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FERTILITY PRESERVATION FOR WOMEN

From egg freezing to ovarian tissue cryopreservation

Broekmans_Anderson

Published 19 November 2018

A very well attended Campus meeting in October on adult female fertility preservation reviewed the full range of treatments and challenges. Richard Anderson from the SIG Fertility Preservation and Frank Broekmans from the SIG Reproductive Endocrinology report.

The SIGs Fertility Preservation and Reproductive Endocrinology held a very successful joint Campus workshop in Copenhagen in October, whose overall aim was to give participants a state-of-the-art review of fertility preservation in adult women. The programme covered both oncology and non-oncology patients, and provided a forum for discussion of challenging aspects of this rapidly developing field.

The programme kicked off with an overview of ovarian ageing by Frank Broekmans covering the physiological changes in follicle quantity and quality with age. This was followed by an overview of the need for fertility preservation by Didi Braat, who presented the key issues in oncology patients and discussed the difficulties in women with other causes of POI.
Issues related to obtaining and storing eggs were presented by the next two speakers, with Michael Grynberg considering the optimal number of oocytes for fertility preservation. Laura Rienzi then presented a review of the potential benefits of automation in the embryology lab, particularly in relation to oocyte cryostorage. She highlighted the very close attention to detail required for oocyte vitrification, which therefore could be more reproducibly performed by a machine.

The next session broadened the focus of the meeting from oncology to non-oncology challenges, with a presentation from Kenny Rodriguez-Wallberg on fertility preservation in transgender men, based on her many years' experience. Kenny highlighted the many challenges and pitfalls in providing these treatments. This was followed by a review of the potential for fertility preservation in Turner syndrome from Helen Picton. She reviewed the reproductive considerations, and noted that normal follicles can sometimes be found in the ovaries of adolescent girls with mosaic Turner syndrome. A small number of cases of successful oocyte cryopreservation have been reported, but none have been used for successful pregnancy yet.

We then had talks from two oncologists, first from Matteo Lambertini covering the now consistent data from several large RCTs showing a reduction in the prevalence of POI with GnRH agonist treatment during chemotherapy for breast cancer. This was followed by Nils Kromon discussing pregnancy after cancer treatment, particularly in relation to the safety of pregnancy in women with a history of breast cancer. A very clear overview of recent data was presented, emphasising that there is now a substantial body of evidence showing that a subsequent pregnancy does not carry an increased risk of relapse or death, even in estrogen receptor positive breast cancer.

Many patients present specific issues and difficulties that can provide both medical and ethical challenges. To address this, we brought together some of the speakers on stage to provide a forum for discussing difficult cases, with the discussion led by Richard Anderson. A number of cases were presented, with very interesting interaction and comments. We will be having a similar difficult case discussion at the next Campus workshop on fertility preservation in children, to be held in Edinburgh in May 2019.

The pros and cons of ovarian tissue preservation were presented by Claus Yding Andersen, concluding that the potential benefits of vitrification have yet to be clearly seen in practice. Claus emphasised that the greatest number of follicles lost following ovarian tissue replacement are during the period of time after the replacement, during revascularisation, rather than related to the cryopreservation technique and it is this aspect, he said, that we should probably focus on. Michael Von Wolff continued the theme by noting how ovarian tissue can survive transport to the laboratory at an appropriate temperature, with benefits for both natural conception and endocrine function in some patients.

The final session brought a view of where the field might be heading. Kirsten Macklon discussed the potential for primordial follicle activation, and presented a trial that is now coming to conclusion in Copenhagen using a physical approach to follicle activation in women with a poor ovarian response. Finally, Evelyn Telfer reviewed current progress towards avoiding tissue replacement altogether by in vitro follicle growth and oocyte maturation. She highlighted the recent progress made in her own lab with defined follicle development right from the primordial stage through to a metaphase II oocyte.

This Campus workshop was very well attended, with 155 registrants from across Europe and indeed from as far away as India and Australia. We hope the next workshop in May 2019 will be equally well attended, and we would like to remind you of the opportunity for junior investigators to submit abstracts for poster and potentially selected for oral presentation at that meeting, with a substantial prize available for the best presenter.