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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
Embryo cryopreservation is the most established technique for fertility preservation in women (Anderson et al., 2015). Like oocyte cryopreservation, this starts with 10–14 days of ovarian stimulation. However, after mature oocytes have been collected, they are fertilised using sperm from a partner or donor. The embryos will then be cryopreserved for later use. When women decide to use the stored embryos later, they will require further hormonal stimulation to prepare the uterus. The embryo that survives the thawing process will be transferred to the uterus. Ideally, the embryo will implant, grow, and result in a successful pregnancy.
Human embryos in medical practice
Published in Elisabeth Hildt, Dietmar Mieth, In Vitro Fertilisation in the 1990s, 2018
Embryo cryopreservation is practicable, whereas at present egg freezing does not yield a viable product. Perhaps 20 per cent of frozen embryos are lost in the freeze/thaw process. Cryopreservation is not universally available and many clinics will decline to freeze embryos surplus to a single transfer if there are not three or more good to reasonable quality embryos, on the basis that transfer of a single thawed embryo subsequently has such a poor pregnancy rate as not to be worthwhile.
Ovarian tissue cryopreservation and transplantation
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Giuliano Bedoschi, Kutluk Oktay
Using the robot-assisted Da Vinci Xi® minimally invasive surgery technique, typically five ports are used: an 8-mm port for the camera, a 12-mm (right or left depending on the site of operation) upper quadrant for access, and three 8-mm ports for instrumentation. In patients presenting a remaining ovary, we bivalve it using curved scissors, avoiding cauterization. This exposes the medulla and creates a vascular bed for the graft as well as doubling the surface area available for transplantation. Next, we introduce the graft into the abdominal cavity through the 12-mm assist port. The graft is then juxtaposed on the ovary so that the stromal sides of the cortical pieces oppose the exposed stroma of the bivalved ovary. We then anastomose the edges of the ECTM scaffold to the edges of ovarian cortex by interrupted sutures using 4-0 Vicryl V Lock continuously. Using this technique, return of ovarian function was obtained 2–3 months after the ovarian tissue transplantation procedure in two subjects who underwent grafting. In vitro fertilization treatment cycles were performed followed by embryo cryopreservation, since both subjects had a desire to form a bank of frozen embryos and the duration of the grafts could not be predicted. Frozen embryos transfers were performed resulting in live births in both subjects (Oktay et al. 2015). Additional cases have been performed and results are pending publication since our earlier report.
The vitrification system may affect preterm and cesarean delivery rates after single vitrified blastocyst transfer
Published in Systems Biology in Reproductive Medicine, 2022
Yunhong Lin, Lincui Da, Shengrong Du, Qingfen Chen, Suzhu Chen, Beihong Zheng
Following the first successful pregnancy and live birth resulting from slow-frozen human embryo recovery and transfer, the effects of various influencing factors related to embryo cryopreservation technology (including the type, concentration, action time, and operating temperature of the cryoprotectant; the cooling rate of the freezing process; the type of vitrification carrier; and the type of related equipment used) on embryo cryopreservation, recovery, and transfer have garnered considerable research attention (Trounson and Mohr 1983; Chu et al. 2018; Inui et al. 2019; Mitsuhata et al. 2020; Takahashi et al. 2020). Vitrification technology uses high-concentration cryoprotectants and accelerates the cooling rate to freeze embryos into a vitrified state to avoid ice crystal formation, thus leading to higher warming survival rates, clinical pregnancy rates, implantation rates, and live birth rates than slow freezing technology (Kuwayama et al. 2005; Fasano et al. 2014; Li et al. 2014; Rienzi et al. 2017).
Luteal phase support for natural cycle frozen embryo transfer: a meta-analysis
Published in Gynecological Endocrinology, 2022
SuQin Su, MeiFang Zeng, JinLiang Duan
From the first human frozen embryo transfer was performed successfully by Trounson and Mohr in 1983 [5], embryo cryopreservation has become an essential complementary process and played an important role in IVF routine programs. It can store excess embryos produced through in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) for subsequent FET, which avoids harm to females resulting from repeated oocyte retrieval, reduces the risk of OHSS and the waste of embryos [6,7]. With the advent of the vitrification technique introduced by Kuwayama in 2005 for cryopreservation [8], FET cycles’ number and pregnancy outcome in assisted reproductive techniques (ART) had significant improvement. A meta-analysis of randomized controlled trials (RCTs) indicates that FET can be associated with a higher live birth rate and clinical pregnancy rate, lower miscarriage rate and moderate to severe OHSS compared to the fresh embryo transfer in IVF cycles [9]. In a general way, Endometrium preparation for FET can be achieved in a natural ovulatory cycle or hormonal replacement cycle with estradiol and progesterone. Two meta-analyses showed that the optimal method of endometrial preparation was unclear among women with normal cycles [10,11]. Nevertheless, subsequently, an increasing number of studies indicated that HRT-FET cycles had lower pregnancy outcomes and higher pregnancy complications [12–15]. In conclusion, the natural cycle protocols may be the preferred method of endometrial preparation among women with normal ovulatory cycles due to ease of use, less side effects and lower cost [6].
Fertility preservation in patients receiving gonadotoxic therapies for systemic autoimmune diseases in Japan
Published in Modern Rheumatology, 2021
Yumi Tsuchida, Miyuki Harada, Hirofumi Shoda, Ayane Goto, Nao Suzuki, Atsuko Murashima, Yutaka Osuga, Keishi Fujio
Gonadotoxic agents are used to treat various malignancies. In the past, many cancer survivors had to give up their hope of having a biological child. However, the importance of fertility preservation in patients with cancer is increasingly being recognized, and the safety and efficacy of various fertility preservation procedures have been reported. For female patients, embryo cryopreservation and oocyte cryopreservation, commonly performed as assisted reproduction techniques for patients with infertility, are an option for patients with cancer as well. In addition, ovarian tissue cryopreservation, although still considered an experimental technique, may be an option for some patients. Gonadotropin-releasing hormone (GnRH) analog therapy may protect the ovaries during chemotherapy, although data regarding its efficacy in fertility preservation are conflicting [1]. Male patients may opt for cryopreservation of sperms [2]. The number of patients who choose these options prior to chemotherapy is increasing [3].