Fertility preservation in patients undergoing gonadotoxic treatments: a Canadian Fertility and Andrology Society clinical practice guideline.

The management of young patients with cancer presents several unique challenges. In general, these patients are ill prepared for the diagnosis and the impact on their fertility. With the improved survival for all tumour types and stages, the need for adequate fertility counselling and a multidisciplinary approach in the reproductive care of these patients is paramount. Recent advances in cryopreservation techniques allow for the banking of spermatozoa, oocytes, embryos and ovarian tissue without compromising survival. This Canadian Fertility and Andrology Society (CFAS) guideline outlines the current understanding of social and medical issues associated with oncofertility, and the medical and surgical technologies available to optimize future fertility.

No. 356-Egg Freezing for Age-Related Fertility Decline.

OBJECTIVE: To provide a comprehensive review and evidence based recommendations for Canadian fertility centres that offer social egg freezing. OUTCOMES: In social egg freezing cycles we evaluated thawed oocyte survival rates, fertilization rates, embryo quality, pregnancy rates, and live birth rates. We also review how these outcomes are impacted by age, ovarian reserve, and the number of eggs cryopreserved. Finally, we discuss the risks of social egg freezing, the alternatives, the critical elements for counselling and informed consent, and future reporting of egg freezing outcome data. EVIDENCE: Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and using key words ("oocyte cryopreservation," "egg freezing," "egg vitrification," "social egg freezing," and "elective egg freezing"). Results included systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. Expert opinion based on clinical experience, descriptive studies, or reports of expert committees was also included to discuss aspects of egg freezing not currently rigorously studied. VALUES: The evidence obtained was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committees of the Canadian Fertility and Andrology Society (CFAS) under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS: Implementation of this guideline should assist the clinician to develop an optimal approach in providing counselling for egg freezing while minimizing harm and improving patient outcomes during treatment. VALIDATION: These guidelines have been reviewed and approved by the membership of the CFAS and by the CPG Committees of CFAS and The Society of Obstetricians and Gynaecologists of Canada (SOGC). SPONSORS: CFAS and SOGC.

Anti-Müllerian hormone (AMH): a reliable biomarker of oocyte quality in IVF.

PURPOSE: To evaluate the impact of serum AMH levels on stimulated IVF implantation and clinical pregnancy rates. METHODS: • DESIGN: Retrospective study with multivariate analysis. • SETTING: Clinique ovo (Montreal University affiliated Center). • PATIENT(S): Six hundred and thirty seven patients undergoing a stimulated IVF protocol were included. Only non-polycystic ovary patients at their first IVF attempt were considered for the analysis. • INTERVENTION(S): None. • MAIN OUTCOME MEASURES(S): Implantation and ongoing pregnancy rates. RESULT(S): Cycle outcomes were analysed according to AMH percentiles based on the AMH normogram per patient's age of our infertile population. Multivariate analyses were done to adjust for potential confounding factors such as age, total exogenous FSH dosage and number of eggs retrieved. Compared to the reference population, a significant lower mean implantation rate (0.26 vs 0.45) was observed in patients under 35 years of age with AMH < 1 ng/ml. Women with AMH < 25th percentile had less chances of having an embryo transferred, lower chances of having an ongoing pregnancy per started IVF cycle and a lower embryo freezing rate compared to the reference population. CONCLUSION(S): Patients with AMH < 0.47 ng/ml should be advised before starting a stimulated IVF cycle of the poorer prognosis compared to our reference population independently of their age, total exogenous FSH dosage and number of eggs retrieved. Therefore, AMH could enable a more individualized number of embryo transfer policy based on oocyte quality.

In vitro metformin anti-neoplastic activity in epithelial ovarian cancer.

OBJECTIVE: Metformin, a commonly used drug in the treatment of type II diabetes, may reduce cancer risk and improve cancer prognosis. We evaluated its effect on epithelial ovarian cancer cell lines. METHODS: The OVCAR-3 and OVCAR-4 cell lines were exposed to metformin with and without cisplatin. Cytotoxicity assays were performed in triplicates using the Alamar colorimetric assay. Levels of total and phosphorylated AMPK, p70S6K and S6K were evaluated by Western blotting following exposure to metformin. RESULTS: Metformin induces dose- and time-dependent growth inhibition of OVCAR-3 and OVCAR-4 cell lines. Metformin potentiated the effect of cisplatin in vitro. Metformin growth inhibition was partly abolished by the AMPK inhibitor, compound C. Western blotting demonstrated that metformin at cytotoxic concentrations, induced AMPK phosphorylation and decreased p70S6K and S6K phosphorylation, suggesting the mechanism for its anti-proliferative action. CONCLUSION: Metformin significantly inhibits the growth of ovarian cancer cell lines and potentiates cisplatin. Further pre-clinical studies are being conducted to determine the applicability of metformin in the treatment of ovarian cancer.

Complicaciones materno fetales en pacientes con Síndrome de Turner. Reporte de dos casos manejados con donación de óvulos / Maternal-fetal complications in patients suffering from Turner syndrome. A report of two cases with oocyte donation

El Síndrome de Turner (ST) es la patología más frecuente que compromete los cromosomas sexuales, es causada por la ausencia completa o parcial del cromosoma X. Las implicaciones reproductivas de estos pacientes que se constituyen en infertilidad por una falla ovárica prematura y disgenesia gonadal, sugieren que el manejo indicado es la donación de óvulos asociada con la generación de embriones in vitro y su posterior transferencia, previa preparación endometrial. En este artículo se informan dos casos de ST manejados con ovodonación y sus implicaciones clínicas en el embarazo: Desproporción cefalo-pélvica por talla baja, complicaciones cardiovasculares que generan linfedema, lesiones aórticas y preeclampsia.