Safeguarding Fertility With Whole Ovary Cryopreservation and Microvascular Transplantation: Higher Follicular Survival With Vitrification Than With Slow Freezing in a Ewe Model.

BACKGROUND: In young women, ovarian cortex cryopreservation before gonadotoxic chemotherapy and its avascular grafting after cancer healing permitted fertility restoration. However, ischemia reduced the grafts' lifespan. Microvascular transplantation of cryopreserved whole ovary may allow immediate revascularization, ensuring better fertility preservation, but the best cryopreservation method is unknown. We aimed to compare slow freezing and vitrification of whole ovary for fertility preservation purposes, in an ewe model. METHODS: Twelve ewes were allocated at random to slow freezing (n = 6) or vitrification group (n = 6). Ewes' left ovary was removed and cryopreserved. Dimethyl sulfoxide 2 M was used as cryoprotector for slow freezing. Vitrification was obtained using increasing concentrations of a vitrification solution of the latest generation (VM3) and gradual temperature lowering to minimize toxicity. After a month, the right ovary was removed, the left ovary was thawed/warmed, and its vessels were anastomosed to the right pedicle. Fertility and ovarian function were assessed for 3 years. Ovarian follicles in native and transplanted ovaries were counted and compared at study completion. RESULTS: Hormonal secretion resumed in all ewes of both groups. One ewe of the slow-freezing group delivered healthy twins 1 year 9 months and 12 days after transplantation. Estimated whole follicle survival was very low in both groups but significantly higher after vitrification than after slow freezing (0.3% ± 0.5% vs 0.017% ± 0.019%, respectively; p < 0.05). CONCLUSIONS: Further progress is needed before whole-ovary cryopreservation can be considered an option for safeguarding fertility. Whole ovary vitrification provides better follicular survival compared to slow freezing and may be a valuable cryopreservation option.

Examination of viability and quality of ovarian tissue after cryopreservation using simple laboratory methods in ewe.

BACKGROUND: The objective of the present study is to assess viability tests and to evaluate follicle ovarian tissue quality after freezing-thawing procedures. METHODS: Ewe's ovaries were harvested at the slaughterhouse, after dissection each ovarian specimen was divided into two groups: fresh tissue (control group) and frozen tissue.In the first part of the study, the follicles viability was assessed by trypan blue staining, calcein AM/ethidium homodimer-1 staining (LIVE/DEAD viability/cytotoxicity kit, Molecular Probes) and morphology in the two groups. In the second part of the study the quality of the whole ovarian tissue was evaluated by the quantification of the release of lactate dehydrogenase measurement (Cytotoxicity Detection kit ROCHE), DNA fragmentation by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL) in primordial and primary follicles (ApopDETEK Kit system Enzo) and morphology in the two groups. 100 Follicles (primordial and primary) were counted on both fresh and frozen hemiovary to assess this various tests. RESULTS: Ovarian follicle viability assessment was similar using trypan blue or calcein/ethidium staining. Follicles showed a decreased viability after freezing-thawing.After cryopreservation, a significant correlation between the percentage of normal follicles and viability rate was found using trypan blue (r=0.82, p<0.05) or calcein AM/ethidium homodimer-1 staining (r=0.76, p<0.05). Increased cytotoxicity showed by enhancement of LDH release was found after cryopreservation (21.60+/-1.1% vs 52.2+/-7.7%). A significant negative correlation between the percentage of morphologically normal follicles and cytotoxicity was observed. No significant difference in DNA fragmentation rate between frozen and control groups was found (26±8.2% vs 38±4.5%). CONCLUSION: We suggest the use of trypan blue staining for the histological assessment of viability, the use of LDH assay for the cytotoxicity assessement and finally the use of DNA fragmentation assessment to valid different freezing-thawing protocols.

Differences in collagen expression in cumulus cells after exposure to highly purified menotropin or recombinant follicle-stimulating hormone in a mouse follicle culture model.

