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1.
J Cancer Res Clin Oncol ; 146(3): 647-657, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32006118

RESUMO

Breast cancer (BC) is the most common malignancy in women with a significant increasing incidence during the reproductive life. However, based on the newest anti-cancer molecular targeting drugs, successful treatments lead to the disease healing particularly in young patients, thus refreshing their motherhood programs. However, as effect of the BC treatment, a premature depletion of the ovarian follicle reserve occurs in more than one-third of patients resulting in permanent infertility. To prevent the cancer treatment-related infertility (CTRI), several options are today utilized. Besides the ovary suppression by gonadotropin-releasing hormone agonist (GnRHa), other procedures include either oocytes or embryos cryopreservation as well as ovarian cortex cryopreservation that are currently adopted before anti-cancer therapies. These modern techniques appear variably successful in terms of pregnancy rate though their safety concerning the hormonal stimulation to promote the folliculogenesis is still debated in relation to the potential oncogenic risk in patients bearing hormone-sensitive tumors as BC, while the ovarian cortex re-implantation often results in a low number of regenerated follicles including oocytes of unknown quality. Recent studies on ovarian stem cells (OSCs) suggest their use for future application in CTRI. In fact, OSCs from ovarian cortex have been shown to differentiate in vitro into oocyte-like cells (OLCs) and express molecular markers of mature oocytes. Once the OSC technology will be optimized and translated to clinical use, oocytes derived from these cells will be molecularly assessed before fertilization to assure their best embryo quality resulting in a safe procedure to treat CTRI in patients as young women with BC.


Assuntos
Neoplasias da Mama , Preservação da Fertilidade/métodos , Infertilidade Feminina/prevenção & controle , Adulto , Feminino , Preservação da Fertilidade/tendências , Humanos , Infertilidade Feminina/etiologia
2.
Radiol Clin North Am ; 58(2): 401-412, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044014

RESUMO

Gynecologic cancers impact women of all ages. Some women may wish to preserve their capacity for future childbearing. With appropriate patient selection, acceptable oncologic outcomes may be achieved with preservation of fertility. Determination of eligibility for fertility preservation is guided by patient factors, tumor histology, and preoperative local staging with pelvic MR imaging. The aim of this article is to educate radiologists on the current guidelines for fertility-sparing techniques in women with early stage cervical, endometrial, and ovarian malignancies.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/terapia , /métodos , Adulto , Feminino , Genitália Feminina/diagnóstico por imagem , Humanos
3.
Cir. pediátr ; 33(1): 25-29, ene. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-186134

RESUMO

Introducción: La transposición ovárica es una técnica quirúrgica que permite alejar los ovarios de la zona de irradiación en pacientes que van a recibir radioterapia abdominal o pélvica. Se han descrito buenas tasas de conservación de función. Sin embargo, no existen estudios en pacientes pediátricos. Presentamos nuestra serie de pacientes intervenidas en nuestro centro. Material y métodos: Estudio retrospectivo de pacientes a las que se le realizó transposición ovárica en nuestra unidad de cirugía oncológica pediátrica entre los años 2008 y 2018. La técnica empleada dependió de la edad, la zona de la irradiación y de la asociación o no con la cirugía del tumor primario. Resultados: Durante el periodo de estudio se realizaron un total de 21 transposiciones ováricas en 13 pacientes (8 bilaterales, 4 izquierdas y 1 derecha). En todos los casos se realizó criopreservación de corteza ovárica dentro del programa de preservación de fertilidad. Once de las 13 intervenciones fueron por laparoscopia, seccionándose el ligamento tubo-ovárico en 16 unidades y en 5 se realizó transposición ovárica sim-ple. La estancia hospitalaria media fue de 2,4 días sin registrarse ninguna complicación en el postoperatorio. Actualmente 9 pacientes continúan seguimiento en sus unidades de oncología pediátrica de referencia, sin haberse notificado ninguna complicación. Conclusión: La transposición ovárica es una técnica segura y reproducible. Estas pacientes requieren un seguimiento prolongado para conocer el estado de los ovarios tras el tratamiento oncológico


