Oocyte and Sperm Cryopreservation In Oncological Patients During Covid-19 Pandemic

During the pandemic, most infertility and IVF Units decided to keep fertility preservation active as an urgent procedure. It is well established that chemotherapy is gonadotoxic and impact negatively on quality of life. The American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) recommend to offer fertility preservation before cancer treatment. Oocyte cryopreservation and sperm cryopreservation are the best treatments of the choices to preserve fertility in cancer patients. This is a prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from February 2020 to January 2021. 149 cancer patients underwent gamete cryopreservation to preserve their fertility. All patients tested for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2 48 hours before cryopreservation. The viral RNA detection was provided only in case of positive swab and no treatment was interrupted. 59 women underwent ovarian stimulation with gonadotropins followed by oocyte retrieval. Women’s basal characteristics were: Age (m±sd) 31.0 ± 7.0 years, FSH (m±sd) 14 ±9IU/l, AMH (m±sd) 2.4 ± 1.3 ng±ml, AFC (m±sd) 9 ±5. 90 men underwent spermatozoa rapid cryopreservation. Men’s basal characteristics were: Age (m±sd) 34±7 years;Total Sperm count x 106 (m±sd) 52.3±49.6, Sperm x 106/ml 28.1±25.5, Total motility (m±sd) 48.0±26.7 %, Progressive motility (m±sd) 22.2±20.5 %, normal morphology (m±sd) 22.3±11.1 %. 296 oocyte were cryopreserved: 5.5±4.3 (mean±sd per patient). Vitrification with closed devices (High-Security Vitrification™ - HSV) was used for oocyte cryopreservation to minimize the risk of viral contamination. 403 Sperm samples were frozen with slow freezing: 5.7±2.1 (m±sd) per patient. All patients tested negative for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2. The oncofertility activity must be maintained even in pandemic periods by implementing adequate safety measures to protect the health of patients and healthcare professionals. Funding: Supported by Italian Ministry of Health "Fertility Preservation in gonadotoxic treatments” project code RF-2011-02348826 Conflict of Interest: None to disclose

HIGH SECURITY CLOSED DEVICES ARE EFFICIENT AND SAFE FOR VITRIFICATION TO PROTECT HUMAN OOCYTES FROM THE RISK OF VIRAL CONTAMINATION ESPECIALLY DURING THE COVID-19 PANDEMIC

Objective: To compare the efficacy of high security versus open devices for human oocytes vitrification. Design: Prospective study. Between October 2015 and April 2020, 737 patients (775 oocytes cryopreservation cycles) were randomly assigned to two Groups: Group 1: 368 patients (389 vitrification cycles) by High Security Vitrification™ (HSV) Group 2: 369 patients (386 vitrification cycles) by Cryotop® open system. Vitrification was performed in case of Ovarian Hyper Stimulation Syndrome, failure semen production and supernumerary oocytes. Materials and Methods: All patients attending IVF and Infertility Center, University Hospital S.Orsola (Italy), were stimulated with recombinant-follicle stimulating hormone and gonadotropin releasing hormone analogues. Oocyte retrieval by transvaginal needle aspiration was performed 36 hours after ovulation triggering with recombinant Human chorionic gonadotropin injection. Metafase II oocytes were vitrified by Kuwayama’s protocol (2005) and microinjected after warming. Results: Results are shown in Table 1. [Formula presented] Conclusions: The efficacy of vitrification was assessed in vitro using survival, fertilization and cleavage rates and in vivo after embryo transfer by pregnancy, implantation and miscarriage rates. Results shows no statistically significant differences using HSV or Cryotop® for oocytes vitrification. Therefore, in order to ensure safety, especially during the current COVID-19 pandemic, the use of the closed device eliminates the potential sample contamination during vitrification and storage without compromising its in vitro and in vivo survival and development.

Sterility Special Interest Group position paper on ART treatments and COVID-19 pandemic

COVID-19 pandemic caused a huge overload of healthcare systems worldwide. For such reason, in a preventive manner, governments and scientific societies recommended to stop any elective medical or surgical treatment in order to reduce the eventual burden on hospitals. Fertility treatments have since then been reserved only to urgent cases as oncologic patients asking for fertility preservation. However, the relevance of such policy on natality rate and on ovarian aging has soon induced the main scientific societies to ask for a fast return to action, considering that infertility should be treated as an urgent condition. In this regard, phase 2 recommendations have been issued to ensure working requirements to be settled in the safest way possible. Therefore, the Special Interest Group on Sterility (GISS) of the Italian Society of Gynecology and Obstetrics (SIGO) and its federates released their guidelines as Italy has been one of the first Western countries to face the phase 2 restart of treatments.