IVF for fertility preservation in breast cancer patients—efficacy and safety issues

Background

Potential risks on future fertility have become a dominant issue in consultation and management of newly diagnosed young cancer patients. Several fertility preservation strategies are currently available. Of those, ovarian stimulation followed by IVF and embryo cryopreservation is the most established one and is especially applicable in reproductive aged breast cancer patients.

Aim

The aim of this study is to provide a comprehensive review on ovarian stimulation and IVF for fertility preservation in newly diagnosed breast cancer patients.

Methods

Review of relevant literature is available through PubMed and Google scholar.

Results

The use of IVF for fertility preservation in breast cancer patients raises dilemmas regarding efficacy and safety of controlled ovarian stimulation. Among these are the suggested role of malignancy and BRCA mutation in reducing ovarian response to stimulation, strategies designated to protect against hyper-estrogenic state associated with stimulation (co-treatment with tamoxifen or letrozole), and possible adjustments to accommodate oncologic-related time constraints.

Conclusion

Ovarian stimulation followed by IVF forms an important fertility preservation strategy for newly diagnosed young breast cancer patients, though live born rates following thawed embryo transfer in these patients are still lacking. Recent advances in controlled ovarian stimulation protocols provide practical options for some of the challenges that breast cancer patients present.     

Disentangling causal paths between obesity and in vitro fertilization outcomes: an intractable problem?

Research questions should be appropriate for the available data. Disentangling causal paths between obesity and in vitro fertilization outcomes may be an intractable problem, but other research questions of clinical importance can be addressed through appropriate study designs and analytic methods.     

Anti-Müllerian hormone and polycystic ovary syndrome: assessment of the clinical pregnancy rates in in vitro fertilization patients

Abstract

Objective: The purpose of this study is to investigate the role of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) for the prediction of clinical pregnancy rates (CPR) in women with polycystic ovary syndrome (PCOS) undergoing IVF treatment.

Design: Prospective cohort study.

Setting: University hospital.

Patients: One hundred and fifty consecutive women with PCOS.

Interventions: All women underwent controlled ovarian stimulation with long agonist protocol followed by IVF procedure. Outcomes of pregnant and non-pregnant groups were compared.

Main outcome measure: CPR; AMH, FSH and AFC means and percentiles.

Results: Fifty-one (34%) clinical pregnancies were observed in 150 women. Mean AMH was 6.7?±?2.8 and 7.1?±?4.3?ng/mL in pregnant and non-pregnant women, respectively (p?=?0.594). The CPR were 27.8%, 35.0% and 37.8% in <25%, 25%–75% and >75% AMH percentiles, respectively (p?=?0.656). There were also no significant difference in mean FSH and AFC between pregnant and non-pregnant women (p?=?0.484 and p?=?0.165, respectively).

Conclusion: AMH, FSH and AFC are not predictive for CPR in women with PCOS undergoing IVF treatment. Mean AMH values were not significantly different between pregnant and non-pregnant women. Although CRP increased in parallel with the raise in AMH percentiles, this remained insignificant.     

Sentinel lymph node biopsy in endometrial cancer—Feasibility,safety and lymphatic complications

Objective

To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former.

Thirteen years’ experience in fertility preservation for cancer patients after in vitro fertilization and in vitro maturation treatments

Purpose

This study aims to describe the experience and outcomes of in vitro maturation without ovarian stimulation (IVM-FP) and conventional in vitro fertilization after ovarian stimulation (IVF-FP) in a fertility preservation (FP) program for women with cancer.

Methods

Retrospective cohort study from 2003 to 2015 was conducted. The study population consisted of 353 women with cancer who underwent 394 FP cycles (187 IVF-FP cycles and 207 IVM-FP) for oocytes and/or embryos cryopreservation.

Result(s)

Comparatively with IVM-FP, IVF-FP had a higher median [25th–75th percentile] number of oocytes collected—12 [8–18] vs 7 [5–13]; oocytes cryopreserved—10 [6–15] vs 5 [2–8]; and, where applicable, embryos cryopreserved—5 [3–7] vs 3 [2–5] (p?<?0.000001). Following FP treatment, 32 patients (9.0%) died, 18 patients (5.6%) conceived spontaneously, and 23 patients (6.5%) returned to attempt pregnancy with a median lapse of returning of 4.6 [3.1–6.1] years. Of these, cryopreserved oocytes or embryos were used in 33 cycles (19 after IVF-FP and 14 after IVM-FP). Overall, the cumulative pregnancy rate (CPR) was 47.6% (10/21) and the live birth rate (LBR) was 38.1% (8/21). Per cycle, CPR and LBR were 37 and 31% following IVF-FP and 14 and 7% following IVM-FP, although these differences did not reach statistical significance. We report the fourth live birth after IVM-FP in cancer, and the first one after IVM embryo warming resulting from in vivo oocyte retrieval and IVM procedure.

Conclusion(s)

Both IVF-FP and IVM-FP are possible options for FP women with cancer. Due to minimal data regarding ultimate outcomes, further follow-up is needed.

