Fertility and sterility最新文献

We share experiences in advocating to defend in vitro fertilization (IVF) in Virginia, Missouri, and Mississippi, provide historical context on the "Personhood" anti-IVF movement, and discuss why "embryo donation" is a more accurate term than "embryo adoption." Some individuals and communities have a deeply-held belief that a fertilized oocyte is a very early human life, and we will likely never change their minds. In the fertility community, most providers consider embryos to be an important part of the continuum between gametes (sperm and eggs) to live birth. Embryos are neither life, nor property, but rather a special class of "potential life" deserving of particular respect. The premise of the "Personhood" movement is that each fertilized oocyte is already an individual living being, subject to child-custody and similar legal protections. Both in nature and in the laboratory, however, only a minority of fertilized eggs result in live birth. Not all IVF embryos are of adequate quality for transfer, and most transferred embryos result in negative pregnancy tests or miscarriages, and rarely, ectopic pregnancies. "Personhood" bills would also criminalize the life-saving, appropriate standard-of-care management of ectopic pregnancies, the most common cause of first-trimester maternal mortality. Efforts to apply a religious and moral lens to regulate and interfere with the practice of IVF based on a mistaken perception that all fertilized eggs are early human beings, would make standard-of-care IVF practice impossible. By equating all fertilized eggs with live-born children, the broadly-worded measures in "Personhood" bills would consign fertility patients to less effective treatments. As a practical matter, "Personhood" bills simply cannot co-exist with legislation to protect the practice of IVF, without inordinate risks to physicians, their practices, and their patients. In response to recent events, the authors encourage all readers to consider participating in state-level advocacy. Sharing IVF experiences and clinical expertise with state legislators (and other officials) can help protect patients, their providers, and the families that they strive to create. Efforts to inappropriately-regulate and restrict in vitro fertilization will decrease access to care, to essential family-building treatments and services.

Objective: To study the impact of unilateral ovariectomy for ovarian tissue cryopreservation (OTC) on the function of the remaining ovary in girls with Turner syndrome.

Design: A prospective cohort study as follow up of OTC in a research setting (The TurnerFertility trial, NCT03381300).

Setting: University hospital in Nijmegen, the Netherlands.

Subjects: A total of 28 girls with Turner syndrome with follicles in their cryopreserved ovarian cortex tissue, aged 5-19 years. Of the 28 girls, 21 girls had a 45,X/46,XX mosaic karyotype, five had structural aberrations of the X-chromosome, one girl had a 45,X monosomy, and one girl had a 45,X/47,XXX karyotype.

Interventions: Girls were monitored annually after OTC for pubertal development and levels of anti-Müllerian hormone (AMH), Follicle Stimulating Hormone, Luteinizing Hormone, Estradiol, and Inhibin B.

Main outcome measures: Thelarche, menarche and onset of premature ovarian insufficiency.

Results: The girls were monitored for a median duration of 3.4 years (maximum 6.6 years). The pubertal development of five prepubertal girls is still unknown, all were under the age of 10 and had low gonadotropins and estradiol levels at the end of the follow-up. Seven of the eight girls around pubertal age (10-12 years) experienced spontaneous thelarche, while one received medication to induce puberty. Eleven of the fourteen girls between the age of 14-17 years experienced spontaneous menarche, three other girls with thelarche still had ongoing puberty at the end of follow-up with normal gonadotropins and AMH levels above the detection limit. Around six to twelve months after OTC, a decline in AMH concentration was observed in 57% of girls (16/28 girls), followed by an increase in AMH concentration in the following years. Six of the total 28 girls started hormone replacement therapy due to symptoms of premature ovarian insufficiency, and all had AMH levels below 0.50 μg/L before OTC.

Conclusion: Pubertal development progressed after unilateral ovariectomy for OTC in most girls with Turner syndrome. Hormone replacement therapy was required within a few years for girls with unfavorable parameters before OTC, such as AMH below 0.50 μg/L. Decisions regarding OTC should be personalized, considering the girl's preferences and specific characteristics.

Objective: To evaluate the long-term safety of controlled ovarian stimulation for fertility preservation prior to breast cancer chemotherapy treatment DESIGN: Retrospective observational cohort SUBJECTS: 213 women aged 18-43 years with newly diagnosed stage I-III breast cancer treated with systemic chemotherapy during 2015-2019. Of those, 74 underwent controlled ovarian stimulation for fertility preservation recipients and 141 did not (controls).

Exposure: Controlled ovarian stimulation for fertility preservation MAIN OUTCOME MEASURES: Invasive disease-free survival, calculated from the time of surgery to the time of detection of breast cancer recurrence or death, whichever came first.

Results: At diagnosis, fertility preservation recipients were significantly younger than controls (32.7 vs 38.5 years), were less likely to be partnered (44.4% vs 90.1%) or parous (38.9% vs 95%) and were more likely to harbor a BRCA germline mutation (36.5% vs 14.2%). Disease characteristics and treatment modalities were comparable between groups, apart from tumor staging, with maximal tumor diameter being over 5 cm in 22.2% of fertility preservation recipients as opposed to 5.7% of controls (P<0.05). Mean follow-up was 60.9 and 65.4 months for fertility preservation recipients and controls, respectively. 5-year-invasive disease free survival was 80% for fertility preservation recipients and 86% for controls (p=0.20). In a multivariate analysis adjusted for statistically significant covariates, invasive disease free survival remained similar between the groups (Hazards Ratio (HR), 0.86, 95CI 0.4-1.87, p = 0.71). Invasive disease free survival rates were not statistically different in clinically relevant subgroups including patients receiving neoadjuvant chemotherapy (HR 1.57, CI 95 0.62-3.99, p=0.34), and those co-treated with tamoxifen during stimulation due to an ER-positive disease (HR 1.66, 95CI 0.67-3.49, p=0.23).

Conclusions: Fertility preservation with controlled ovarian stimulation for patients with breast cancer was not found to impair long-term oncologic outcomes, including in emerging clinically relevant subgroups.

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