Overview of fertility preservation: History, management, available strategies and future directions in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#The increasing number of young survivors after cancer treatment and of patients with non-malignant conditions who are at risk for subfertility has resulted in a demand for fertility preservation services, including the Philippines.@*Objective@#The aim of this paper is to provide an overview of the history, indications, and management principles of fertility preservation. Also, the available strategies in the Philippines in both pre-pubertal and post-pubertal men and women and future directions of the field in the country will be discussed.@* Materials and methods@#Literature review, historical accounts@*Results and conclusions@#Fertility preservation should be a priority when treating children and adults of reproductive age with agents that have deleterious effects on the gonads. If harmful treatment will be used, the options of fertility preservation should be discussed, as early as possible by the primary physician in collaboration with the oncologist and the reproductive medicine specialist. Most of the known options for fertility preservation are available in the Philippines and are being implemented in the local IVF centers. Recent developments hint of a potentially faster progress in the field with the establishment of the Philippine Society for Fertility Preservation in collaboration with other professional societies and a linkage with the Department of Health with the signing into law of the National Integrated Cancer Control Act of 2019.

Rapid freezing versus Cryotop vitrification of mouse two-cell embryos / 대한생식의학회지

OBJECTIVE: To compare our in-house method of embryo freezing with Cryotop vitrification in terms of immediate survival, subsequent cleavage and blastocyst formation, and cell numbers in blastocysts. METHODS: Two-cell mouse embryos were randomly allocated into three groups: a non-frozen control group (group 1, n=300), a group that underwent Cryotop vitrification (group 2, n=300), and a group that underwent our in-house freezing method (group 3, n=300). RESULTS: There were no significant differences between groups 2 and 3 in the immediate survival rate (96.3% vs. 98.6%, respectively; p=0.085), the further cleavage rate (91.7% vs. 95.0%, respectively; p=0.099), or the blastocyst formation rate (80.7% vs. 78.6%, respectively; p=0.437). The cell numbers in the blastocysts from groups 1, 2, and 3 were comparable (88.99±10.44, 88.29±14.79, and 86.42±15.23, respectively; p=0.228). However, the percentage of good-quality blastocysts in the Cryotop vitrification group was significantly higher than in the group in which our in-house method was performed, but was lower than in the control group (58.0%, 37.0%, and 82.7%, respectively; p < 0.001). CONCLUSION: At present, our method is inferior to the commercial Cryotop vitrification system. However, with further improvements, it has the potential to be useful in routine practice, as it is easier to perform than the current vitrification system.

Efeito da adição do ácido linoleico conjugado no cultivo in vitro de embriões F1 Holandês x Zebu na sobrevivência pós-vitrificação / Effect of conjugated linoleic acid addition in in vitro culture medium in F1 Holstein X Zebu embryo survival post vitrification

