This document discusses fertility preservation options for cancer patients. It notes that chemotherapy and radiation can damage fertility, but fertility preservation techniques exist to help mitigate this, including freezing eggs, sperm, ovarian tissue or testicular tissue. It recommends that oncologists discuss these options proactively with patients to give them hope for biological children after cancer. Specific techniques are described such as in vitro fertilization with eggs or sperm frozen before treatment. Referral to fertility specialists is advised so patients can explore preservation options before starting cancer treatment.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
SHARE Presentation: Having Children after Cancerbkling
Dr. Diana Chavkin, Reproductive Endocrinology and Infertility (REI) specialist at Genesis Fertility and Reproductive Medicine, made this presentation at SHARE about fertility preservation options before and after cancer treatment.
If you'd like to hear the audio, visit www.sharecancersupport.org/chavkin
The information in this presentation is not intended to be a substitute for professional medical advice, diagnosis or treatment. The presentation was given on May 15, 2014.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Cancer survivors are increasing because of advances in early detection and treatment options. Fertility preservation in cancer patients gives hope to have a family later in life. Spread the awareness about fertility preservation to fulfill the dream of parenthood..!!!
May occur very early on during the attachment or migration stages (No objective evidence e.g. –ve hCG)
May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
Coughlan et al. suggest a more complete working definition taking into account maternal age, number of embryos transferred, and number of cycles completed.
They define RIF as the failure of clinical pregnancy after 4 good quality embryo transfers, with at least three fresh or frozen IVF cycles, and in women under the age of 40
RIF is a complex problem with a wide variety of etiologies / mechanisms/ treatment options.
Recommendations vary depending on the source of their problem. Perhaps the best and yet most complex answer is personalized medicine, a personal approach to each patient depending on her unique set of characteristics.
It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
Predictive Factors influencing pregnancy rate after intrauterine inseminationDrRokeyaBegum
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
SHARE Presentation: Having Children after Cancerbkling
Dr. Diana Chavkin, Reproductive Endocrinology and Infertility (REI) specialist at Genesis Fertility and Reproductive Medicine, made this presentation at SHARE about fertility preservation options before and after cancer treatment.
If you'd like to hear the audio, visit www.sharecancersupport.org/chavkin
The information in this presentation is not intended to be a substitute for professional medical advice, diagnosis or treatment. The presentation was given on May 15, 2014.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Cancer survivors are increasing because of advances in early detection and treatment options. Fertility preservation in cancer patients gives hope to have a family later in life. Spread the awareness about fertility preservation to fulfill the dream of parenthood..!!!
May occur very early on during the attachment or migration stages (No objective evidence e.g. –ve hCG)
May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
Coughlan et al. suggest a more complete working definition taking into account maternal age, number of embryos transferred, and number of cycles completed.
They define RIF as the failure of clinical pregnancy after 4 good quality embryo transfers, with at least three fresh or frozen IVF cycles, and in women under the age of 40
RIF is a complex problem with a wide variety of etiologies / mechanisms/ treatment options.
Recommendations vary depending on the source of their problem. Perhaps the best and yet most complex answer is personalized medicine, a personal approach to each patient depending on her unique set of characteristics.
It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
Predictive Factors influencing pregnancy rate after intrauterine inseminationDrRokeyaBegum
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
Which type of Gonadotrophins should we use for ovarian stimulation in IVF?Hesham Al-Inany
There are many types of gonadotropins: some are recombinant , others are urinary derived. some contain LH like activity , others do not. which to use?? many research with conflicting results but the final word came from Cochrane mega- systematic review. This talk will illustrate this issue
Since the birth of Louise Brown, the first baby born through in vitro fertilization, in 1978, assisted reproductive technology has advanced significantly. The success rate of in vitro fertilization (IVF) has risen dramatically over the last four decades as a result of developments in incubation methods, micromanipulation technology, and a general understanding of assisted reproduction.