Introduction: Ovarian transposition is a surgical procedure allow-ing gonadal mobilization from a radiation spotlight to a safer, radiation therapy-free place in patients receiving abdominal or pelvic radiation therapy. And these patients can be managed using minimally invasive surgery. Although some authors have reported good results in fertility preservation with this technique, there are no long-term studies in the pediatric population. We present our results with this procedure in our oncological patients from the last decade. Materials and methods: Retrospective review of medical reports of patients who underwent laparoscopic ovarian transposition in our pediatric oncological surgery unit from 2008 to 2018. The technique varied depending on age, irradiation zone, and concomitant oncologi-cal resections. Results: A total of 21 ovarian transpositions were successfully per-formed in 13 patients. Eight were bilateral, four were left and only one was right. An ovarian cortex cryopreservation was simultaneously carried out in all patients. Eleven procedures were completed laparoscopically, and the suspensory ovarian ligament was divided in sixteen cases. The Fallopian tube was divided in one case, and a simple ovarian transposition was conducted in five cases. Mean hospital stay was 2.4 days, and no complications in the immediate postoperative period were noted. Conclusion: Ovarian transposition is a feasible, safe technique. These patients require an extended follow-up to assess ovarian function after oncological treatment


Assuntos
Humanos , Feminino , Criança , Adolescente , Preservação da Fertilidade/métodos , Preservação da Fertilidade/tendências , Atenção Terciária à Saúde , Criopreservação/métodos , Ovariectomia/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias , Epidemiologia Descritiva , Ovário/cirurgia , Radioterapia/métodos , Laparoscopia
5.
Gynecol Oncol ; 155(3): 522-529, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604663

RESUMO

An increasing number of women in modern societies are delaying childbearing beyond the age of 35, and gynecologic cancers affect a significant proportion of reproductive age women who wish to preserve fertility for a future chance of childbearing. As a result, providing treatment options for fertility preservation in women with gynecologic cancer has become a crucial component of cancer survivorship care. In this review article, we discussed the current knowledge on fertility-sparing surgical approaches, as well as assisted reproductive technologies that can be utilized to preserve reproductive potential in women with cervical, endometrial, and ovarian cancer. A brief section on fertility preservation in pediatric gynecologic malignancies is also provided.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias dos Genitais Femininos/terapia , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Técnicas de Reprodução Assistida
6.
Gynecol Oncol ; 155(2): 287-293, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31493900

RESUMO

OBJECTIVE: To compare the oncologic outcome of women who underwent fertility-sparing surgery (FSS) vs. radical surgery (RS) for treatment of NEOC in a prospective, nationwide, population-based study and report on the reproductive outcomes in women after FSS. METHODS: Using the Swedish Quality Register for Gynecological Cancer, we identified all women ages 18-40 treated with either FSS or RS for stage I NEOC between 2008 and 2015. Progression-free survival (PFS) and overall survival (OS) rates were compared using the Kaplan-Meier method. Data on use of assisted reproductive technology (ART) treatments and obstetrical outcomes after FSS were extracted from the National Quality Register for Assisted Reproduction (Q-IVF) and the Swedish Medical Birth Register. RESULTS: During the study period, 73 women ages 18-40 received a stage I NEOC diagnosis. The majority, 78% (n = 57), underwent FSS. The 5-year OS rate, regardless of surgical approach, was 98%. There were no statistical differences between OS and PFS rates in women treated with FSS, compared to RS. Recurrences were more common after RS than FSS: 12.5% (2/16) vs. 3.5% (2/57), respectively. Following FSS, 11 women gave birth to 13 healthy children (all conceived naturally). Additionally, 12% of the women in the cohort developed infertility and received ART treatment (n = 7). CONCLUSION: FSS is not associated with worse oncologic outcomes than RS in young women with early stage NEOC. The prognosis was excellent in both groups, with an OS of 98%. Natural fertility was maintained in women treated with FSS, only 12% required ART treatment.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Análise de Variância , Intervalo Livre de Doença , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/mortalidade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Ovarianas/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Gravidez , Complicações Neoplásicas na Gravidez/mortalidade , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Prospectivos , Suécia/epidemiologia , Adulto Jovem
7.
J Assist Reprod Genet ; 36(9): 1805-1822, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31399917

RESUMO

PURPOSE: With over 80% of paediatric and adolescent cancer patients surviving into adulthood, quality-of-life issues such as future fertility are increasingly important. However, little is known about regret around decisions to pursue or forgo fertility preservation (FP). We investigated the risk of decision regret in families involved in making a FP decision and explored contributive factors. METHODS: Parents and patients ≥ 15 years were invited to participate. Participants completed a 10-item survey, including a validated Decision Regret Scale. Scores ≥ 30 indicated high regret. Free-text response items allowed participants to provide reasons for satisfaction or regret. RESULTS: A total of 108 parents and 30 patients participated. Most (81.4%) reported low regret (mean score 13.7). On multivariate analysis, predictors of low regret included having a FP procedure and a fertility discussion pre-treatment. Most participants believed that FP offers hope for future fertility. Some reported dissatisfaction with the process of decision-making. CONCLUSION: Overall levels of regret in the study population were low, with factors associated with quality, timely discussion and belief in the success of FP technology being predictors of low regret. However, dissatisfaction with the decision-making process itself revealed that refinements to the programme are required to meet families' needs.