     

The effects of soybean isoflavones and 17β-estradiol in uterus and mammary glands of diabetic rat models

The objective of this study was to evaluate the action of soy isoflavones and 17 beta estradiol on the extracellular matrix in the uterus and mammary gland of diabetic rats. Sixty adult female rats underwent ovariectomy, then randomized into seven groups of ten animals each: Non-diabetic: GI Sham control animals ovariectomized; and GII control ovariectomized that received propylene glycol vehicle. Diabetic: GIII Sham control diabetic animals ovariectomized; GIV ovariectomized diabetic animals receiving propylene glycol vehicle; GV diabetic ovariectomized animals treated with soy isoflavones (150?mg/kg by gavage); GVI ovariectomized diabetic rats treated with estrogen (17b-estradiol, 10?mg/kg, subcutaneously); GVII diabetic ovariectomized animals treated with soy isoflavones (150 mg/kg by gavage), and with estrogen (17b-estradiol, 10 mg/kg combination therapy). Treatments occurred during 30 consecutive days. After animals euthanasia, a portion of the uterus was immersed in liquid nitrogen for molecular biology analysis, the other portion of uterus and mammary glands were removed and processed for paraffin embedding. Soy isoflavones (GV) and 17b estradiol improved the production of compounds of extracellular matrix, such as small leucine-rich proteoglycans (SLRPs). The combination of both therapies had an additive effect in SLRPs expression. Soy isoflavones contribute to the uterine integrity of SLRPs of diabetic rats.     

Simultaneous cul-de-sac and tubal pregnancy following in vitro fertilization

Objective

The aim of this study is to share a valuable experience of heterotopic pregnancy following in vitro fertilization.

Different ovarian response by age in an anti-Müllerian hormone-matched group undergoing in vitro fertilization

Background  

Recently, serum anti-Müllerian hormone (AMH) has been used as a good marker of ovarian response during in vitro fertilization (IVF). However, in the clinical setting, we felt that ovarian response was clearly different by age with the same AMH level. Then in this study we evaluated the relationship between serum AMH, age and parameters related to ovarian response and compared these parameters in regard to age within serum AMH-matched group.     

Labor as a bacteriuric event—assessment and risk factors

Objective. Little is known regarding the prevalence of early postpartum bacteriuria. We sought to evaluate the incidence of bacteriuria following labor and to identify risk factors predisposing to this condition.

Methods. Three hundred and fifty parturients were recruited, 301 were included in the analysis. Women receiving antibiotic drugs during delivery were excluded. Urine cultures were obtained from the study group before delivery and prior to discharge. Data regarding management of labor was collected prospectively.

Results. Positive urine cultures were present on admission in 5.4% of women, whereas 12.9% had a positive urine culture at discharge (p < 0.003). Bacteriuria was acquired during labor in 12.7% of patients who had negative cultures on admission. Escalating number of digital vaginal examinations (p = 0.04), recurrent bladder catheterization (p = 0.05), duration of epidural anesthesia (p = 0.002), and vacuum delivery (p = 0.02) correlated significantly with an increased risk for acquiring bacteriuria.

Conclusion. Labor is a bacteriuric event. Iatrogenic interventions can predispose parturients with sterile urine cultures to postpartum bacteriuria.     

Anti-ovarian antibodies and in vitro fertilization: cause or consequence?

OBJECTIVES: To assess anti-ovarian antibodies (AOA) in serum samples at various times of in vitro fertilization (IVF) attempts to determine whether ovarian stimulation could result in the production of such autoantibodies in women. PATIENTS AND METHODS: Prospective study on 134 patients and 138 IVF cycles using a classical long protocol. For each attempt, four serum samples were obtained, respectively, at the onset of downrelation (S1), end of downregulation (S13), after 7 days of follicular stimulation (S21) and the day of follicular puncture (SP). Five hundred and fifty two samples were tested with an enzyme-linked immunosorbent assay for three isotypes (IgG, IgA, IgM) of AOA. RESULTS: In the whole group, mean concentrations of AOA for each isotype were compared group by group: S1-S13, S1-S21, S1-SP, S13-S21, S13-SP, S21-SP. Not any significant difference was observed whatever the isotype considered. DISCUSSION AND CONCLUSION: This study shows the absence of influence of endogenous or exogenous ovarian stimulation by gonadotropins on anti-ovarian autoimmunity.     

Milk versus TEST-yolk — preincubated sperm; in vitro fertilization outcome

Objective: Preincubation of sperm in TEST-yolk medium enhances in vitro fertilization (IVF) outcome. However preincubation of sperm in milk at 5°C enhances the results of sperm penetration assay and hemizona assay. This study was therefore performed to determine the influence of milk on in vitro fertilization rate of human oocytes, as compared with TEST-yolk medium. Study design: Forty-one consecutive couples undergoing an IVF procedure were randomized. Of these 20 couples were admitted for the milk study (group 1) and 21 couples for the TEST-yolk study (group 2). Each ejaculate was Percoll-processed and the sperm pellet was resuspended in 0.5 ml of culture medium. An equal volume of heat-inactivated homogenized cow's milk (95°C, 10 min) was added to sperm suspension from group 1 and an equal volume of TEST-yolk medium was added to sperm suspension from group 2. After 2 h of incubation at 5°C and washing with culture medium at 37°C, oocytes were inseminated. Oocytes from group 1 couples were inseminated with milk-treated spermatozoa and those from group 2 couples with yolk-treated spermatozoa. Oocytes were evaluated for fertilization after 18 h. Results: Sperm preincubated in milk fertilized 75 out of 100 mature oocytes (75%). TEST-yolk-treated sperm fertilized 45 out of 64 mature oocytes (70%). The difference was not statistically significant. Conclusions: Preincubation of spermatozoa in milk, as compared with preincubation in TEST-yolk medium yields a similar IVF outcome, so milk may be a suitable alternative medium for preincubation of spermatozoa to enhance its fertilizing potential.