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Copyright of Basic & Clinical Andrology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In men cured of childhood cancer, fertility disorders related to damage to the stock of spermatogonial stem cells (SSCs) constitute one of the main side effects of treatments, adversely affecting the patients' quality of life. The development of new technologies in human reproduction is necessary to provide curative solutions for this iatrogenic infertility. The preservation of immature testicular tissue (ITT) fragments is recommended for prepubescent patients expected to be exposed to highly gonadotoxic treatments. The SSCs present in the prepubertal testicle constitute a source of cells for developing future therapies with the hope of restoring fertility. Testicular stem cell transplantation and autografting of ITT fragments are potential fertility restoration techniques that have proven effective in preclinical models of non-human primates. We will discuss here the advantages and limitations of these two therapeutic approaches, which are promising for clinical application in the near future. [ABSTRACT FROM AUTHOR]

The initiation of spermatogenesis in young males reaching puberty allows for the preservation of sperm from around the age of 12. However, for prepubescent boys not yet producing sperm, the freezing of testicular tissue (CTT) is now an accepted and recommended option according to the latest guidelines from the National Cancer Institute. CTT aims to preserve spermatogonial stem cells (SSC) before administering treatments that pose a high risk of future fertility impairment. The quality of the preserved testicular tissue, based on various clinical parameters of the patient and its potential to restore fertility post-treatment, is still under discussion, highlighting the need for a personalized approach in managing the fertility of young patients. [ABSTRACT FROM AUTHOR]

Fertility preservation (FP) techniques have developed considerably in recent years, thanks in particular to advances in oocyte vitrification. In France, the indications for using these techniques are no longer limited to oncological or even medical indications. Ovarian endometriosis carries a risk of damaging the ovarian follicular capital due to the multiple and recurrent nature of the lesions and the significant incidence of repeated ovarian surgery. As there are still very few cohort studies reporting on the results of preservation in patients with endometriosis, it is still difficult to establish formal recommendations. The aim of this review is to identify the arguments in favour of FP in endometriosis and to describe recently published cohort studies in order to develop a management strategy. [ABSTRACT FROM AUTHOR]

Copyright of Basic & Clinical Andrology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The number of women who turn to assisted reproduction clinics to have their eggs frozen is increasing in countries where this procedure is available. For various reasons these women are seeking to preserve their chances of becoming pregnant in the future. In the societal context where lasting relationships are formed at an older age than before, there are more single people than ever. With egg freezing, these women can afford to be more relaxed and will not need to discuss the desire for pregnancy at the first appointment because their biological clock is ticking. Even if only a minority of women will eventually use their cryopreserved oocytes, several studies have indicated that most of them are satisfied with having gone through the procedure which seems to have given them some peace of mind. Nevertheless, it would be wise to identify in advance those women who may not find support in this technique. This mini-review seeks to describe the issues and benefits of non-medical oocyte self-preservation, always bearing in mind that this procedure does not guarantee a pregnancy later on. [ABSTRACT FROM AUTHOR]

In order to restore fertility in patients with preserved testicular tissue from patients cured of paediatric cancer in particular, different approaches of in vitro maturation of (pre)pubertal testicular tissue have emerged in order to reproduce in vitro the complete process of spermatogenesis and have continued to evolve over the last 50 years. The aim of in vitro spermatogenesis is to generate in vitro spermatozoa from isolated spermatogonial stem cells (SSCs) or intact fragments of testicular tissue. Isolated SSCs, obtained after enzymatic and/or mechanical dissociation of testicular tissue, can be grown in liquid medium (twodimensional culture) or within a matrix (three-dimensional culture). The culture of testicular tissue fragments or organotypic culture, most often performed on agarose gel in gas-liquid interphase, allows the preservation of the interactions of SSCs with their microenvironment. Progressively, different models are emerging with the aim of mimicking the physiological conditions of spermatogenesis, particularly its spatio-temporal organisation. This research has led to the production of functional spermatozoa and viable and fertile offspring in mice. Translational research has been set up to transfer these technologies to human testicular tissue. [ABSTRACT FROM AUTHOR]

In France, fertility preservation (FP) was until recently very rarely offered to transgender persons despite the existing desire for a child. The proposed treatments, hormone therapy and reassignment surgery, are far from being without risk on gametic quality and production. French law authorizes fertility preservation before any treatment with sterilizing risks. Thus, several Cecos centers have responded to these new requests. A national multicenter survey was conducted between January 2019 and October 2020 in 28 centers of the French Cecos network. Each center was surveyed to find out how many TG individuals were coming, being informed, and being managed for FP. During this period, nearly 600 trans individuals presented to a Cecos center. Trans men were significantly younger than trans women. Nearly half of the trans people who came were able to perform oocyte or sperm conservation. However, 66% of trans women did so while only 11% of trans men did. Thus, the vast majority of Cecos centers are able to treat trans people for FP. This is the first study with such a large population. [ABSTRACT FROM AUTHOR]

