Cargando…
Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases
BACKGROUND: The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with r...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10416401/ https://www.ncbi.nlm.nih.gov/pubmed/37563616 http://dx.doi.org/10.1186/s13048-023-01250-x |
_version_ | 1785087765768044544 |
---|---|
author | Saito, Saki Yamada, Mitsutoshi Yano, Rika Takahashi, Kazuko Ebara, Akiko Sakanaka, Hiroe Matsumoto, Miho Ishimaru, Tomoko Utsuno, Hiroki Matsuzawa, Yuichi Ooka, Reina Fukuoka, Mio Akashi, Kazuhiro Kamijo, Shintaro Hamatani, Toshio Tanaka, Mamoru |
author_facet | Saito, Saki Yamada, Mitsutoshi Yano, Rika Takahashi, Kazuko Ebara, Akiko Sakanaka, Hiroe Matsumoto, Miho Ishimaru, Tomoko Utsuno, Hiroki Matsuzawa, Yuichi Ooka, Reina Fukuoka, Mio Akashi, Kazuhiro Kamijo, Shintaro Hamatani, Toshio Tanaka, Mamoru |
author_sort | Saito, Saki |
collection | PubMed |
description | BACKGROUND: The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation. METHODS: We conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome. RESULTS: Forty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29–37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1–4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5–14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15–1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15–4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5–100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0–100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births. CONCLUSIONS: Oocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13048-023-01250-x. |
format | Online Article Text |
id | pubmed-10416401 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-104164012023-08-12 Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases Saito, Saki Yamada, Mitsutoshi Yano, Rika Takahashi, Kazuko Ebara, Akiko Sakanaka, Hiroe Matsumoto, Miho Ishimaru, Tomoko Utsuno, Hiroki Matsuzawa, Yuichi Ooka, Reina Fukuoka, Mio Akashi, Kazuhiro Kamijo, Shintaro Hamatani, Toshio Tanaka, Mamoru J Ovarian Res Research BACKGROUND: The indications for fertility preservation (FP) have expanded. A few patients who underwent gonadotoxic treatment did not have the opportunity to receive FP, leading to concerns that these patients may develop premature ovarian insufficiency. However, the usefulness of FP in women with reduced ovarian reserve has also been questioned. Progestin-primed ovarian stimulation can improve the controlled ovarian stimulation (COS) protocol, but there is limited data on the efficacy of FP with progestin-primed ovarian stimulation. METHODS: We conducted a prospective study of 43 women with cancer or autoimmune diseases before and after gonadotoxic treatment at the reproductive unit of Keio University Hospital, counselled between 1 January 2018 and 31 December 2021. After counselling, informed consent was obtained for FP from 43 patients, with those who underwent gonadotoxic treatment of the primary disease being prioritised. Gonadotropin-releasing hormone analogue or progestin was used to suppress luteinising hormone in COS before or after gonadotoxic treatment. The number of cryopreserved mature oocytes was the primary outcome. RESULTS: Forty-three patients and 67 assisted reproductive technology cycles were included in the analysis. The median age at entry was 32 [inter quartile range (IQR), 29–37] years. All patients in the post-gonadotoxic treatment group had their oocytes frozen. Gonadotoxic treatment resulted in fewer oocytes [median 3 (IQR 1–4); pre-gonadotoxic treatment group: five patients, 13 cycles] vs. median 9 (IQR 5–14; pre-gonadotoxic treatment group: 38 patients, 54 cycles; P < 0.001). Although anti-Müllerian hormone levels were lower in the post-gonadotoxic treatment group (n = 5, 13 cycles, median 0.29 (IQR 0.15–1.04) pg/mL) than in the pre-gonadotoxic treatment group (n = 38, 54 cycles, median 1.89 (IQR 1.15–4.08) pg/mL) (P = 0.004), oocyte maturation rates were higher in the post-gonadotoxic treatment group [median 100 (IQR 77.5–100) %] than in the pre-gonadotoxic group [median 90.3 (IQR 75.0–100) %; P = 0.039]. Five patients in the pre-gonadotoxic treatment group had their cryopreserved embryos thawed, of which three had live births. CONCLUSIONS: Oocytes obtained for FP from women with cancer or autoimmune disease for FP are of satisfactory quality, regardless of whether they are obtained post-gonadotoxic treatment or COS protocols. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13048-023-01250-x. BioMed Central 2023-08-10 /pmc/articles/PMC10416401/ /pubmed/37563616 http://dx.doi.org/10.1186/s13048-023-01250-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Saito, Saki Yamada, Mitsutoshi Yano, Rika Takahashi, Kazuko Ebara, Akiko Sakanaka, Hiroe Matsumoto, Miho Ishimaru, Tomoko Utsuno, Hiroki Matsuzawa, Yuichi Ooka, Reina Fukuoka, Mio Akashi, Kazuhiro Kamijo, Shintaro Hamatani, Toshio Tanaka, Mamoru Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title | Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title_full | Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title_fullStr | Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title_full_unstemmed | Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title_short | Fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
title_sort | fertility preservation after gonadotoxic treatments for cancer and autoimmune diseases |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10416401/ https://www.ncbi.nlm.nih.gov/pubmed/37563616 http://dx.doi.org/10.1186/s13048-023-01250-x |
work_keys_str_mv | AT saitosaki fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT yamadamitsutoshi fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT yanorika fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT takahashikazuko fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT ebaraakiko fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT sakanakahiroe fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT matsumotomiho fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT ishimarutomoko fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT utsunohiroki fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT matsuzawayuichi fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT ookareina fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT fukuokamio fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT akashikazuhiro fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT kamijoshintaro fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT hamatanitoshio fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases AT tanakamamoru fertilitypreservationaftergonadotoxictreatmentsforcancerandautoimmunediseases |