[How to preserve female fertility before cancer treatments?]. / Comment préserver la fertilité féminine lors du traitement d'un cancer en vue de rendre possible une grossesse ultérieure?

Over the past decades, major advances in diagnosis and treatment have markedly improved the rates of cure for many young adults and children cancers. As a result, the field of fertility preservation (FP) has developed to overcome the adverse effects of cancer treatments on gonadal function. The strategy of FP will depend on patient's age, the puberty status, and the time frame before the initiation of gonadotoxic treatments. Embryo or oocyte cryopreservation after controlled ovarian hyperstimulation is currently the most established technique of FP, but ovarian tissue freezing may also be offered despite it is still considered experimental. More recently, in vitro maturation (IVM) of oocyte has been proposed in the strategy of FP since it does not require ovarian stimulation and can be performed at any time of the menstrual cycle. Therefore, IVM represents an attractive approach for urgent FP or/and in patients suffering from estrogen-sensitive cancers. In addition, GnRH agonists administration during chemotherapy has also been considered as a technique of FP, with controversial results.

New trends in female fertility preservation: in vitro maturation of oocytes.

As antineoplastic treatments have become more successful, an increasing number of women with cancer survive to endure the long-term consequences of chemotherapy. One of the most important of these consequences in young females is premature ovarian failure and infertility. Owing to increasing survival rates, many of these young women are seeking methods to preserve their fertility. Currently, embryo/oocyte cryopreservation obtained after controlled ovarian stimulation appears to provide the best fertility preservation option. However, patients may not have enough time to undergo ovarian stimulation prior to chemotherapy and/or have contraindications to exogenous gonadotropin administration owing to estrogen-dependant tumors. In vitro maturation of oocytes is an attractive alternative for fertility preservation in cancer patients because it does not require ovarian stimulation and it can be performed at any time of the menstrual cycle. In addition, this technique can be combined with ovarian tissue cryobanking. In this review, we discuss the position of in vitro maturation of oocytes in the fertility preservation strategy in young women.

Predictive factors for pregnancy after controlled ovarian stimulation and intrauterine insemination: A retrospective analysis of 4146 cycles.

BACKGROUND: The variability in indications and low rate of pregnancy compared to IVF have led many authors to dismiss IUI and offer IVF first-line instead. OBJECTIVES: To determine what are the predictive factors for clinical pregnancy (CP) and live birth (LB) in intrauterine insemination (IUI) cycles following controlled ovarian stimulation (COS). METHODS: Retrospective unicentric study, between January 2009 and December 2016. Patients aged 18 to <43 years who had an IUI following COS with gonadotropins. Statistical analysis was performed using Chi square and logistic regression. RESULTS: 4146 cycles (1312 couples) included. Mean age was 34.7 +/- 4years. LBR per couple was 39% for anovulatory infertility compared to (p < 0.05) unex-plained infertility (28.6%), mixed (23.4%), male factor (20.1%), unilateral tubal (14.2%), low ovarian reserve (13.2%), and endometriosis (stage I and II) (11.1%). Multivariate analysis showed the following factors were associated with CP: Cycle rank ≤3 (Odds ratio (OR) = 1.5, 95% CI: 1.2-1.9, p < 0.001), age <38 years (OR = 1.5, 95% CI: 1.2-2, p < 0.001), ≥2 preovulatory follicles (OR = 1.4, 95% CI: 1.1-1.8, p = 0.004), TMSC ≥ 5 millions (OR = 1.8, 95% CI: 1.3-2.4, p < 0.001). Endometriosis, low ovarian reserve, unilateral tubal and male factor had a negative impact on CPR (OR = 0.3, 95% CI: 0.1-0.5, p < 0.001; OR = 0.4, 95% CI: 0.3-0.7, p < 0.001; OR = 0.5 95% CI: 0.3-0.9, p = 0.01; OR = 0.6, 95% CI: 0.4-0.8, p = 0.002 respectively) compared to anovulatory infertility. CONCLUSION: We confirm that IUI can be an efficient treatment in selected indications. Young patients with anovulatory infertility seem to be the ideal candidates, with a 39% LBR per couple.

In vitro maturation of oocytes: uncommon indications.

Retrieval of immature oocytes from unstimulated ovaries, followed by in vitro maturation (IVM) was initially proposed to avoid the risks and side effects of exogenous gonadotropin administration. Therefore, during the past decades, IVM was mainly offered to patients with polycystic ovary syndrome (PCOS) at high risk of ovarian hyperstimulation syndrome (OHSS). However, the development of fertility preservation has recently opened new perspectives in the field of IVM. The present review summarizes uncommon indications of IVM, which is a viable option to treat infertility in patients with ovarian resistance to FSH, but may also be considered to preserve fertility in leukemia as well as before ovarian transposition and endometrioma excision.

Ovarian tissue and follicle transplantation as an option for fertility preservation.

OBJECTIVE: To review and summarize data from the scientific literature on ovarian tissue and follicle transplantation as an option for fertility preservation. DESIGN: Review of pertinent literature. SETTING: University hospital. PATIENT(S): Women having undergone ovarian tissue transplantation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Review of the literature. RESULT(S): Over the last decade, the field of ovarian transplantation and cryopreservation has significantly progressed, becoming applicable in humans. Indeed, fresh and frozen cortical ovarian tissue transplantations have been successfully reported worldwide, resulting in around 28 healthy babies. Although ovarian-tissue harvesting seems to be safe, the risk of reimplantation of cancer from ovarian cortical transplants cannot be estimated at this time. As a consequence, auto-transplantation of ovarian tissue in women having suffered from systemic hematological malignancies is not recommended. In these situations, reimplantation of isolated ovarian follicles might represent an interesting option in the future. CONCLUSION(S): Although the clinical experience is limited, the robust results obtained open new perspectives for the management of premature ovarian failure resulting or not from gonadotoxic treatments.