TFG ivettefernandezrodriguez

PRESERVATION OF FEMALE FERTILITY IN
PREPUBERAL PATIENTS
Ivette Fernàndez Rodríguez
Genetic Degree, Faculty of Biosciences. Universitat Autònoma de Barcelona, Cerdanyola del Vallès 08193, Spain
INTRODUCTION
OBJECTIVES
Nowadays, 1 of 6 couples is affected by infertility. This is why preservation of female fertility
has taken such a great importance, especially in patients exposed to conditions that enhance
the loss of it. The most common cause of loss of fertility in females is the primary ovarian
insufficiency (POI). The development of assisted reproduction techniques aimed to preserve
female fertility has become an essential step in Assisted Reproduction.
The techniques utilized with better results for the preservation of female fertility are
cryopreservation of oocytes and cryopreservation of embryos. Despite the progress in the
scope of fertility preservation in recent years the fertility preservation in prepuberal female
patients remains a challenge in this area.
 To discuss the most appropriate techniques in the case
of prepuberal patients by presenting cases of
childhood cancer and galactosemia.
 To expose the problems associated with the available
techniques for this patients in both cases.
MATERIAL AND METHODS
In this work, only English-language published articles
have been selected from NCBI’s database; including
author manuscripts, review articles and committee
opinions.
RESULTS
At the present, despite of the large number of techniques available for fertility
preservation, only ovarian tissue cryopreservation can be applied to prepuberal
patients because techniques requiring ovarian stimulation are not suitable
because of the absence of maturation of the hypothalamic-hypophyseal-ovarian
axis.
That is why it is impossible to apply efficient techniques of oocyte
Histological biopsy of a prepuber ovarian Histological biopsy of an adult ovarian cryopreservation or embryo cryopreservation in adult woman. The main fact is
We can see primordial follicles in the cortical
region.
We can see primary follicles, antral follicles
and Graaf follicles
that they require the production of mature oocytes.
The Ovarian Tissue Cryopreservation is the only fertility preservation technique in prepuberal patients.
Ovarian tissue
cryopreservation
Cortical tissue
Orthotropic
transplant
Natural
conception
Propitious
environment for
follicular
development
Whole ovary
Heterotopic
transplant
Limited for the
Difficult neovascularization
Follicular
number of grafts
which
committed graft viability
development
used in the
Less propitious environment
transplant because monitoring
for follicular development
of the ovarian size
Easy and
monitoring follicular
FIV and ICSI are necessary for
Invasive
recuperation
conception
surgery
Transplant with
pedicle
Absence of gonadotropin
response for follicular maturation
POI
9p13
CHILDHOOD CANCER
Chemotherapy
Radiotherapy
Irreversible gonadal damage, especially in the
granulose cells, which can not produce estrogens
Depending on the age of exposition, the duration, and
the zone to be radiated
Long duration surgery
Fast introduction and
extraction of cryoprotector
inside all cells of the ovary
CLASSIC GALACTOSEMIA (1:16.000/60.000)
Deleterious mutations in GALT
His not a well-established protocol yet
Immediate
administration of blood to
the graft during the
transplant
POI
Possible ischemia due to
thromboembolism in vascular pedicle
More probability of the reintroduction
or cancer cells due to the use of medulla
ovarian tissue
Reduction in the patient’s follicles
number, making spontaneous conception
less probable
Possibility of reintroduction of cell cancer in the
transplant. It is necessary to develop cell tumor
detection techniques in the ovarian tissue before the
transplant. But only in cancer types with high
probability of metastasis in the ovary
CONCLUSIONS
 In childhood patients the current technique is ovarian tissue cryopreservation due to the other techniques used in adults with better
results, like oocyte and embryo cryopreservation, can not be used in this patients.
 Other new techniques, like ovary transposition, in vitro oocyte maturation, follicular cultures or co – treatment with GnRH analogs,
will be good options in a prepuberal female patient that wants to preserve her fertility, but these are still in developmental phases
and present high risk for the patients.
 In galactosemia cases we have to consider the possibility of primary insufficiency ovarian reversion and spontaneous conception,
whereas, in childhood cancer cases we have to consider the possibility of the reintroduction of cancer cells within the transplant. For
this reason, it is recommended to perform cancer cell detection techniques in cancer types which have high risk of causing ovarian
metastasis.
 Oocyte and embryo donations and adoption are options that should be considered.
BIBLIOGRAPHY
Ovarian tissue cryopreservation: a committee opinion. The Practice Commitee of American Society for Reproductive Medicine. Fertility and Sterility 2014:101(5); 1237-43.
Britt van Erven, Cynthia S Gubbels, Ron J van Golde et al. Fertility preservation in female classic galactosemia patients. Orphanet Journal of Rare Diseases 2013, 8:107
Murat Sonmezer, Kutluk Okatay. Fertility preservation in female patients. Human Reproduction Update, Vol.10, No.3 pp.251-266,2004