Background: With multiple options available today to become a parent, how does the matter of genetic relatedness factor into adolescent cancer patients' fertility preservation (FP) decision making? This study reports on and normatively analyzes this aspect of FP decision making. Methods: A convenience sample of Israeli adolescent cancer survivors and their parents were invited to participate in individual, semi-structured interviews. Results: In discussing the importance of genetic relatedness to future children or grandchildren, participants repeatedly brought up the interrelated issues of nature, normalcy, and personal identity. Regardless of preference or ambivalence for genetic relatedness, the majority of participants were aware of alternative parenting options and noted both their advantages and disadvantages. However, knowledge of alternative parenting options was not uniform. Conclusions: To ensure that adolescent patients and their parents make informed FP decisions that meet their personal goals and values, it is important for physicians to discuss alternative parenting options with them in a culturally sensitive manner. Greater credence also should be given to those who question the importance of genetic relatedness. [ABSTRACT FROM AUTHOR]

Endometriosis is a benign gynecological pathology, affecting 2.1 to 4.2 million women in France and 6 to 10% of women of childbearing age. It is responsible for 30-40% of cases of hypo or infertility. This decrease in fertility is multifactorial, linked to the disease itself, but also to the consequences of the surgeries especially ovarian proposed. As such, endometriosis is now recognized as an indication of fertility preservation, mainly by vitrification of mature eggs, especially in cases of recurrent, bilateral ovarian lesions, or before potentially harmful fertility surgeries. The French recommendations of 2017 (CNGOF HAS) therefore recommend to limit ovarian surgeries as much as possible in this context of endometriosis and to discuss the indications of fertility preservation in the Plutidisciplinary Concertation Meeting. The 3 recently published retrospective series show that the chances of retaining a sufficient number of eggs are higher in women under 35 years of age, with no history of ovarian surgery, and that the use of vitrified eggs as part of endometriosis is an effective strategy, with 46% of live birth per woman, in the recent Cobo series. However, the question of the real indications of PF and its place in the life course of an affected patient remains unanswered: tools must be built to refine the prediction of the real risk of infertility of patients with endometriosis and to propose a strategy of preservation at the right time, for a reasonable financial and human cost, validated by robust medico-economic studies. [ABSTRACT FROM AUTHOR]

Current knowledge on ovarian physiology has challenged the traditional concept of folliculogenesis, creating the basis for novel ovarian stimulation protocols in assisted reproduction technology. The purpose of this review was to evaluate the efficacy of novel clinical interventions that could aid clinicians in individualizing their protocols to patients' characteristics and personal situations. We conducted a literature review of the available evidence on new approaches for ovarian stimulation from both retrospective and prospective studies in the PubMed database. Here, we present some of the most important interventions, including follicle growth in the gonadotropin-independent and dependent stage, manipulation of estradiol production throughout ovarian stimulation, control of mid-cycle gonadotropin surges, and luteal phase support after different stimulation protocols and trigger agents. The latest research on IVF has moved physicians away from the classical physiology, allowing the development of new strategies to decouple organ functions from the female reproductive system and challenging the traditional concept of IVF. [ABSTRACT FROM AUTHOR]

Résumé Préserver la fertilité est habituel en cancérologie mais moins systématique au cours des pathologies dysimmunitaires, qui peuvent pourtant justifier l’utilisation de traitements gonadotoxiques chez le sujet jeune, ou affecter la fertilité par elles-mêmes. Cette revue a pour objectif de clarifier les indications et méthodes de préservation de la fertilité dans ce contexte. Le cyclophosphamide est le seul traitement immunosuppresseur nécessitant de préserver la fertilité féminine tandis que chez l’homme, on proposera une préservation avant traitement par cyclophosphamide, méthotrexate, mycophénolate mofétil ou inhibiteurs de mTOR. D’autres facteurs inhérents à la pathologie ou intrinsèques au patient peuvent altérer la fertilité. Pour augmenter les chances de succès, il faut donc anticiper en réalisant un bilan de fertilité, ce qui est possible grâce à un lien permanent entre centre d’assistance médicale à la procréation et interniste. Le choix des modalités de préservation de la fertilité féminine dépendra de l’âge, de l’activité de la maladie, du délai possible avant un traitement, de la possibilité d’une grossesse future mais aussi du désir de la femme voire du couple. Avant la puberté, la seule méthode reconnue est la cryoconservation de tissu ovarien. Chez la femme pubère, la cryoconservation d’ovocytes matures doit être proposée en première intention. En cas d’urgence, de contre-indication ou de refus, on envisagera une cryoconservation de tissu ovarien ou un traitement par agonistes de la GnRH. Pour l’homme après la puberté, on réalisera une cryoconservation de sperme. Avant la puberté, la biopsie testiculaire avec cryoconservation de spermatogonies reste expérimentale. Fertility preservation is routinely performed in cancerology but less systematically used in the field of immune diseases, even though the use of gonadotoxic treatments in young patients may be required and even though the disease itself can alter fertility. This review aimed to clarify the indications and methods of fertility preservation in this context. Cyclophosphamide is the only immunosuppressive drug requiring fertility preservation in women. In men, fertility preservation should be proposed before treatment with cyclophosphamide, methotrexate, mycophenolate mofetil or mTOR inhibitors. Other factors inherent to the disease or the patient may alter fertility. Thus, screening for infertility and fertility preservation have to be implemented as much as possible to increase the chances of successful procreation in patients with immune disease. For women, the choice between the different preservation methods depends on the patient's age, disease activity, the time available before the start of treatment, the possibility of future pregnancy and the woman's and even couple's wishes. Before puberty, the only accepted method is cryopreservation of ovarian tissue. After puberty, the first-line method is the cryopreservation of mature oocytes. If the treatment has to be started in an emergency, if ovarian hyperstimulation/oocyte retrieval is contraindicated or if the patient refuses this option, cryopreservation of ovarian tissue or GnRH agonists could be proposed. For men, the accepted method is sperm cryopreservation. For prepubertal boys, the cryopreservation of spermatogonia after testicular biopsy is still experimental. [ABSTRACT FROM AUTHOR]