Assuntos
Preservação da Fertilidade/psicologia , Neoplasias , Satisfação Pessoal , Adolescente , Adulto , Criança , Estudos Transversais , Emoções , Feminino , Preservação da Fertilidade/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Pais , Adulto Jovem
8.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31383814

RESUMO

BACKGROUND: Fertility preservation enables patients undergoing gonadotoxic therapies to retain the potential for biological children and now has broader implications in the care of transgender individuals. Multiple medical societies recommend counseling on fertility preservation before initiating therapy for gender dysphoria; however, outcome data pre- and posttreatment are limited in feminizing transgender adolescents and young adults. METHODS: The University of Pittsburgh Institutional Research Board approved this study. Data were collected retrospectively on transgender patients seeking fertility preservation between 2015 and 2018, including age at initial consultation and semen analysis parameters. RESULTS: Eleven feminizing transgender patients accepted a referral for fertility preservation during this time; consultation occurred at median age 19 (range 16-24 years). Ten patients attempted and completed at least 1 semen collection. Eight patients cryopreserved semen before initiating treatment. Of those patients, all exhibited low morphology with otherwise normal median semen analysis parameters. In 1 patient who discontinued leuprolide acetate to attempt fertility preservation, transient azoospermia of 5 months' duration was demonstrated with subsequent recovery of spermatogenesis. In a patient who had previously been treated with spironolactone and estradiol, semen analysis revealed persistent azoospermia for the 4 months leading up to orchiectomy after discontinuation of both medications. CONCLUSIONS: Semen cryopreservation is a viable method of fertility preservation in adolescent and young adult transgender individuals and can be considered in patients who have already initiated therapy for gender dysphoria. Further research is needed to determine the optimal length of time these therapies should be discontinued to facilitate successful semen cryopreservation.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Disforia de Gênero/terapia , Sêmen , Adolescente , Aconselhamento , Estradiol/uso terapêutico , Estrogênios/uso terapêutico , Feminino , Disforia de Gênero/psicologia , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Masculino , Estudos Retrospectivos , Espironolactona/uso terapêutico , Adulto Jovem
9.
J Assist Reprod Genet ; 36(9): 1823-1835, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31376104

RESUMO

PURPOSE: Vitrification is a well-accepted fertility preservation procedure for cryopreservation of oocytes and embryos but little is known regarding ovarian tissue, for which slow freezing is the current convention. The aim of the present study was to assess the efficiency of non-equilibrium vitrification compared to conventional slow freezing for ovarian cortex cryopreservation. METHODS: Using prepubertal sheep ovaries, the capacity of the tissue to sustain folliculogenesis following cryopreservation and in vitro culture was evaluated. Ovarian cortex fragments were cultured in wells for 9 days, immediately or after cryopreservation by conventional slow freezing or non-equilibrium vitrification in straws. During culture, follicular populations within cortex were evaluated by histology and immunohistochemistry for PCNA and TUNEL. Steroidogenic activity of the tissue was monitored by assay for progesterone and estradiol in spent media. RESULTS: No significant differences in follicle morphology, PCNA, or TUNEL labeling were observed between cryopreservation methods at the initiation of culture. Similar decreases in the proportion of primordial follicle population, and increases in the proportion of growing follicles, were observed following culture of fresh or cryopreserved ovarian tissue regardless of cryopreservation method. At the end of culture, PCNA and TUNEL-positive follicles were not statistically altered by slow freezing or vitrification in comparison to fresh cultured fragments. CONCLUSIONS: Overall, for both cryopreservation methods, the cryopreserved tissue showed equal capacity to fresh tissue for supporting basal folliculogenesis in vitro. Taken together, these data confirm that both non-equilibrium vitrification and slow-freezing methods are both efficient for the cryopreservation of sheep ovarian cortex fragments.