Understanding the Frozen Embryo Transfer Procedure: A Comprehensive GuideSCI IVF Hospital
The prospective mother’s ovaries are artificially stimulated in new IVF rounds to generate a larger number of mature eggs. The eggs are then extracted via a process known as a follicular puncture or ovum pick-up (OPU) and then fertilized in the lab using the husband’s or donor sperm. Here is a list of frozen embryo transfer tips to improve your success rate of embryo transfer.
IVF failure can be heartbreaking for both patients and doctors. This presentation discusses what you can learn from a failed IVF cycle, to maximise chances of success in the next IVF cycle
Mark Perloe, MD Atlanta, 404-843-2229 Learn about the factors that can adversely affect fertility and the tests that can help pinpoint problems. Fertility treatment options including IVF and other high tech options are presented.
In vitro fertilization (IVF) is a type of assistive reproductive technology (ART). It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo.
Conceiving Dreams_ The Journey at Kanpur’s IVF Clinics.pdfCrysta IVF
We are your trustworthy companion as you approach parenthood! Being the best IVF facility in Delhi, we're committed to supporting you in realizing your goal of becoming a parent. We are here to help, whether you need IUI, IVF, or ICSI. We provide a variety of reproductive treatments at Crysta, and customized plans for infertility in both men and women. We also offer donation programs and complete gynecological care.
IVF Treatment in India: IVF is Like a Beam of Hope for Infertile PupilMedMonks
IVF Treatment: Infertility means the inability of couple (due to male or female partner or both) to be able to conceive after having regular unprotected intercourse.
Fertility preservation involves freezing your eggs, sperm, embryos or reproductive tissue so that you can hopefully have a biological family in the future. Therefore, it is essential to preserve your fertility if you are diagnosed by any serious disease like Cancer. Here are some tips on Fertility Preservation by IVF Jindal Chandigarh.
Due to everyday changing lifestyle, many couples suffers from infertility issues and as a solution to this stem cells therapy comes up in the front line.Know more in detail about infertility and application of stem cells.
In vitro fertilization (IVF) is the process of fertilizing an egg with sperm outside the body in a
laboratory setting and then implanting and developing the embryo in the woman's uterus, where it
will implant and grow into a baby.
Understanding the benefits & risks of ivf treatmentivfmeerut
One of the effective treatment that involved in infertility treatment is IVF that is In Vitro Fertilization. This is a kind of assisted reproductive technology and gestational surrogacy.
To know more visit https://meerutivf.com/
Here's a collection of some of my LinkedIn Posts on the Coronavirus Pandemic.
I don't claim to be an expert - but do try to think logically as a doctor, and use my common sense to reason !
How MICE ( Medical Innovation, Creativity , Innovation and Entrepreneurship) labs is helping medical students to think out of the box at JJ Hospital by allowing them to tinker
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Doctor, will I be able to have a baby ? Fertility after cancer
1. Doctor, will I be able toDoctor, will I be able to
have a baby ?have a baby ?
Life after cancerLife after cancer
Dr Aniruddha Malpani
www.drmalpani.com
2. The child with cancerThe child with cancer
Early diagnosis, because of
better awareness and better
imaging techniques, means the
diagnosis is being made more
often
Newer treatment protocols
translates into more effective
treatment and better survival
4. IVF specialists are seeingIVF specialists are seeing
two types of childhoodtwo types of childhood
cancer patients:cancer patients:
Newly diagnosed
patients ;
and
Long-term survivors.
6. Doctor, why didn’t you tell me toDoctor, why didn’t you tell me to
freeze my eggs / sperm ?freeze my eggs / sperm ?
This is a question your survivors
will ask you when their cancer is
treated and they come for a 5-
year followup
How will you answer ?
You will have wasted their
golden opportunity
7. Think of the future as well !Think of the future as well !
Many young cancer survivors
feel they received inadequate
information on their fertility
preservation options.
Fertility preservation gives
patients hope for a high
quality life after cancer
Please discuss this proactively
8. Newly diagnosed patientsNewly diagnosed patients
Need to cope with diagnosis of a
life-threatening disease.
Significant shock and emotional
distress
Shortened “window of
opportunity” for treatment. Time
is of the essence.