Résumé Depuis la parution de la loi de bioéthique de 2004, la préservation de la fertilité fait partie du parcours de soins des patientes devant être traitées par des chimiothérapies et/ou radiothérapie et/ou chirurgie ovarienne gonadotoxiques et des patientes pour lesquelles la fertilité risque d’être prématurément altérée. Il existe plusieurs techniques de préservation de la fertilité féminine, dont trois techniques d’assistance médicale à la procréation : la cryoconservation embryonnaire, d’ovocytes isolés et de cortex ovarien. Le choix de la ou des techniques dépend du type de traitement, des doses et de sa durée, mais aussi de l’âge de la patiente, de son statut marital, de l’urgence de la mise en place de son traitement anticancéreux et de l’hormonosensibilité de la tumeur. Les résultats de ces techniques, dans le cadre de la préservation de la fertilité, sont en pleine évolution et compte tenu d’une utilisation différée des embryons, ovocytes et fragments ovariens cryoconservés, ne sont pas encore définitifs. Since the publication of the Bioethics Act of 2004, the fertility preservation is a part of care of patients that will be treated with gonadotoxic chemotherapy and/or radiotherapy and/or ovarian surgery and of patients with fertility that could be prematurely altered. There are several techniques for preserving female fertility. Three techniques of assisted reproductive biology are possible: embryo cryopreservation, isolated oocytes cryopreservation and ovarian cortex cryopreservation. The choice of the technique(s) depends on the type of treatment, its duration and the doses, but also on the age of the patient, her marital status, the emergency of her anticancer treatment and the hormonosensitivity of the tumor. The results of these techniques of fertility preservation are evolving and given the delayed use of embryos, oocytes and ovarian fragments, are not yet definitive. [ABSTRACT FROM AUTHOR]

Résumé La préservation de la fertilité masculine doit être envisagée dans et en dehors du champ du cancer avant l’introduction de thérapeutiques dites gonadotoxiques (chimiothérapie, radiothérapie, chirurgie) et lorsqu’une pathologie risque d’altérer prématurément la fertilité. La technique de préservation de la fertilité est adaptée en fonction de l’âge de l’homme. Depuis plus de quarante ans, la congélation de spermatozoïdes est proposée en France chez l’homme après la puberté. Plus récemment, la congélation du tissu testiculaire est envisagée chez le garçon pré-pubère voire l’adolescent ou l’adulte jeune dans les situations où la congélation des spermatozoïdes n’a pas pu être effectuée. Male fertility preservation should be proposed before gonadotoxic treatment (chemotherapy, radiotherapy or surgery) in case of malignant or non-maligant disease or when fertility might be prematurely impaired. The techniques of fertility preservation should be adjusted according to the age of patient. Sperm cryopreservation has been performed since more than 40 years in France in pubertal males. More recently, testicular tissue freezing has been proposed for fertility preservation in prepubertal boys and more exceptionally in adolescents or young adults in case of sperm cryopreservation failure. [ABSTRACT FROM AUTHOR]

Premature ovarian failure (POF) affects about 1% of women before 40 years old and it is characterized by a premature follicular loss and/or a blocked follicular maturation. In the context of a pregnancy project, oocyte donation is currently the main suggested option. However, with the improvement of freezing techniques, oocyte or ovarian preservation widely developed. Initially proposed as part of the oncofertility procedure, the fertility preservation (FP) has seen its indications expand to any pathology whose natural evolution or treatment is likely to alter the fertility. The suggested techniques will depend on the age, the pathology, the appearance of puberty or not and the presence of antral follicles. The reference technique is the oocyte vitrification after stimulation cycles. Cryopreservation of ovarian tissue and oocytes vitrification after in vitro maturation is still experimental in the context of the POF. The care must be comprehensive with a complete psychological support. A genetic counseling must also be performed to prevent any disease to be transmitted to the offspring. [ABSTRACT FROM AUTHOR]

Klinefelter and Turner syndromes are generally associated with numerical sex chromosome abnormalities, the most common chromosomal abnormalies in newborns. They are both responsible for premature gonadal deficiency in most of cases, with non obstructive azoospermia in males and premature ovarian failure in females. Indeed, alterations in their exocrine gonadal function are put in place from the in utero life characterized by a depletion in spermatogonia stem cells or in primordial follicles. As a result, these patients are most often infertile in adulthood. Fertility preservation procedures aremore andmore often proposed with a precocious intervention just after the onset of puberty when possible. Ejaculated or testicular sperm freezing has been proposed in Klinefelter syndrome and mature oocytes freezing in Turner syndrome. [ABSTRACT FROM AUTHOR]