Assuntos
Criopreservação/métodos , Folículo Ovariano , Ovário/fisiologia , Animais , Estradiol/metabolismo , Feminino , Preservação da Fertilidade/métodos , Folículo Ovariano/citologia , Folículo Ovariano/fisiologia , Progesterona/metabolismo , Antígeno Nuclear de Célula em Proliferação/metabolismo , Puberdade , Ovinos , Técnicas de Cultura de Tecidos , Vitrificação
10.
Pediatr Blood Cancer ; 66(11): e27966, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31407498

RESUMO

BACKGROUND: Over half of male childhood cancer survivors experience infertility after treatment, which is known to cause distress and impact future quality of life. Sperm banking rates remain low, and little is known about how adolescent and young adult (AYA) males and their families make fertility preservation (FP) decisions. This study examined AYA and parent perceptions of participating in a research study focused on testing a new FP decision tool at the time of cancer diagnosis. METHODS: Forty-four participants (19 mothers, 11 fathers, 14 male AYAs 12-25 years old) from 20 families completed brief assessments at diagnosis and approximately one month later, including a qualitative interview exploring the impact of study participation. Verbatim transcripts were coded through thematic content analysis using the constant comparison method. RESULTS: Two major themes emerged: (1) a positive effect of participating in the study and (2) a neutral effect (no positive/negative effect of participation). Subthemes that emerged for participants who noted a positive effect included (a) participation prompted deeper thinking, (b) participation influenced family conversations, and (c) participation resulted in altruism/helping others. No participant reported a negative effect. CONCLUSIONS: This study demonstrates that participation in family-centered research focused on FP among AYA males, before treatment begins, is perceived as beneficial or neutral at the time of a new cancer diagnosis. These findings provide support for future family-centered FP interventions for this population.


Assuntos
Atitude Frente a Saúde , Tomada de Decisões , Família , Preservação da Fertilidade/psicologia , Neoplasias/psicologia , Preservação do Sêmen/psicologia , Adolescente , Adulto , Criança , Pai/psicologia , Feminino , Preservação da Fertilidade/métodos , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Infertilidade Masculina/psicologia , Masculino , Mães/psicologia , Neoplasias/complicações , Projetos Piloto , Pesquisa Qualitativa , Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
11.
Acta Clin Croat ; 58(1): 147-156, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363337

RESUMO

Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Recuperação de Oócitos/métodos , Indução da Ovulação/métodos , Adulto , Neoplasias da Mama/terapia , Feminino , Humanos , Infertilidade Feminina/prevenção & controle , Adulto Jovem
12.
Cancer Radiother ; 23(6-7): 737-744, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31455591

RESUMO

The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Braquiterapia , Terapia Combinada/métodos , Feminino , Humanos , Metástase Linfática , Recidiva Local de Neoplasia/cirurgia , Guias de Prática Clínica como Assunto , Carga Tumoral , Neoplasias do Colo do Útero/patologia
13.
Blood ; 134(9): 746-760, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31292116

RESUMO

Patients with hematologic malignancies and those undergoing hematopoietic cell transplantation (HCT) face a complex set of challenges when considering options for fertility preservation (FP). There are no standard options for prepubertal children, and women with hematologic malignancies may not be eligible for standard FP options. Fortunately, initial therapies for most blood cancers are not highly gonadotoxic, affording an important opportunity for postremission counseling and referrals to fertility specialists. These patients face a high risk of relapse, and many will be referred for autologous or allogeneic HCT, which carries an extremely high risk of infertility. The expanding indications for HCT to include benign hematologic disorders as well as autoimmune diseases mandate that all hematologists are familiar with these risks. Oncofertility researchers are continually pushing the boundaries of what may be possible for our patients; in the meantime, communication and shared decision-making between hematologists and patients, as well as program-building, education, and outreach are essential to ensure that these patients, many of whom will be cured, maintain all of their options for a fulfilling life after intensive therapy.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Feminino , Neoplasias Hematológicas/complicações , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Infertilidade/etiologia , Infertilidade/terapia , Masculino , Qualidade de Vida
14.
Urol Clin North Am ; 46(3): 341-351, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277729

RESUMO

The presence of cancer in the testis, as well as the therapies used to treat testis cancer, can impair fertility potential for affected men. Fertility preservation is an important aspect of survivorship care and should be offered to all patients before initiating treatment. The only established means of fertility preservation in men is cryopreservation of sperm. Methods for fertility preservation in prepubertal boys are still experimental. Physicians treating men with testicular cancer should be familiar with the available options. This article outlines testicular cancer and its treatment's effects on fertility, fertility preservation options, and barriers to accessing this specialized care.


