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Reproductive Choice and Advancing Technologies
Published in Robert M. Veatch, Laura K. Guidry-Grimes, The Basics of Bioethics, 2019
Robert M. Veatch, Laura K. Guidry-Grimes
In some cases of death, it is possible for physicians to extract sperm from the deceased. The sperm would then need to be cryopreserved (frozen and maintained in a storage facility) and later thawed and used in an IVF process for a chance at creating children. Currently, posthumous reproduction is only possible with male gametes, although it could become possible with ovarian tissue in the future. Ovarian tissue cryopreservation is already routinely used to preserve fertility for patients undergoing cancer treatments. Ethical questions are raised when a grieving spouse, unmarried partner, or parents of the deceased request that physicians take these steps (ESHRE Task Force on Ethics and Law, 2006; Ethics Committee of the American Society for Reproductive Medicine, 2018).
Fertility and Cancer
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Michelle Peate, Lesley Stafford, Yasmin Jayasinghe
Women who cryopreserved oocytes, embryos, or ovarian tissue prior to cancer treatment will have an option to use this material. Embryos can be transferred, and oocytes fertilised and transferred, into a prepared uterus. There are limited data on live birth rates from frozen embryos or oocytes following cancer. Live birth rates per frozen embryo transfer are approximately 44.1% in women younger than 35 years and 35.8% in women aged 35–39 years (Kato et al., 2012), with rates up to 75% reported (Shapiro et al., 2010). Similar live birth per transfer rates of 50–55% in women younger than 36 years and 18–37% in women over 34 years have been reported (Chang et al., 2013; Goldman et al., 2013). Both procedures may require hormonal stimulation to stimulate oocyte maturation and prepare the uterus for embryo transfer and this is contraindicated in hormone responsive cancers; however, there are no data to suggest that hormonal stimulation for oocyte maturation impacts on prognosis or recurrence. With ovarian tissue cryopreservation there may be concerns about re-seeding the cancer (Donnez & Dolmans, 2015). Should these options be unsuccessful or unfeasible, it may be worth considering using donor eggs or embryos.
Fertility preservation in pediatric and adolescent girls
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Ovarian tissue cryopreservation (OTC) is currently the only fertility preservation option available to prepubertal girls, and it is also available to postpubertal girls who cannot, or do not want to, delay cancer treatment in order undergo an oocyte cryopreservation cycle (Figure 26.3).7,57 OTC can also be combined with ovarian stimulation and oocyte cryopreservation to increase overall yield.58 It is still considered experimental in the United States but is being increasingly used as a fertility preservation option throughout the world. Ovarian tissue cryopreservation theoretically represents an efficient method of preserving thousands of ovarian follicles at one time, as well as provides the potential to return native hormone production once retransplanted.7,59
Fertility preservation in ovarian cancer patients
Published in Gynecological Endocrinology, 2021
Maria Luís Santos, Ana Sofia Pais, Teresa Almeida Santos
In ovarian cancer patients, fertility preservation options are very limited. Oocyte cryopreservation is still the best option and the only one established along with embryo cryopreservation. Fertility preservation surgery must be carefully thought-through and involve a multi-disciplinary assessment of the chance of recurrence. The artificial ovary and in vitro maturation of oocytes is a very attractive option in these patients, but further milestones have to be achieved. Ovarian tissue cryopreservation will not be an option as long as the risk of reseeding cancer cells is not fully eliminated. Ovarian protection from chemotherapy using gonadotrophin releasing hormone (GnRH) agonists or other options seem to be appealing but can only be recommended when its value is recognized by high quality evidence studies.
The first family group of α1-AT-P in the world with repeated hematomas: 10-year follow-up
Published in Climacteric, 2019
S. Luo, X. Ruan, Y. Wang, X. Li, Z. Xu, M. Min, M. Li, L. Zhang, Y. Li, H. Wang, J. Cheng, L. Zhang, Y. Wang, A. O. Mueck
With more evidence emerging, ovarian tissue cryopreservation has been proven a valid and effective fertility preservation technique11, which allows the ovaries to be mainly transplanted orthotopically12. This may be a viable solution when abdominal hemorrhage occurs for the first time, thus avoiding repeated hemorrhage caused by follicle rupture. Our team in China recently reported the first successful cryopreserved ovarian tissue retransplantation13. If α1-AT-P could be cured by gene editing in the future, a patient’s ovaries could be retransplanted. Furthermore, Stern et al.14 reported retransplantation performed in heterotopic sites, such as a subcutaneous location, which might be suitable for α1-AT-P patients. If a hematoma occurs, it can be more easily detected in the subcutis than in the pelvis.
Ovarian tissue cryopreservation: prospective randomized study on thawed ovarian tissue viability to estimate the maximum possible delivery time of tissue samples
Published in Gynecological Endocrinology, 2019
Fengyu Jin, Xiangyan Ruan, Du Juan, Yanglu Li, Jiaojiao Cheng, Husheng Wang, Alfred O. Mueck
Recently several publications concluded that ovarian tissue cryopreservation is now a valid technique for fertility protection [1–3,13–16], added to the embryo and oocyte cryopreservation [17,18]. This technique is well known in Western countries but only recently was established in China as the ‘International Fertility Protection Center – Ovarian Tissue Cryobank of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University,’ and is to our knowledge until today the only one in China. Guidelines for this technique have been recently summarized from the ‘Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology’ [2] in close cooperation with international experts. Ovarian tissue cryopreservation particularly is the only option for women whose cancer treatment cannot be postponed, and maintains the capability to restore long-term hormonal function after cure from cancer [18].