Information about infertility risks and fertility preservation options should be provide for all patients who receive gonadotoxic treatments. However, efforts to apply this recommendation from International Scientific Societies are mainly focused on oncological patients and in a lesser extent on patients diagnosed with benign diseases, including hematological benign diseases, auto-immune diseases, gynecological or genetic disorders. However, these indications count for 8 to 19 % of the fertility preservation demands and the risk of premature ovarian failure due to the treatment or the disease itself can be considered as high for several young patients. Counseling and adequate management of these patients might require particular attention due to severe healthy conditions that can be observed in some auto-immune diseases. In this revue, we address the specific issues of each non-oncological indication based on the literature and on personal experience. [ABSTRACT FROM AUTHOR]

Initially offered to women with polycystic ovary syndrome, particularly at risk of ovarian hyperstimulation, in vitro maturation (IVM) of oocytes has recently seen new indications. The IVM technique is an option for fertility preservation (FP), especially in women with hormone-dependent cancer, representing a contraindication for ovarian stimulation, or when the therapeutic management of cancer must be urgently initiated. Indeed, IVM can be proposed whatever the phase of the cycle and without prior treatment, thus allowing an oocyte collection almost immediately after the cancer diagnosis. In addition, it can be combined with ovarian tissue cryopreservation for optimizing the number of vitrified oocytes, and consequently the chances of future pregnancy after cancer recovery. This review is aiming to report the published data upon IVM thus far, and to discuss its position in female FP strategy. [ABSTRACT FROM AUTHOR]

Fertility is identified as one of the major concerns of young women who survived cancer in childhood or adolescence. The impact of the treatments on the ovarian reserve, and on the uterus in case of radiotherapy must be evaluated before treatment. Fertility preservation techniques used in adults are mostly feasible for adolescents, but some constraints are sometimes limiting. The impuberic girls can only benefit fromovarian cortex freezing. Virginity limits the achievement of oocyte vitrification. An ovarian reserve evaluation after treatment is useful and may lead to discuss fertility preservation after the end of the treatments. Information on the impact of the treatment and on fertility preservation techniques should be an integral part of adolescent girls' oncological management, but in practice there are sometimes some difficulties in approaching the subject or in decision-making. The systematic integration of this issue into the path of care and the strengthening of the links between oncology and reproduction teams have led to an improvement in fertility preservation care for adolescent girls. [ABSTRACT FROM AUTHOR]

The fertility preservation couseling must be part of the personalized care plan as soon as a gonadotoxic treatment is considered. The fertility preservation technique should be discussed in a multidisciplinary staff meeting and will depend on: the age of the patient, her pubertal status, her ovarian reserve, the pathology, the emergency to introduce the treatment, the type and doses of gonadotoxic considered. The reference technique, in the pubertal patient, is the vitrification of mature oocytes, collected after ovarian stimulation when it is possible to have a delay of at least two weeks before the beginning of treatment and in the absence of contraindication to temporary hyperestrogeny. Oocyte vitrification can also be performed after in vitro oocyte maturation (IVM) and is an interesting strategy in case of hormone-dependent pathology, orwhen emergency does not allowovarian stimulation. Cryopreservation of ovarian tissue is the only technique possible before puberty or when chemotherapy has already been started. The objective is to subsequently transplant ovarian fragments to restore endocrine and exocrine function. Its main limit remains the theoretical risk of reintroduction of malignant cells [ABSTRACT FROM AUTHOR]

Cancer treatment has adverse side effects, among them, gonad toxicity may result in infertility. Testicular tissue freezing is proposed to preserve fertility in pre-pubertal boy, adolescent or young adult in case where sperm freezing could not be carried out. In order to restore fertility of cured but infertile patients, several modalities to use frozen testicular tissue are currently under study and could be envisaged to produce sperm suitable for Assisted Reproductive Techniques : (i) in vitro maturation of spermatogonial stem cells (SSC) (in vitro spermatogenesis), (ii) in vivo maturation of SSC after autologous transplantation or testicular tissue grafting in the testis of cur Key words: cancer, fertility preservation, germ cell transplantation [ABSTRACT FROM AUTHOR]

Women fertility preservation is a major challenge in the management of patients with autoimmune diseases. Use of highly gonadotoxic alkylating agents, such as high-dose cyclophosphamide, should be preceded by fertility preservation because of the very high risk of premature ovarian failure. Some patients show a decrease in ovarian reserve, especially in systemic lupus erythematosus, but the indication of fertility preservation in this case remains controversial because infertility is not demonstrate out of any treatment. The technique of choice in the pubescent patient is mature oocytes vitrification after ovarian stimulation. Embryo freezing, ovarian cryopreservation or in vitro oocyte maturation may also be indicated. Interest of GnRH agonist treatments remains controversial. Finally, evaluation of obstetrical prognosis will be necessary because a pregnancy could be not recommanded with advanced stage disease. [ABSTRACT FROM AUTHOR]