Assuntos
Preservação da Fertilidade/métodos , Infertilidade Masculina/etiologia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/terapia , Fatores Etários , Criopreservação , Humanos , Masculino
15.
Future Oncol ; 15(22): 2635-2643, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339047

RESUMO

Despite rectal cancer being unusual before 40, fertility preservation (FP) remains a major concern for these reproductive-age women. Treatment usually involves pelvic radiotherapy, neoadjuvant chemotherapy, and surgery of rectum and mesorectum resection, at high risk of impairing fertility in women with risks of premature ovarian failure and radio-induced uterus damage. To date, there is no consensus on FP strategy for rectal cancer. We shared experiences between oncofertility experts from a French research network Groupe de Recherche et d'Etude en Cryoconservation Ovarienne et Testiculaire about a case of rectal cancer in a young woman. Indications, advantages and disadvantages of different FP strategies were discussed: ovarian transposition, cryopreservation of ovarian cortex and oocyte vitrification. This case was the starting point that led to the development of a French multidisciplinary e-meeting for sharing experiences and for suggesting the best strategy when faced with a complex oncofertility case.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Neoplasias Retais/terapia , Reprodução , Adulto , Feminino , França/epidemiologia , Humanos , Oócitos/crescimento & desenvolvimento , Oócitos/patologia , Ovário/crescimento & desenvolvimento , Ovário/patologia , Neoplasias Retais/complicações , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Vitrificação
16.
Zhonghua Zhong Liu Za Zhi ; 41(7): 486-495, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31357834

RESUMO

Breast cancer in young women is a relatively common disease in China. Its clinical, pathological and genetic characteristics make the disease special. The consequences of anticancer treatments including premature menopause and impaired fertility have far-reaching impact for these women both medically and psycho-socially. Thus, specific multimodality care is paramount. To standardize the diagnosis and treatment process of breast cancer and fertility management strategy in young patients, based on the literature and relevant international guidelines, the oncology specialists and experts on reproductive medicine discuss and propose this "Chinese Consensus Guidelines for Breast Cancer in Young Women: Clinical Practice and Fertility Preservation" .


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Preservação da Fertilidade/métodos , Guias como Assunto , Infertilidade Feminina/prevenção & controle , China , Feminino , Humanos , Oncologia
17.
Reprod Biol Endocrinol ; 17(1): 56, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311554

RESUMO

BACKGROUND: To investigate the therapeutic effects of menstrual blood derived mesenchymal stem cells (MB-MSCs) combined with Bushen Tiaochong recipe (BSTCR) on epirubicin induced premature ovarian failure (POF) in mice. METHODS: Twenty-four female C57BL/6 mice of 6-8 weeks were intraperitoneally injected with epirubicin to induce POF, and then they were randomized into 4 groups of 6 mice each and treated with PBS, MB-MSCs, BSTCR, and MB-MSCs combined with BSTCR, respectively. Six mice of the same age were used as controls. Vaginal smear, TUNEL and hematoxylin-eosin staining were to observe estrous cycles, ovarian cell apoptosis and follicles. Enzyme-linked immunosorbent analysis determined serum estradiol, follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels. RT-qPCR and Western Blot analysis were to determine GADD45b, CyclinB1, CDC2 and pCDC2 expressions. RESULTS: Epirubicin treatment resulted in a decrease in the number of primordial, primary, secondary and antral follicles, an increase in the number of atretic follicles and ovarian cell apoptosis, a decrease in estradiol and AMH levels, an increase in FSH levels, and estrous cycle arrest. However, MB-MSCs combined with BSTCR rescued epirubicin induced POF through down-regulating GADD45b and pCDC2 expressions, and up-regulating CyclinB1 and CDC2 expressions. The combined treatment showed better therapeutic efficacy than BSTCR or MB-MSCs alone. CONCLUSIONS: MB-MSCs combined with BSTCR improved the ovarian function of epirubicin induced POF mice, which might be related to the inhibition of GADD45b expression and the promotion of CyclinB1 and CDC2 expressions. The combined treatment had better therapeutic efficacy than BSTCR or MB-MSCs alone.