Extracellular matrix (ECM) formation by cumulus cells is an important process that determines fertilization and embryo quality. Several collagen types are present in the ovarian follicular ECM and are related to proliferation, steroidogenesis, and luteinization. In vitro mouse follicles can optimally grow and provide developmentally competent oocytes with 10 IU/L recombinant follicle-stimulating hormone (rFSH). As a model for superovulation, experiments with 100 IU/L rFSH or 100 IU/L highly purified menotropin (HP-hMG) exposure during antral growth were undertaken. Col4a1, Col4a2, and Col6a2 expression levels were analyzed at three time points during antral growth and at a 4-h interval up to 16 h after ovulation induction using quantitative PCR. The presence and induction of the collagen mRNA and protein were confirmed in cumulus from in vivo- and in vitro-grown follicles, and TGFBs 1 and 2 were assayed as potential regulators. The study revealed that exposure to 100 IU/L FSH, as in both superovulation conditions, significantly influenced the follicle morphology and slowed down nuclear maturation and mucification (P < 0.05). This coincided with an increased expression of the three collagens in the cumulus-oocyte complex at the end of antral growth and in the first hours following the ovulatory dose of human chorionic gonadotropin (P < 0.05). The increased expression might reflect a differentiation but is most likely due to a precocious luteinization of the cumulus. Growth in HP-hMG resulted in higher Tgfb1 mRNA and protein levels, fewer COCs with an increased collagen expression and with a more synchronous nuclear maturation. This suggests that the presence of luteinizing hormone activity tempered the effect of the elevated FSH dose.

Difficulties improving ovarian functional recovery by microvascular transplantation and whole ovary vitrification.

OBJECTIVE: To evaluate recovery of endocrine function and fertility after transplantation and vitrification of whole ovaries. DESIGN: Animal study. SETTING: Lyon Veterinary School, France. ANIMAL(S): Ewes. INTERVENTION(S): In group 1 (n = 5), the left ovary was removed with its vascular pedicle and was transplanted onto the contralateral pedicle. In group 2 (n = 5), the left ovary with its pedicle was cryopreserved after a vitrification procedure. After thawing, transplantation was performed by microvascular anastomosis to the contralateral ovarian pedicle. MAIN OUTCOME MEASURE(S): Median ischemia time, progesterone levels, histologic examination. RESULT(S): Successful microsurgical transplantation was performed in both groups. The median ischemia time was statistically significantly longer in group 2 (287 minutes, range: 226 to 349] versus 129 minutes [range: 125 to 130]) in group 1. In group 1, four sheep recovered spontaneous ovarian endocrine function about 2.5 (range: 2.00 to 3.75) months after transplantation. Two ewes gave healthy live births at 12 and 25 months, respectively, after transplantation. In group 2, one ewe recovered ovarian endocrine function 6 months after transplantation. However, histologic evaluation showed a follicular survival rate of 6% in group 1, and total follicle loss in group 2. CONCLUSION(S): Autograft of whole sheep ovaries with microvascular anastomosis seems technically feasible but resulted in a very poor follicle survival rate (6%), in spite of endocrine function recovery and birth of two lambs. Attempts at cryopreservation with vitrification resulted in no follicle survival at all.

Sperm deoxyribonucleic acid fragmentation as a prognostic indicator of assisted reproductive technology outcome.

OBJECTIVE: To examine sperm DNA fragmentation in semen used for assisted reproduction procedures to establish this factor's prognostic role in fertilization rate, embryo development, pregnancy rate, and outcome. DESIGN: Prospective study. SETTING: Department of Medicine and Biology of Reproduction of the Edouard Herriot Hospital in Lyon, France. PATIENT(S): 322 couples, divided into 88 cycles of in vitro fertilization (IVF) or 234 cycles of intracytoplasmic sperm injection (ICSI). INTERVENTION(S): Sperm DNA fragmentation was detected in sperm obtained 2 to 5 months before the ART procedure. MAIN OUTCOME MEASURE(S): Sperm DNA fragmentation was measured with the terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) technique. RESULT(S): There was a negative statistical correlation between the rate of fragmentation and the semen characteristics. A statistically significant negative relationship was found for sperm DNA fragmentation and fertilization when ICSI and IVF were compared. With ICSI, a statistically significant negative relationship was found between fertilization rate and percentage of sperm DNA fragmentation (DNA fragmentation index, or DFI). The risk of nontransfer due to blocked embryo development increased when the DFI exceeded 15% (18.2% for ICSI vs 4.2% for IVF) with an odds ratio of 5.05. The miscarriage risk increased fourfold when the DFI exceeded 15% (37.5% for ICSI vs 8.8% for IVF). CONCLUSION(S): Sperm DNA fragmentation measured 2 to 5 months before the assisted reproduction procedure was a prognostic indicator of the fertilization, pregnancy, and miscarriage rates and the pregnancy outcome.