Please refer as soon as possible !
9. Newly diagnosed patientNewly diagnosed patient
Your major focus is to design
the best treatment plan. You
have lots of things to do
Establish a diagnosis
Stage the disease
Select the best protocol
Refer to a medical oncologist
Refer to a radiation therapist
Refer to a support groups
Discuss costs
10. Refer toRefer to
Specialty multi-disciplinary clinic for
a second opinion ?
Surgical oncologist for staging?
Medical oncologist for
chemotherapy ?
Radiation therapist ?
Please also refer to IVF specialist for
fertility preservation !
11. You have cancer !You have cancer !
You need to discuss many
emotionally-charged topics
Cancer-related infertility and
fertility preservation also need to
be discussed because you can
take proactive steps toward
preserving their fertility
Their future ability to have
children will significantly improve
their quality of life.
12.
13. Having babies enhances qualityHaving babies enhances quality
of life for survivorsof life for survivors
Many cancer survivors
have a strong urge
to have a family.
Their brush with
death makes them
better parents
14. Cancer-related InfertilityCancer-related Infertility
Chemotherapy and pelvic radiation
compromise future fertility
More powerful drugs = better
survival and more infertility
Infertility is a source of long-term
distress in survivors –
especially if this
could have been
prevented !
16. The two things every pediatricThe two things every pediatric
oncologist needs to knowoncologist needs to know
about fertilityabout fertility
Chemotherapy and pelvic
radiotherapy damages gonadal
reserve and can cause
infertility
Fertility preservation
techniques can help to
mitigate this damage
17. Dramatic improvements inDramatic improvements in
preserving fertilitypreserving fertility
Take proactive steps to preserve
fertility before initiating cytotoxic
therapy. Decisions should be made
as early as possible. Even one dose of
chemo can impair fertility
We can freeze
◦ Eggs
◦ Sperm
◦ Ovarian tissue
◦ Testicular tissue
18. Sperm preservationSperm preservation
Should be routine for all
postpubertal boys
Touchy topic. Needs to be discussed
proactively
Easy to freeze sperm
Major expense is the storage cost
( over many years)
Sperm can only be used for ICSI –
they are worth their weight in gold !
19. Testicular tissue preservationTesticular tissue preservation
Option for prepubertal boys
Still experimental
In vitro sperm maturation –
hope for the future
Technology will evolve and
improve over time
21. Ovarian tissue preservationOvarian tissue preservation
Ovarian tissue freezing for
prepubertal girls
Much more complex and
expensive
Still experimental
Refer to specialty center
22. Following hormonal stimulation, oocytes are aspirated
directly from the ovaries, using ultrasound guidance.
About 10-15 oocytes are retrieved (which typically
produces 5-6 high quality embryos)
24. VitrificationVitrification
New technology- fast freezing of
vitrification. Much better results
• Fast freezing prevents ice crystal
formation that can damage DNA
No increase in congenital
anomalies compared with
naturally conceived infants.
25.
26.
27.
28.
29.
30. Cryopreservation of OvarianCryopreservation of Ovarian
Cortical TissueCortical Tissue
Experimental. May be only
option for prepubertal patients
Summary of procedure:
◦ Retrieve ovarian tissue by
laproscopy
◦ Freeze strips of ovarian cortical
tissue ( contains primordial
follicles)
◦ Later, reimplant tissue; hip, arm
◦ Or graft ovarian tissue onto
the remaining ovary
31. Cryopreservation of OvarianCryopreservation of Ovarian
Cortical TissueCortical Tissue
Advantages: no hormonal
stimulation, no time delay
Disadvantages:
◦ Experimental procedure; few live
births
◦ 25% follicles die because of initial
ischemia
◦ Concern for reimplantation of
cancer cells with ovarian tissue
implantation (not suitable if there
may be metastases in the ovaries)
32.
33. Retrieval and In Vitro MaturationRetrieval and In Vitro Maturation
( IVM) of Immature Oocytes( IVM) of Immature Oocytes
Another option might include
aspiration of immature oocytes from
the small “antral” follicles of the
ovary with maturation of these
oocytes in a laboratory setting in the
future.