Assuntos
Antígenos de Diferenciação/metabolismo , Estro/sangue , Preservação da Fertilidade/métodos , Células-Tronco Mesenquimais , Insuficiência Ovariana Primária/induzido quimicamente , Animais , Ciclo Celular , Epirubicina , Feminino , Transplante de Células-Tronco Mesenquimais , Camundongos Endogâmicos C57BL , Ovário/anatomia & histologia , Ovário/fisiologia , Insuficiência Ovariana Primária/terapia
18.
Expert Opin Drug Saf ; 18(9): 841-852, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238745

RESUMO

Introduction: Systemic Autoimmune Diseases (SADs) include systemic lupus erythematosus, antiphospholipid antibody syndrome, rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, mixed connective tissue disease, idiopathic inflammatory myopathies and vasculitis. SADs often occur in women of childbearing age and can affect fertility. Both infertility treatments and fertility preservation techniques are thus often indicated. Areas covered: The literature regarding the safety of fertility-related drugs for both fertility preservation and infertility treatment in patients affected by SADs was reviewed. Based on current knowledge, all the options for fertility preservation should be contemplated in patients with SADs who are at risk for fertility loss, including GnRH analogue administration, oocyte/embryo vitrification and ovarian tissue cryopreservation. Similarly, if pregnancy is not contraindicated in a patient with a SAD, neither should be any fertility treatment. Expert opinion: Women with SADs should postpone conception until a stable disease has been achieved for at least 6 months. When infertility treatments are needed, women with antiphospholipid antibodies should receive concomitant anticoagulation. If in vitro fertilization/intra-cytoplasmic sperm injection and embryo transfer is required, ovarian hyperstimulation and the inherent risk of thrombosis should be eliminated by GnRH-agonist trigger and cycle segmentation. Counselling about adherence to anti-rheumatic therapy to prevent disease exacerbations is also critical.


Assuntos
Doenças Autoimunes/complicações , Preservação da Fertilidade/métodos , Infertilidade Feminina/terapia , Anticorpos Antifosfolipídeos/imunologia , Doenças Autoimunes/fisiopatologia , Criopreservação/métodos , Feminino , Fertilização In Vitro/métodos , Humanos , Infertilidade Feminina/etiologia , Gravidez , Técnicas de Reprodução Assistida
19.
Best Pract Res Clin Endocrinol Metab ; 33(1): 89-102, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31208678

RESUMO

While still considered an experimental procedure in most countries, ovarian tissue cryopreservation and transplantation has been increasingly applied worldwide to restore fertility in patients with malignant and non-malignant pathologies with risk of premature ovarian insufficiency. It has yielded more than 130 live births up to now and almost all transplanted patients recovered their ovarian function. This study summarizes ovarian tissue cryopreservation and transplantation indications, procedures, their efficacy and main results and proposes different strategies to improve this strategy. Although the main focus of this study is on ovarian tissue cryopreservation and transplantation as a strategy to restore fertility, we believe that it is also important to discuss other applications for this approach.


Assuntos
Criopreservação , Preservação da Fertilidade/métodos , Infertilidade/terapia , Ovário , Criopreservação/métodos , Feminino , Humanos , Ovário/transplante , Gravidez , Insuficiência Ovariana Primária/terapia , Reoperação , Transplante Autólogo
20.
Anim Reprod Sci ; 207: 119-130, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31208845

RESUMO

Fertility preservation is not only a concern for humans with compromised fertility after cancer treatment. The preservation of genetic material from endangered animal species or animals with important genetic traits will also greatly benefit from the development of alternative fertility preservation strategies. In humans, embryo cryopreservation and mature-oocyte cryopreservation are currently the only approved methods for fertility preservation. Ovarian tissue cryopreservation is specifically indicated for prepubertal girls and women whose cancer treatment cannot be postponed. The cryopreservation of pre-antral follicles (PAFs) is a safer alternative for cancer patients who are at risk of the reintroduction of malignant cells. As PAFs account for the vast majority of follicles in the ovarian cortex, they represent an untapped potential, which could be cultivated for reproduction, preservation, or research purposes. Vitrification is being used more and more as it seems to yield better results compared to slow freezing, although protocols still need to be optimized for each specific cell type and species. Several methods can be used to assess follicle quality, ranging from simple viability stains to more complex xenografting procedures. In vitro development of PAFs to the pre-ovulatory stage has not yet been achieved in humans and larger animals. However, in vitro culture systems for PAFs are under development and are expected to become available in the near future. This review will focus on recent developments in (human) fertility preservation strategies, which are often accomplished by the use of in vitro animal models due to ethical considerations and the scarcity of human research material.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Folículo Ovariano/citologia , Ovário , Vitrificação , Animais , Criopreservação/veterinária , Feminino , Preservação da Fertilidade/veterinária , Humanos
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