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.

Vitrificación ovocitaria para posponer fecundidad: experiencia de la Unidad de Medicina Reproductiva de Clínica Monteblanco / Oocyte vitrification to postponement of fertility

Antecedentes: Múltiples variables médicas y sociales han llevado al desarrollo de técnicas que permitan a la mujer posponer su fertilidad; dentro de ellas la vitrificación ovocitaria surge como una técnica relativamente sencilla y muy promisoria en este campo. Objetivo: Presentar la experiencia del Centro de Medicina Reproductiva de Clínica Monteblanco, en mujeres que han vitrificado sus ovocitos y posteriormente han intentado embarazarse con ellos. Método: Se revisaron todos los casos de vitrificación ovocitaria con posterior intento de embarazo, realizados desde el año 2007 a la fecha. Resultados: Del total de ciclos de vitrificación ovoci-taria, 22 mujeres han intentado un embarazo posterior al procedimiento. La mediana de edad al momento de la vitrificación fue de 36 años. En 10 pacientes no hubo transferencia embrionaria, ya fuera por no fecundación (4 casos) o por detención del desarrollo embrionario (6 casos); 12 pacientes fueron transferidas, la mitad de ellas lograron embarazo. Discusión: En este trabajo se presenta la primera serie nacional de casos de vitrificación de óvulos con posterior intento de embarazo; 12 de 20 pacientes lograron ser transferidas y 6 de ellas lograron el embarazo. Las mujeres más jóvenes vitrificaron un mayor número de ovocitos, tuvieron más embriones y tuvieron una mayor posibilidad de lograr embarazo. Conclusión: Pese a que la vitrificación ovocitaria no es una solución definitiva a la postergación de la fertilidad, representa en estos casos una alternativa válida.

Background: The postponement of pregnancy responds to several medical and social reassons. Oocy-te vitrification is a relatively simple and promising technique for this purpose. Objective: To illustrate the experience at the Reproductive Medicina Unit of Monteblanco of cases of women who underwent oocyte vitrification and attempted later to get pregnant. Methods: We reviewed all cases of oocyte vitrification with later attempt of pregnancy since 2007. Results: In the studied period, 20 cycles of oocyte vitrification were registered, thereof 22 women attempted a pregnancy after that. Median age at vitrification was 36 years old. Ten patient did not underwent embryo transfer, either by fertilization failure (4 patients) or detention of embryonic development (6 patients). Six of 12 patients that underwent embryo transfer, achieved pregnancy. Discussion: We report the first series of vitrification cases with posterior attempt of pregnancy in Chile; 12 of 20 women underwent embryo transfer and 6 of them got pregnant. Young women had a more oocytes, embryos and a better chance to achieve pregnancy. Conclusion: Despite the fact that vitrification is not the final solution for today's postponement of fertility, it represents a useful alternative for these cases.

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.

Successful pregnancy derived from slowly freezing donated human oocytes by intracytoplasmic sperm injection / 中华泌尿外科杂志

Objective To set up a novel clinical method for storage of oocytes by slowly freezing and successful pregnancy by intracytoplasmic sperm injection (ICSI). Methods The frozen oocytes (n=33) in metaphase Ⅱ (28),which were normal in morphology,were denuded of their cumulus-corona complex.The protective freezing solution contained 1,2-propanediol (1.5 mol/L) and sucrose (0.35 mol/L) and the process was slow for freezing and rapid for thawing.The recipients of these oocytes received hormone replacement therapy (HRT). Results A high survival rate of oocytes (32/33) was obtained when the sucrose concentration was 0.35 mol/L.ICSI induced a higher fertility rate (23/28),a good embryo cleavage rate (21/23) and a satisfactory embryo morphology for thawed oocytes.Embryo transfers were performed in 6 cycles/6 cases. Four cases got clinical pregnancy by demonstration of four gestation sacs on B ultrasonic examination 7 weeks after ICSI,1 fetal was first trimester spontaneous abortion,another 3 survival fetal were ongoing pregnancy and the first case gestation week is 17 weeks. Conclusions This study is the first successful application of human oocyte cryopreservation in China and this method can increase the survival rate of freezing oocytes.It’s easy to carry out,low in cost and high in the recovery rate of oocytes after thawing.