Originally developed for patients suffering from cancer, fertility preservation (FP) has rapidly invaded others medical fields, and represents now the standard of care for all patient diagnosed with diseases that could impair fertility or having to receive gonadotoxic treatments. Recent advances in cryopreservation techniques now allow considering oocyte, embryo or ovarian tissue freezing. FP should now be offered not only in oncologic situations, but also in genetic or endocrine disorders, as well as benign ovarian diseases at risk of premature ovarian failure, autoimmune diseases, or iterative pelvic surgeries. Otherwise,when the ovarian reserve is already reduced, the induction of multi- follicular growth remains a challenge and indications of FP have to be discussed. This review will discuss the different strategies of FP in young girls and women of reproductive age, regarding different medical indications. [ABSTRACT FROM AUTHOR]

Chemotherapy to treat cancer is usually responsible for early ovarian follicle depletion. Ovarian damage induced by cancer treatments frequently results in infertility in surviving patients of childbearing age. Several fertility preservation techniques have been developed. Nowadays, oocyte or embryo cryopreservation with or without ovarian stimulation and cryopreservation of the ovarian cortex are the most commonly used. However, these methods may be difficult to implement in some situations, and subsequent use of the cryopreserved germ cells remains uncertain, with no guarantee of pregnancy. Improved knowledge of the molecular mechanisms and signaling pathways involved in chemotherapy-induced ovarian damage is therefore necessary, to develop new strategies for fertility preservation. The effects of various chemotherapies have been studied in animal models or in vitro on ovarian cultures, suggesting various mechanisms of gonadotoxicity. Today the challenge is to develop molecules and techniques to limit the negative impact of chemotherapy on the ovaries, using experimental models, especially in animals. In this review, the various theories concerning ovarian damage induced by chemotherapy will be reviewed and emerging approaches for ovarian protection will be explained., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé Les femmes indemnes porteuses de mutation des gènes BRCA1 ou BRCA2 peuvent-elles être considérées comme à risque d’altération prématurée de leur fertilité, et donc relevant d’une proposition systématique de préservation de leur fertilité ? Les femmes porteuses de mutation des gènes BRCA1 ou BRCA2 sont à haut risque de développer des cancers du sein et tubo-ovariens. Le traitement d’un cancer du sein précoce, fréquent dans cette population, entraîne un risque d’infertilité, lié à la toxicité ovarienne de la chimiothérapie, à la durée recommandée de l’hormonothérapie lorsqu’elle est indiquée, et au délai conseillé avant de démarrer une grossesse. D’autre part, les données de la littérature suggèrent un risque d’insuffisance ovarienne prématurée chez les femmes porteuses de mutation BRCA1/2 : ont été constatées une avance de l’âge de la ménopause et une mauvaise réponse à la stimulation ovarienne. Plusieurs hypothèses physiopathologiques soutiennent cette constatation, comme l’implication des gènes BRCA dans le maintien de la longueur des télomères, les anomalies de la réparation de l’ADN favorisant l’apoptose ovocytaire, des différences de génotype de FMR1 . Les techniques de préservation de la fertilité actuelles ont des limites, dont certaines spécifiques au contexte de mutation BRCA1/2 : absence de risque carcinologique de la stimulation en situation de mutation BRCA1/2 non clairement démontrée, rentabilité limitée des techniques de vitrification ovocytaire, greffe de cortex ovarien non adaptée chez ces femmes à risque. Ainsi, les données sur le risque augmenté d’insuffisance ovarienne restant peu robustes, une telle proposition systématique semble discutable. Should all women with BRCA1 or BRCA2 genes mutations be considered at risk of prematurely impaired fertility, and thus should a fertility preservation systematically be proposed? Women carrying mutations of BRCA1 or BRCA2 are at high risk for breast and tubo-ovarian cancer. The treatment of a breast cancer at a young age, unrare in this population, is associated with a risk of infertility, due to the ovarian toxicity of chemotherapy, to the recommended duration of hormonotherapy when indicated, and to the time advised before starting a pregnancy. Furthermore, some data in the literature suggest a higher risk of premature ovarian failure among women with BRCA1/2 mutation: advance of the age at menopause and poorer response to ovarian stimulation have been observed. Several pathophysiological hypotheses support this finding, as the involvement of the BRCA genes in maintaining telomere length, the DNA repair anomalies promoting oocyte apoptosis, differences in FMR1 genotype. Current fertility preservation techniques have limitations, some of them being specific to BRCA1/2 women: absence of oncological risk due to stimulation in BRCA1/2 women not clearly demonstrated, oocyte vitrification techniques limited rentability, graft of ovarian cortex not suitable in these women at high risk. Thus, data on the increased risk of premature ovarian failure remaining weak, such a systematic proposal seems questionable. [ABSTRACT FROM AUTHOR]

