Live birth after orthotopic grafting of autologous cryopreserved ovarian tissue and spontaneous conception in Italy.

OBJECTIVE: To describe a live birth obtained in Italy after autologous orthotopic transplantation of cryopreserved ovarian cortical tissue. DESIGN: Case report. SETTING: University department of gynecology and obstetrics, reproductive medicine and IVF unit. PATIENT(S): A 29-year-old patient affected by ß-thalassemia (intermedia phenotype) who underwent chemotherapy and bone marrow transplantation at age 21 years, resulting in a complete precocious ovarian failure. INTERVENTION(S): Before being treated with chemotherapy (busulfan, cyclophosphamide, and cyclosporine) for bone marrow transplantation, the patient underwent laparoscopic sampling of ovarian cortical tissue that was frozen and cryopreserved in liquid nitrogen. Eight years later, the ovarian tissue was thawed and grafted during laparoscopy at an orthotopic site. MAIN OUTCOME MEASURE(S): Ultrasound and endocrine monitoring of the postgrafting restoration of ovarian function; conception, pregnancy, and live birth. RESULT(S): Three months after grafting, the decrease of circulating FSH levels and the parallel increase of E(2) levels demonstrated ovarian function restoration, which was confirmed by bidimensional ultrasound and color Doppler examinations. After some ovulatory cycles, the patient spontaneously conceived 16 months after transplantation. After 39 weeks of uneventful gestation, a healthy girl weighing 3,970 g was born. CONCLUSION(S): Autologous grafting of cryopreserved ovarian cortex at an orthotopic site may allow ovarian function restoration, spontaneous conception, and birth of a healthy baby.

Fertility Preservation Methods in Breast Cancer.

Thanks to the recent advances in reproductive medicine, more and more young women with breast cancer may be offered the possibility of preserving their fertility. Fertility can be endangered by chemotherapy, by treatment duration and by patient's age at diagnosis. The currently available means to preserve a young woman's fertility are pharmacological protection with gonadotrophin-releasing hormone analogues during chemotherapy, and ovarian tissue or oocyte/embryo freezing before treatment. New future venues, including in vitro maturation, will improve the feasibility and efficacy of the fertility preservation methods in breast cancer patients.

Oocyte cryostorage to preserve fertility in oncological patients.

Thanks to the progress in oncostatic treatments, young women affected by cancer have a fairly good chance of surviving the disease and leading a normal post-cancer life. Quite often, however, polychemiotherapy and/or radiotherapy can induce ovarian damage and significantly reduce the content of follicles and oocytes inside the ovary, thus predisposing the patient to menstrual disorders, infertility, and precocious menopause. Several techniques have been proposed to preserve fertility in these patients; among them oocyte collection and cryopreservation prior to the oncostatic treatment has been widely applied in the last decade. The proper indications, the permitting conditions, the available hormonal stimulation protocols, as well as the effectiveness and limits of this option will be discussed herein, with a comprehensive and up-to-date review of the two techniques commonly used to cryostore oocytes, the slow-freezing technique and the vitrification technique.

FSH-receptor Ala307Thr polymorphism is associated to polycystic ovary syndrome and to a higher responsiveness to exogenous FSH in Italian women.

OBJECTIVE: Herein we analyzed FSH-R polymorphism at position 307 aiming (a) to assess the prevalence of the three allelic variants (Ala307Ala, Ala307Thr and Thr307Thr) in relation to the type of ovary and (b) to clarify if the allelic variant could influence the responsiveness to exogenous FSH. STUDY DESIGN: We prospectively studied a group of 106 Italian women undergoing in vitro fertilization (IVF), among which 40 were subjects with polycystic ovary syndrome (PCOS) and 66 were normo-ovulatory women with a normal ovarian morphology at transvaginal ultrasound. DNA extraction, denaturing high-performance liquid chromatography (dHPLC) and DNA sequencing were used to detect the FSH-R 307 polymorphic genotype and the whole exon 10 was analyzed. RESULTS: The heterozygote variant Ala307Thr was significantly more frequent than the homozygote variants in women with PCOS, whereas in normo-ovulatory women with normal ovary the three allelic variants had a comparable prevalence. Women bearing the Ala307Thr variant showed a higher ovarian responsiveness to exogenous FSH than normo-ovulatory subjects. CONCLUSIONS: The heterozygote FSH-R polymorphism Ala307Thr is significantly more frequent in women with PCOS than in normo-ovulatory subjects and is more frequently associated with a higher ovarian responsiveness to exogenous FSH.

Low-dose acetylsalicylic acid plus prednisolone as an adjuvant treatment in IVF: a prospective, randomized study.

OBJECTIVE: To test whether adjuvant therapy with acetylsalicylic acid (ASA) and prednisolone (ASA+Pred) could improve the outcome of IVF in good-pregnancy prognosis patients. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENT(S): Three hundred ninety-five infertile couples undergoing IVF. INTERVENTION(S): Patients were randomized to receive ASA+Pred (n = 97) or nothing (n = 298), in addition to the routinely used IVF medications. MAIN OUTCOME MEASURE(S): The primary endpoint was implantation rate (IR). Secondary endpoints were number of retrieved oocytes and pregnancy rate (PR). The blood flow in uterine arteries and subendometrial vessels also was measured. RESULT(S): Patients who received ASA+Pred had significantly more retrieved oocytes. The PR and IR in the study group and in controls were 50.5% and 40.6% and 25.1% and 19.4%, respectively, values that were not significantly different from one another. Uterine blood flows were not significantly different between treated and nontreated patients. A statistically significantly lower incidence of severe ovarian hyperstimulation syndrome was noted among treated patients who were at high risk of developing ovarian hyperstimulation syndrome (1.7% vs. 6.5%). CONCLUSION(S): Adjuvant treatment with ASA+Pred improves ovarian responsiveness but does not significantly improve uterine blood fluxes, PR, and IR. It may be effective in preventing the onset of severe ovarian hyperstimulation syndrome.