Avaliou-se o efeito da adição do ácido linoleico conjugado (CLA) ao meio de cultivo in vitro na viabilidade pós-vitrificação de embriões F1 Holandês x Zebu. Foram utilizados três meios de cultivo: controle (n=340 oócitos): meio SOF e soro fetal bovino (SFB), sem o CLA; SFB+CLA (n=359 oócitos): meio SOF, SFB e CLA; CLA (n=339 oócitos): meio SOF e CLA, sem o SFB. Todos os blastocistos produzidos foram submetidos à vitrificação, pelo método de Open Pulled Straw. Quinze blastocistos de cada tratamento foram fixados para quantificação lipídica por coloração com Sudan Black B. Para avaliar a viabilidade embrionária, foi observada a capacidade de reexpansão e eclosão pós-aquecimento dos embriões (controle=27; SFB+CLA=30; CLA=17). Foram realizadas transferências em um ou dois embriões por receptora para avaliação da sobrevivência in vivo: T1 [receptoras que receberam um blastocisto (n=17 embriões, sendo controle=5, SFB+CLA=6 e CLA=6)]; T2 [receptoras que receberam dois blastocistos, (n= 54 embriões, sendo controle=18, SFB+CLA=14 e CLA=22)]. Não houve diferença nas taxas de clivagem (62,1%; 74,0%; 74,0% para controle; SFB+CLA; CLA, respectivamente), produção de blastocistos em relação aos clivados (59,7%; 47,7%; 38,3% para controle; SFB+CLA; CLA, respectivamente) e produção de blastocistos em relação ao total de oócitos (37,1%; 35,4%; 28,3% para controle; SFB+CLA; CLA, respectivamente) (P>0,05). Houve diminuição de gotículas lipídicas nos embriões cultivados em meio suplementado com CLA em relação aos embriões cultivados na presença do SFB e na ausência do CLA (P<0,05). A taxa de reexpansão foi maior no grupo controle (70,4%) em relação ao CLA (47,1%) e menor no grupo SFB+CLA (43,3%) (P<0,05). O CLA foi eficaz em reduzir a deposição de lipídeos intracitoplasmáticos nas células embrionárias, porém não houve diferença de viabilidade após a desvitrificação dos embriões.(AU)

The effect of adding conjugated linoleic acid (CLA) to the culture media on the viability after cryopreservation of F1 Holstein X Zebu embryos was evaluated. Three different culture media were tested: control (n = 340 oocytes): SOF medium and fetal bovine serum (FBS) without the CLA; FBS + CLA (n = 359 oocytes): SOF, FBS and CLA; CLA (n = 339 oocytes): SOF and CLA without the FBS. The produced blastocysts were subjected to vitrification, by the Open Pulled Straw method. Fifteen blastocysts per treatment were fixed for lipid quantification by staining with Sudan Black B. Embryo re-expansion and hatching capability were used to assess viability (control = 27; FBS + CLA = 30; CLA = 17). Transfers of one or two embryos to recipients were performed to evaluate in vivo survival: T1 [recipients that received one blastocyst (n=17 embryos, Control=5, FBS+CLA=6 and CLA=6)]; T2 [recipients that received two blastocysts (n =54 embryos, Control=18, FBS+CLA=14 and CLA=22)]. There was no difference in cleavage rate (62.1%; 74%; 74% for Control; FBS + CLA, CLA, respectively), blastocyst production in relation to the cleaved structures (59.7%; 47.7%; 38 3% for Control; FBS + CLA, CLA, respectively) and blastocyst production relative to the total oocytes (37.1%, 35.4%, 28.3% for Control; FBS + CLA, CLA, respectively) between treatments (P> 0.05). A reduction of lipid droplets was observed in embryos cultured in medium supplemented with CLA compared to embryos cultured in the FCS in the absence and presence of CLA (P <0.05). The reexpansion rate was higher in the Control group (70.4%) compared to the CLA (47.1%) and lowest for FBS+CLA (43.3%) (P<0.05). The hatching rates were similar among treatments, 42.1%; 23.1%; 25% for control; SFB + CLA; CLA respectively (P>0.05). Only one pregnancy was observed in early and confirmatory diagnosis, as the result of a Control group embryo transfer. Although embryos cultured with CLA have shown smaller intracytoplasmic lipid content, no difference was observed in viability following vitrification between treatments.(AU)

Successful pregnancy following transfer of frozen-thawed embryos in a patient with pseudomyxoma peritonei who underwent peritonectomy and bilateral oophorectomy / 부인종양

Pseudomyxoma peritonei is a rare, chronic relapsing disease in which tumor cells in the abdomen produce excessive mucin with a significant mortality rate. We describe a young unmarried nulligrava who underwent fertility preservation by in vitro fertilisation and embryo cryopreservation prior to radical surgery and adjuvant chemotherapy. Pregnancy was achieved, although complicated by obstructive uropathy. She delivered a healthy infant at 32 weeks' gestation. The few descriptions of fertility and pregnancy outcome in pseudomyxoma peritonei that appear in the literature are reviewed.

