Discussion on Ethical Value and Application Principle of Cryopreservation and Transplantation of Human Ovarian Tissue / 中国医学伦理学

In recent years, with the continuous progress of medical technology, the survival rate of cancer patients after treatment has been continuously improved, and more and more young cancer patients begin to pay attention to the fertility problem after survival. For prepubertal or adolescent cancer patients who require urgent chemoradiotherapy, and for reproductive female patients, ovarian tissue cryopreservation (OTC) follows by transplantation is the only option to preserve their fertility at present. Although the OTC technology has been carried out as a routine clinical project in a few medical institutions in China, it is still in the stage of clinical trial research in majority medical institutions. There are still many technical and ethical challenges in clinical practice of OTC technology. Therefore, this paper discussed the ethical principles that should be followed in clinical practice of human OTC and transplantation, and briefly analyzed the corresponding ethical issues. When implementing this technology, the indications should be followed strictly, the wishes of patients should be respected and true and full informed consent should be obtained while ensuring that the cancer treatment of patients is not delayed. Besides, it is significants to accumulate enough experience for minor patients to fully protect their rights and interests and promote the construction of relevant national laws and regulations.

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.

Improvement in Ovarian Tissue Quality with Supplementation of Antifreeze Protein during Warming of Vitrified Mouse Ovarian Tissue

Ice easily recrystallizes during warming after vitrification, and antifreeze protein (AFP) can inhibit the re-crystallization. However, no study has evaluated the effect of AFP treatment only thereon during warming. This study sought to compare AFP treatment protocols: a conventional protocol with AFP treatment during vitrification and first-step warming and a new protocol with AFP treatment during the first-step warming only. According to the protocols, 10 mg/mL of LeIBP (a type of AFP) was used. Five-week-old B6D2F1 mouse ovaries were randomly divided into a vitrified-warmed control and two experimental groups, one treated with the conventional AFP treatment protocol (LeIBP-all) and the other with the new AFP treatment protocol (LeIBP-w). For evaluation, ratios of ovarian follicle integrity, apoptosis, and DNA double-strand (DDS) damage/repairing were analyzed. The LeIBP-treated groups showed significantly higher intact follicle ratios than the control, and the results were similar between the LeIBP-treated groups. Apoptotic follicle ratios were significantly lower in both LeIBP-treated groups than the control, and the results were not significantly different between the LeIBP-treated groups. With regard to DDS damage/repairing follicle ratio, significantly lower ratios were recorded in both LeIBP-treated groups, compared to the control, and the results were similar between the LeIBP-treated groups. This study demonstrated that both protocols with LeIBP had a beneficial effect on maintaining follicle integrity and preventing follicle apoptosis and DDS damage. Moreover, the new protocol showed similar results to the conventional protocol. This new protocol could optimize the mouse ovary vitrification-warming procedure using AFP, while minimizing the treatment steps.

Ovarian tissue cryopreservation and transplantation in patients with cancer

Chemotherapy and radiotherapy improved survival rates of patients with cancer. However, they can cause ovarian failure and infertility in women of reproductive age. Infertility following cancer treatment is considered a major quality of life issue. Ovarian tissue cryopreservation and transplantation is an important option for fertility preservation in adult patients with cancer who need immediate chemotherapy or do not want to undergo ovarian stimulation. Ovarian tissue freezing is the only option for preserving the fertility of prepubertal patients with cancer. In a recent review, it was reported that frozen-thawed ovarian transplantation has lead to about 90 live births and the conception rate was about 30%. Endocrine function recovery was observed in 92.9% between 3.5 and 6.5 months after transplantation. Based on our review, ovarian tissue cryopreservation and transplantation may be carefully considered before cancer treatment in order to preserve fertility and endocrine function in young cancer survivors.

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.

Ovarian tissue cryopreservation and transplantation / 대한산부인과학회지

This review focuses on the current options for fertility preservation in patients with high risk of premature ovarian failure. Available cryopreservation options include embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. Ovarian tissue cryopreservation and transplantation has been tried for some time in animals, but only recently successful pregnancy and livebirth in human has been reported. Options of developing follicles and restoring fertility after ovarian tissue cryopreservation are autotransplantation, xenotransplantation, and tissue culture. This review discusses the merits and faults of each option and future directions for developing and standardizing the ovarian tissue cryopreservation and transplantation procedure, systemically covering previously published data.