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FERTILITY PRESERVATION Hesham Al-Inany, M.D, PhD
WHY THIS TALK  ,[object Object],[object Object],[object Object]
BREAST CANCER ,[object Object],[object Object],[object Object]
AUTO IMMUNE  DISEASES TREATED WITH CHEMOTHERAPY.   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HAEMATOPOIETIC STEM CELL TRANSPLANTATION  ( HSCT ) ,[object Object]
CONSEQUENCES OF MULTI-AGENT  CHEMOTHERAPY AND RADIOTHERAPY ,[object Object],[object Object]
FACTORS AFFECTING THE EXTENT OF CHEMOTHERAPY INDUCED GONADOTOXICITY.   ,[object Object],[object Object]
FACTORS AFFECTING THE EXTENT OF RADIOTHERAPY INDUCED GONADOTOXICITY ,[object Object],[object Object],[object Object],[object Object]
AMENORRHEA ,[object Object],[object Object],[object Object],[object Object]
Lee et al. JCO, 2006 Agents Effect on sperm ,[object Object],Prolonged azoospermia ,[object Object],Azoospermia in adulthood after treatment before puberty ,[object Object],Azoospermia likely, but always given with other highly sterilizing agents ,[object Object],Prolonged azoospermia not often observed at indicated dose ,[object Object],Can be additive with above agents in causing prolonged azoospermia, but cause only temporary reductions in counts when used alone ,[object Object],Only temporary reductions in counts at doses used in conventional regimens, but additive effects are possible ,[object Object],?
SO WHAT TO DO??
ASAP ,[object Object]
FERTILITY PRESERVATION STRATEGIES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
PHARMACOLGIC PROTECTION  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Potentially relevant RCTs identified and screened for retrieval (n= 1439) RCTs excluded,  Duplicate publication (n=78) RCTs retrieved for more detailed evaluation (n=1361) RCTs excluded Does not fulfill the inclusion criteria (n= 1336) Potentially appropriate RCTs to be included in the meta-analysis (n=25) RCTs excluded from meta-analysis: - GNRH agonist was begun after chemotherapy; no concomitant treatment of GnRH agonist and chemotherapy (n= 6) - Majority of patients had oophorectomy prior to treatment  (n= 1) - Ovarian suppression performed reversibly (GnRH agonist for 3 years) or irreversibly (oophorectomy or radiotherapy). Data not provided separately (n= 1) RCTs included in meta-analysis (n=17) RCTs withdrawn, by outcome: - No data available for inclusion  (n= 13) RCTs with usable information,  by outcome (n= 4)
VALUE OF GNRH AGONIST IN REDUCING POF
FERTILITY PRESERVATION STRATEGIES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
IVF ,[object Object],[object Object],[object Object]
CRYOPRESERVATION OF PREIMPLANTATION EMBRYOS ,[object Object],[object Object],[object Object],[object Object],[object Object]
LIMITATIONS ,[object Object]
LIMITATIONS ,[object Object],[object Object],[object Object],[object Object]
FERTILITY PRESERVATION STRATEGIES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
OOCYTE CRYOPRESERVATION. ,[object Object],[object Object]
LIMITATIONS  ,[object Object],[object Object],[object Object]
Vitrification   1min, 37 ℃   WS1,2 5min×2 3min DS TS LN 2 Thawing WS  + ES1 + ES2 3min ES3 9min VS1  VS2  VS3  VS4 P1 2hrs Cryotop (20μl for each drop, at R.T.) 3min 15sec x 4 Before ICSI (7.5%EG,7.5%DMSO in ES) (15%EG,15%DMSO,0.5M Suc in VS) (1M Suc in TS, 0.5M Suc in DS)
FERTILITY PRESERVATION STRATEGIES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
OVARIAN TRANSPOSITION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REPRODUCTIVE FUNCTION OF TRANSPOSED OVARIES. ,[object Object],[object Object],[object Object]
REPRODUCTIVE FUNCTION OF TRANSPOSED OVARIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPLICATIONS OF OOPHROPEXY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MALE: SPERM CRYOPRESERVATION  ,[object Object],[object Object],[object Object]
SAFETY ,[object Object]
OFFSPRING ,[object Object]
FERTILITY PRESERVATION STRATEGIES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Jeruss and Woodruff (2009) New England Journal of Medicine. What Technique is Appropriate ?
CONCLUSION. ,[object Object],[object Object],[object Object]
THANK YOU!

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Fertility preservation

  • 1. FERTILITY PRESERVATION Hesham Al-Inany, M.D, PhD
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  • 11. SO WHAT TO DO??
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  • 15. Potentially relevant RCTs identified and screened for retrieval (n= 1439) RCTs excluded, Duplicate publication (n=78) RCTs retrieved for more detailed evaluation (n=1361) RCTs excluded Does not fulfill the inclusion criteria (n= 1336) Potentially appropriate RCTs to be included in the meta-analysis (n=25) RCTs excluded from meta-analysis: - GNRH agonist was begun after chemotherapy; no concomitant treatment of GnRH agonist and chemotherapy (n= 6) - Majority of patients had oophorectomy prior to treatment (n= 1) - Ovarian suppression performed reversibly (GnRH agonist for 3 years) or irreversibly (oophorectomy or radiotherapy). Data not provided separately (n= 1) RCTs included in meta-analysis (n=17) RCTs withdrawn, by outcome: - No data available for inclusion (n= 13) RCTs with usable information, by outcome (n= 4)
  • 16. VALUE OF GNRH AGONIST IN REDUCING POF
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  • 25. Vitrification 1min, 37 ℃   WS1,2 5min×2 3min DS TS LN 2 Thawing WS + ES1 + ES2 3min ES3 9min VS1 VS2 VS3 VS4 P1 2hrs Cryotop (20μl for each drop, at R.T.) 3min 15sec x 4 Before ICSI (7.5%EG,7.5%DMSO in ES) (15%EG,15%DMSO,0.5M Suc in VS) (1M Suc in TS, 0.5M Suc in DS)
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  • 35. Jeruss and Woodruff (2009) New England Journal of Medicine. What Technique is Appropriate ?
  • 36.

Notes de l'éditeur

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