Copyright of Biologie Aujourd'hui is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Every year in France, more than 15,000 women and 9,000 men under the age of 45 are diagnosed with cancer and are potentially at risk of treatment-induced altered fertility. The 2004 law on bioethics stipulates that every person exposed to medical care that may alter his/her reproductive function may be offered a gametes and germinal tissues cryopreservation. However, studies show heterogeneity in patient's information and care, as well as a lack of awareness among medical teams on various existing conservation strategies. Therefore, the 2014-2019 Cancer Plan guarantees that all patients have access to fertility preservation. It aims to systematically inform patients, during the consultation explaining their treatment options, about the risks of cancer treatments on their future fertility and opportunities for preservation that are available. Patients, who wish so, should be referred to a specialist in fertility preservation. 'Clinico-biological fertility preservation' platforms are developing across the country, formalising the links between assisted reproductive technology centres and oncology professionals. They associate specialist consulting facilities and technical cryobiology platform. Finally, support will be provided to research into innovative cancer treatments-induced risks on fertility, and on the prevention and reduction of the associated risks to fertility. Current knowledge and validated practices will also be published as professional guidelines. [ABSTRACT FROM AUTHOR]

Résumé Le recueil d’ovocytes immatures sans stimulation ovarienne, suivie de leur maturation in vitro (MIV), a initialement été proposé dans le but d’éradiquer les risques et effets indésirables liés à l’administration de gonadotrophines exogènes. Ainsi, au cours des dernières décennies, la MIV a principalement été proposée à des femmes porteuses d’un syndrome des ovaires polykystiques, particulièrement à risque de syndrome d’hyperstimulation ovarienne. Cependant, le développement de la préservation de la fertilité féminine a récemment ouvert de nouvelles perspectives pour cette technique de laboratoire. Cet article reprend la place de la MIV dans la stratégie de la préservation de la fertilité féminine. Recovering immature oocytes from unstimulated ovaries, followed by in vitro maturation (IVM) was initially proposed to avoid the risks and side effects of exogenous gonadotropin administration. Therefore, during the past decades, IVM was mainly offered to patients with polycystic ovary syndrome at high risk of ovarian hyperstimulation syndrome. However, the development of fertility preservation has recently opened new perspectives in the field of IVM. The present review reports the possible indications of IVM, in the strategy of female fertility preservation. [ABSTRACT FROM AUTHOR]

Résumé La vitrification ovocytaire est l’une des stratégies pouvant être proposée aux femmes dès la puberté pour préserver leur fertilité avant la mise en route d’un traitement anticancéreux gonadotoxique. L’objectif de notre article a été de faire une mise au point basée sur la littérature et notre expérience clinique concernant la faisabilité et les problèmes cliniques et logistiques liés à la vitrification ovocytaire dans le domaine de l’oncofertilité : les âges « limites », le délai nécessaire pour stimuler, les protocoles de stimulation, la réponse à la stimulation ovarienne ; pour quelles chances de grossesse ultérieure ? Oocyte vitrification is a preservation fertility strategy, which can be performed in women after puberty to preserve gametes before beginning a gonadotoxic anticancer treatment. Based on available literature and our personal data, we aim to provide an overview about the feasibility, the clinical and logistic difficulties of oocyte vitrification in the field of oncofertility: limit age for oocyte cryopreservation, time required and protocols for ovarian controlled stimulation, ovarian response to stimulation, for what hopes of pregnancy? [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: La cryoconservation du tissu ovarien (CTO) constitue un moyen de préserver la fertilité des femmes et jeunes filles devant suivre un traitement potentiellement gonadotoxique (chimiothérapie, radiothérapie…). Cette étude a pour objectif d’analyser les indications et le devenir des patientes qui ont bénéficié d’une CTO dans notre centre de biologie et médecine de la reproduction après 17 années de pratique. Patientes et méthodes: Étude rétrospective réalisée chez 46 patientes ayant bénéficié d’une CTO avant un traitement stérilisant dans le service d’AMP- CECOS du CHU de Clermont-Ferrand, de janvier 1997 à décembre 2009. Résultats: L’âge moyen des patientes lors du prélèvement était de 19,5ans. Les patientes étaient mineures dans 52 % des cas au moment du prélèvement. Par ordre de fréquence décroissante, les pathologies présentées par les patientes au moment de la CTO étaient hématologiques, des tumeurs ovariennes, des sarcomes ou tumeurs neuroectodermiques (PNET) et des néoplasies mammaires. Dans 93,5 % des cas, le prélèvement du cortex ovarien a été pratiqué par cœlioscopie. Suite au prélèvement de tissu ovarien, 82,6 % des patientes ont été traitées par chimiothérapie. Une greffe de moelle osseuse a été réalisée chez 48 % des patientes. Au moment du recueil des données, 57 % des patientes pour qui un suivi de la fonction ovarienne avait été réalisé, présentaient une insuffisance ovarienne prématurée. Huit patientes ont présenté une grossesse après l’arrêt du traitement. Il s’agissait d’une grossesse naturelle pour cinq d’entre elles. Les trois autres patientes ont obtenu une grossesse après recours à l’assistance médicale à la procréation (fécondation in vitro et don d’ovocytes). Discussion et conclusion: Nous rapportons un suivi à long terme des patientes prises en charge dans notre centre pour un prélèvement et une CTO. Notre étude a pour originalité d’évaluer l’ensemble des aspects de prise en charge, de la décision de proposer une CTO aux patientes à leur devenir plusieurs années après le prélèvement. Il s’agit donc d’une approche multidisciplinaire à la fois oncologique, gynécologique et pédiatrique de la CTO qui est souvent étudiée de façon restrictive dans la littérature. Enfin, il semble essentiel d’instaurer une surveillance médicale spécifique pour ces patientes. Ce suivi doit permettre une évaluation satisfaisante du développement pubertaire et de la fonction ovarienne, la prise en charge de la carence œstrogénique et de l’infertilité secondaire, l’accompagnement des patientes dans leur désir de maternité. [ABSTRACT FROM AUTHOR]