Cryopreservation of the ovary by vitrification as an alternative to slow-cooling protocols.

OBJECTIVE: To study the thermal properties of a cryoprotectant solution, called VS4, and of VS4-impregnated whole sheep ovaries with pedicle. DESIGN: Physical and experimental animal study. SETTING: Academic research environment. ANIMAL(S): Five- to 6-month-old ewes. INTERVENTION(S): Thermal properties on cooling of a cryoprotectant solution called VS4 were measured by differential scanning calorimetry. VS4 contains 2.75 mol/L dimethyl sulfoxide, 2.76 mol/L formamide, and 1.97 mol/L propylene glycol. Whole sheep ovaries were collected at the slaughterhouse and prepared for a vitrification procedure. Cortex and vessels underwent histologic examination before and after vitrification, and the thermal properties of VS4-impregnated ovarian cortex were then studied. MAIN OUTCOME MEASURE(S): Critical cooling rates (V(ccr)), vitreous transition temperature (Tg), end-of-melting temperature (Tm), follicle viability assessment by trypan blue test, and histologic examination of ovary and vessel structure. RESULT(S): The critical cooling rate (V(ccr)) of VS4 solution was estimated to be 14.3 +/- 1.1 degrees C/min. Its vitreous transition temperature (Tg) was -125.2 +/- 0.2 degrees C, and its end-of-melting temperature (Tm) -34.3 +/- 0.1 degrees C. Following our vitrification procedure, immediate follicle viability was 61.4% +/- 2.2%. The percentage of normal primordial follicles remaining after vitrification was 48% +/- 3.8%. The V(ccr) of VS4-impregnated cortex could not be determined because of the quantity of ice forming as of the top programmed cooling rate (-300 degrees C/min). The mean ovarian cortex cooling rate actually attained experimentally during vitrification was -342.9 +/- 49.6 degrees C/min. CONCLUSION(S): Vitrification of entire organs, such as ovaries, is a great challenge in cryobiology and reproductive medicine. Physical studies seem indispensable for progress with this technique. Thus, our ovarian perfusion procedure needs improving to enhance ovarian cortex impregnation and bring down the V(ccr) rate in both tissue and VS4 solution.

Follicular viability and histological assessment after cryopreservation of whole sheep ovaries with vascular pedicle by vitrification.

OBJECTIVE: To evaluate a cryopreservation technique by vitrification of whole ovaries with their vascular pedicle in sheep, by using two cryoprotectant solutions. DESIGN: Animal study. SETTING: Fertility clinic in a university teaching hospital. ANIMAL(S): Five to 6-month-old ewes. INTERVENTION(S): Whole sheep ovaries with their vascular pedicles were collected at the slaughterhouse and prepared for cryoprotectant toxicity tests and freezing procedures. MAIN OUTCOME MEASURE(S): Follicle viability assessment by trypan blue test and histological examination of ovary and vessel structure. RESULT(S): No statistically significant difference in follicle viability or normal primordial follicle rates were observed between ovaries exposed or nonexposed to cryoprotectant solutions. Nor was any statistically significant difference observed before and after vitrification with the two cryoprotectant solutions. The decrease in the number of primordial follicles was smaller when frozen-thawed ovaries were treated with VS4 solution containing dimethyl sulfoxide, formamide, and propylene glycol. There were fewer nuclear anomalies and general follicular anomalies with the VS4 solution. Pedicle fractures occurred in most ovaries during thawing (11/15). CONCLUSION(S): Cryopreservation of whole ovary by vitrification appears a promising technique in reproductive medicine. The best histologic results were obtained with the VS4 cryoprotectant. Further studies are required to overcome vitrified ovarian vessel fracture.