Analysis of impact factors for post-thaw embryo survival rate and clinical pregnancy rate of frozen-thawed embryo transfer program / 上海第二医科大学学报

Objective To explore the impact factors for post-thaw embryo survival rate and clinical pregnancy rate in frozen-thawed embryo transfer program. Methods The clinical data of 573 cycles of frozen-thawed embryo transfers were retrospectively analysed. Groups were divided according to the pre-freeze embryo quality, pre-freeze embryonic developmental stage, frozen-thawed embryo quality and cryopreservation technique, respectively, and post-thaw embryo survival rates and/or clinical pregnancy rates were compared among groups. Results The clinical pregnancy rate of high quality pre-freeze embryo was significantly higher than that of low quality pre-freeze embryo (31.8% vs 20.0%) (P< 0.05). There was no significant difference in the post-thaw survival rates and clinical pregnancy rates between embryos frozen at day 2 of ferrtilization and those frozen at day 3 of ferrtilization(79. 1% vs 82.9% and 25.5% vs 31.2%, respectively) (P>0.05). The clinical pregnancy rates of the transfer cycles only with fully intact embryos and with mixed embryos were significantly higher than that only with partially damaged embryos(36.7% vs 24.1% and 29.2% vs 24.1%, respectively)(P<0.05). The post-thaw survival rate and post-thaw high-quality embryo rate were significantly higher in those processed with modified cryopreservation technique than in those processed with original cryopreservation technique (82.0% vs 66.3% and 50.0% vs 27.5%, respectively)(P<0.05). Conclusion Pre-freeze embryo quality, post-thaw embryo survival rate and post-thaw embryo quality have a positive correlation to subsequent clinical pregnancy rate. Favorable cryopreservation technique may ensure the success of post-thaw embryo recovery and transfer.

Fertility preservation for women with malignancies: current developments of cryopreservation / 부인종양

The preservation of fertility in female cancer survivors has become an important health issue. The different cryopreservation options available for fertility preservation are embryo, oocyte, and ovarian tissue cryopreservation. Oocyte cryopreservation is available for women without partners, but there is a limited experience with this technique and the pregnancy rate is still low. In spite of recent reports of successful birth after autotransplantation of cryopreserved-thawed human ovarian cortical tissues, clinical experience is also limited and this technique remains still experimental. Whole ovary cryopreservation itself poses several challenges. Further researches for establishing optimal cryopreservation and thawing protocols and increasing post-thawing survival, pregnancy, and delivery rates are necessary. In this article, the strategies for fertility preservation in cancer survivors are discussed. The different options and their results are discussed, as well as their indications, efficacy and ethical issues.

Fertility preservation in female cancer survivors / 대한산부인과학회지

Cancer is not rare in women in reproductive ages, and there has been a remarkable improvement in the survival rates due to progress in cancer treatment. Moreover, women have been delaying the initiation of childbearing to later in life. Thus the preservation of fertility in female cancer survivors has become an important health issue. Because of the variations in the type of cancer, type and dose of chemotherapy, the time available before onset of treatment, the patient's age, and the status of partners, each case should be individualized and requires a different strategy in fertility preservation. When a partner or donor sperm is available, embryo cryopreservation is now an established and acceptable technique for fertility preservation, providing a delay in the initiation of chemotherapy or radiotherapy. Oocyte cryopreservation is available for women without partners, but there is a limited experience with this technique and pregnancy rate is still low. In spite of the recent reports of successful birth after autotransplantation of cryopreserved-thawed human ovarian tissue, clinical experience is also limited and this technique remains still experimental. Further researches for establishing optimal cryopreservation and thawing protocols and increasing post-thawing survival, pregnancy, and delivery rates are necessary. In this article, the mechanisms of reproductive failure after cancer therapy and the strategies for fertility preservation in cancer survivors are discussed.