The evolution of medical techniques as well as legislative changes currently allow to propose fertility preservation strategies in the context of transidentity. During "female to male" transition, androgen therapy has an impact on gonadal function since it usually induces a blockage of ovulation with amenorrhea. Although this effect is reversible when treatment is stopped, the possible long-term effects of testosterone treatment on future fertility or health of future children are poorly known. In addition, transitional surgeries definitely compromise fecundity when they include bilateral ovariectomy and/or hysterectomy. Yet, although long ignored or poorly expressed, the desire for parenthood is a reality in transgender men. Fertility preservation options in FtM transition rely on oocyte or ovarian tissue cryopreservation. The purpose of this review is to provide an overview of the literature regarding fertility preservation in transgender men. Although series remain limited, the increase in the number of recently published articles reflects the interest in improving the management of fertility issues in transgender men., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Résumé: Objectifs: Évaluer différentes techniques chirurgicales d’ovariectomie partielle pour cryopréservation. Évaluer les conséquences d’une exposition préalable aux traitements cytotoxiques sur la qualité de l’ovaire prélevé. Patientes et méthodes: Étude observationnelle rétrospective unicentrique, sur 4ans, des femmes ayant eu une chirurgie pour cryopréservation ovarienne pour chimio ou radiothérapie à haut risque de faillite ovarienne précoce. Plusieurs techniques d’ovariectomie partielle ont été proposées : avec clampage du pédicule vasculaire gonadique (prélèvement indirect), sans clampage (prélèvement direct) et à la pince agrafeuse automatique. Le tissu ovarien était immédiatement préparé pour la cryoconservation en salle d’opération. L’ensemble du prélèvement était divisé en petits fragments. Pour chaque ovaire, un compte des fragments était effectué. Un fragment était examiné afin de déterminer le nombre de follicules primordiaux. Résultats: L’ovariectomie et la cryopréservation ont été réalisées chez 13 patientes. Deux évènements hémorragiques sont survenus avec la technique directe, sans conséquence pour les patientes. Le nombre de fragments obtenus avec les techniques indirecte et directe était de respectivement 19 vs 15, p =0,18 ; le nombre de follicules primordiaux était de 38 vs 36, p =0,87. L’agrafeuse automatique consommait trop de tissu ovarien pour être intéressante. Il y avait moins de fragments, 15 vs 20, p <0,05 et de follicules primordiaux, 35 vs 40, p =0,65, après une première cure de chimiothérapie. Discussion et conclusion: La technique avec clampage vasculaire est plus sûre mais sans différence sur la qualité du prélèvement. Une seule cure de chimiothérapie a un impact péjoratif sur la qualité du prélèvement. [ABSTRACT FROM AUTHOR]

Résumé: L’incidence du cancer chez les sujets jeunes ainsi que les taux de survie sont en constante augmentation. La question de la fertilité est une des thématiques clés de la qualité de vie après la maladie. Depuis la parution du décret de décembre 2006 en France, tout patient qui sait sa fertilité menacée par des traitements médicaux peut avoir accès aux différentes techniques de préservation. Plusieurs options peuvent être discutées : la congélation d’embryons ou d’ovocytes et la cryopréservation de tissu ovarien. Si ces différentes techniques de préservation de la fertilité évoluent rapidement, il reste néanmoins difficile de faire le choix de la stratégie la plus adéquate pour une patiente et un protocole donné. Ce choix tiendra compte de l’âge de la patiente au moment du diagnostic, du type de cancer, de la nature du protocole de chimiothérapie requis (type de molécule et dose totale) et le degré d’urgence de la mise en œuvre du traitement. [ABSTRACT FROM AUTHOR]

Recent advances in cancer therapy have resulted in an increased number of long-term cancer survivors. Infertility, however, might be the consequence of an efficient cancer treatment. For young patients affected by cancer accesses to the partly established and partly still experimental options to preserve fertility are crucial. As decisions on fertility preservation have to be made in the short time period after diagnosis and before onset of cancer treatment, counselling is challenging. Based on an overview on technical options to preserve fertility, the ethical dilemma will be discussed and the nowadays available study results concerning the psychological dimension and the requirements for counselling will be presented. Due to the complexity of the topic a multidisciplinary approach considering experts' recommendations is indispensable [ABSTRACT FROM AUTHOR]

