIZE, DURATION

Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment.

MAIN RESULTS AND THE ROLE OF CHANCE

Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue 'ex vivo' (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception.

LIMITATIONS, REASONS FOR CAUTION

Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions.

WIDER IMPLICATIONS OF THE FINDINGS

Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used for this study and the authors have no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Authors+Show Affiliations

Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium. Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32951035

Citation

Delattre, S, et al. "Combining Fertility Preservation Procedures to Spread the Eggs Across Different Baskets: a Feasibility Study." Human Reproduction (Oxford, England), vol. 35, no. 11, 2020, pp. 2524-2536.
Delattre S, Segers I, Van Moer E, et al. Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study. Hum Reprod. 2020;35(11):2524-2536.
Delattre, S., Segers, I., Van Moer, E., Drakopoulos, P., Mateizel, I., Enghels, L., Tournaye, H., & De Vos, M. (2020). Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study. Human Reproduction (Oxford, England), 35(11), 2524-2536. https://doi.org/10.1093/humrep/deaa193
Delattre S, et al. Combining Fertility Preservation Procedures to Spread the Eggs Across Different Baskets: a Feasibility Study. Hum Reprod. 2020 Nov 1;35(11):2524-2536. PubMed PMID: 32951035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study. AU - Delattre,S, AU - Segers,I, AU - Van Moer,E, AU - Drakopoulos,P, AU - Mateizel,I, AU - Enghels,L, AU - Tournaye,H, AU - De Vos,M, PY - 2020/04/06/received PY - 2020/07/02/revised PY - 2020/9/21/pubmed PY - 2020/9/21/medline PY - 2020/9/20/entrez KW - IVM KW - fertility preservation KW - oncofertility KW - oocyte vitrification KW - ovarian tissue cryopreservation SP - 2524 EP - 2536 JF - Human reproduction (Oxford, England) JO - Hum Reprod VL - 35 IS - 11 N2 - STUDY QUESTION: What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER: In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY: FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION: Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE: Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue 'ex vivo' (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION: Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS: Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER: N/A. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/32951035/Combining_fertility_preservation_procedures_to_spread_the_eggs_across_different_baskets:_a_feasibility_study_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/deaa193 DB - PRIME DP - Unbound Medicine ER -
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