Résumé: La préservation de la santé reproductive est un élément essentiel de la qualité de vie. La cryopréservation de spermatozoïdes est efficace pour préserver la fertilité après la puberté. Pour les garçons prépubères, la cryopréservation de tissu testiculaire immature (TTI) est une approche de préservation de la fertilité prometteuse. La congélation lente est la méthode conventionnelle pour préserver ce tissu puisqu’elle est la seule à avoir démontré la conservation du potentiel reproducteur du tissu congelé par la naissance de souriceaux. Les méthodes de cryopréservation du TTI humain font toujours l’objet de recherches. La congélation lente permet la préservation de spermatogonies capables de proliférer. Toutefois, après décongélation et xénotransplantation à la souris, la proportion de spermatogonies résiduelles est faible et leur différentiation est anormale. La procédure de congélation à l’origine de la formation de cristaux de glace induisant des dommages tissulaires et cellulaires ainsi que l’environnement de la transplantation peuvent être impliqués. La vitrification, technique de cryopréservation transformant le liquide en un solide amorphe dépourvu de cristaux de glace, est une alternative potentielle pour préserver le tissu. La vitrification de tissu testiculaire a été étudiée chez plusieurs espèces. L’obtention d’une descendance chez la caille à partir de spermatozoïdes issus de TTI vitrifié confirme le potentiel de la vitrification en matière de préservation de la fertilité. Pour la préservation du tissu testiculaire humain, la vitrification et la congélation lente semblent équivalentes pour préserver des spermatogonies capables de proliférer. Toutefois, avant toute validation de l’une ou l’autre technique, l’obtention d’une spermatogenèse normale et la capacité de fertilisation des spermatozoïdes produits dans le tissu cryopréservé devront être investiguées. [ABSTRACT FROM AUTHOR]

Cancer prognosis has considerably improved over recent decades and increasing numbers of young adults live with the long-term consequences of their treatment. Their quality of life is often serious compromised by the inability to conceive a child. As such the recent and rapidly evolving practice of fertility preservation needs to become a standard option in cancer care. Embryos, oocytes, spermatozoa, and germinal tissue can be cryopreserved without damage until such time that the patient, freed from their illness can envisage starting a family. Fertility can be persevered prior to initiation of gonadotoxic treatments by different methods. Some options, in particular in prepubescent boys (and even in adolescents and young adults), though a high research priority and a source of great hope, remain highly experimental. Since the available options combine both validated and experimental methods, it is necessary that care teams are multidisciplinary and that they discuss these choices with the patient and (for children) their family. Even though some patients, through choice or otherwise, are not candidates for Fertility Preservation, their decision, taken in the light of complete, correct and understandable information about the available options, must be respected in accordance with their rights to determine their own reproductive future. The current situation in France needs improvement and multidisciplinary structures are forming where cancer specialists work closely with specialists in reproductive medicine and biology to provide rapid and coordinated patient care. The national cancer institute (INCA) with the Agence de la biomédecine have co-published a report that brings the knowledge of all involved in the care of these patients up to date and makes a series of propositions to improve the situation and notably to guarantee equitable access to quality care for all concerned persons. The principal areas of improvement are: [ABSTRACT FROM AUTHOR]

Global improvements in patient prognosis and impetus gained fromthe two French cancer plans have lead to reconsider the importance of quality of life on survival, and especially of fertility preservation as an essential part of oncologic supportive care. Post treatment, patients should have the opportunity to enjoy and plan parenthood in keeping with their expectations. The regional cancer network ONCOPACA-Corse has implemented coordinated actions to promote rapid access to this specific care. This platform will provide access to emerging techniques, in particular for the female and the paediatric population, and patients' followup. Delivering specific information to oncologic staffs is essential to reach this objective. [ABSTRACT FROM AUTHOR]

Abstract: Oocyte vitrification is a new technique in cryobiology that will lead to a number of improvements in assisted reproduction practices, oocyte donation and the preservation of female fertility. Professionals already versed in the techniques of micromanipulation will be able to master the new procedures, which should not be delegated to unqualified staff. When adopted by clinical units, oocyte vitrification will require changes in laboratory and administrative organization. The technique will also modify the ethical outlines of reproductive biology. France today is running behind in the application of this major development in cryobiology. The reasons are many and have to do with a long waiting period for authorization from national health authorities, a lack of material and human resources and a foreseeable shake-up in the nationally established egg donation program. However, recently a new law of bioethics has recognized the breakthrough that this new technique represents by allowing couples covered by the French national health care program for Assisted Reproductive Technologies (ART) to choose oocyte vitrification as an option. [Copyright &y& Elsevier]

Techniques for fertility preservation can be offered in women of reproductive age receiving chemotherapy. The use of a GnRH agonist during chemotherapy is one of the first techniques that has been proposed. Underlying mechanisms remain controversial, but the results of nonrandomized trials in breast cancer and other diseases were encouraging. Randomized trials in breast cancer show conflicting results, and are difficult to interpret. There are also some concerns about a possible interaction with the effectiveness of cancer treatment that remain to be evaluated, even if the data available seem to be reassuring. Thus, currently, the use of this method of fertility preservation is controversial, but should probably be mentioned and explained to patients, and eventually proposed, rather in trials. Other methods for fertility preservation currently available, that have a promising efficiency and are compatible with the use of agonists, should be preferred in these patients. [ABSTRACT FROM AUTHOR]