35. Referrals to IVF specialistReferrals to IVF specialist
Oncologists should refer interested
patients to reproductive specialists as
soon as possible
Pretreatment fertility counseling and
fertility preservation improves quality of
life.
“ Losing my hair would be temporary,
but losing my ability to have children
would be permanent and devastating.”
36. Hope for the futureHope for the future
In vitro gametogenesis
Using stem cells for
generating gametes in vitro
39. FAQsFAQs
Should survivors be tested for their
fertility once they become adults ?
Should they tell their prospective
spouses about the possibility of their
fertility being reduced ?
Does pregnancy increase the risk of
cancer recurrence?
40. FAQsFAQs
Is it safe to delay the chemo ?
Does egg/tissue freezing really work?
What are the success rates of each
treatment? How many babies have
been born?
What is the safety of fertility
treatments (especially for hormone
sensitive cancers)?
41. FAQsFAQs
How long can the eggs/ sperm be
stored ?
What happens if the patient dies?
How much do the treatments cost?
Insurance coverage? Financial
assistance?
What is the birth defect rate of
children born to cancer survivors?
42.
43. Please protect your patient’sPlease protect your patient’s
fertility !fertility !
Editor's Notes
1) Women who undergo chemotherapy or radiation during their reproductive years face a 40-80% chance of losing their fertility, and male cancer patients have a 30-75% risk. The actual risk depends on patient age and quantity and type of cancer therapy. (Quinn 2007)
2) **Include statistic from study about survivors not remembering discussing risk of infertility and fertility preservation before therapy
McShane script: Prior to consideration of fertility preservation, it is useful to review the basic requirements for conception. These include viable sperm, reasonable oocyte (egg) quality, and a normal endometrial cavity which can gestate the pregnancy. The normal semen analysis per WHO standards is 20 million/cc with a volume of 1-5 cc’s, 50% or greater motility, and 40% normal forms. However, it is certainly possible to achieve pregnancy with lesser sperm quality although assisted reproduction may be required.
Additional Notes:
Woodruff: The time required for oocyte maturation with ovulation induction is generally about 2 weeks from the onset of menses. Hence, if the decision to undergo conventional IVF and embryo freezing is made much after day 3 of the menstrual cycle, the day of menstrual cycle by when ovulation induction is usually initiated, the patient will have to wait until the onset of the next menstrual period prior to initiating ovulation induction.
ASCO Guidelines: “There are little human data available for the newer agents such as taxanes.
McShane script: The foundation of successful IVF is the recruitment of multiple oocytes since human reproduction is inherently inefficient. The goal of an IVF cycle is usually retrieval of 10 or 15 oocytes which results in the generation of 3 to 5 good quality embryos after insemination and culture.
McShane Script: If the patient does not have a male partner or if she desires to cryopreserve her oocytes rather than embryos, oocyte preservation via vitrification has become a viable alternative in recent years. The classicial approach to embryo cryopreservation did not work well for oocytes but fortunately, a newer approach has evolved in the last several years which appears to be very viable and can be used for social indications or oocyte donation as well as oncofertility. To generate multiple oocytes for retrieval, the time requirement and the time within the menstrual cycle are the same as for an IVF cycle. The risks short term of the stimulation, retrieval and possible ovarian hyperstimulation syndrome are the same. Given that vitrification is a newer procedure, the risk to the offspring at this time is relatively unknown.
Additional Notes:
Kim: “Vitrification is a solidification of liquid by an extreme elevation in viscosity while rapid cooling takes place and eliminates ice crystal formation and growth”
Dr. Kondapolli: oocyte turned into glass
Jensen: “Recent technological advances have now improved oocyte cryopreservation such that oocytes can survive the freezing or vitrification process approximately 50% to 60% of the time, with fertilization rates of 60% to 70% with use of intracytoplasmic sperm injection.
McShane Script: Cryopreservation of ovarian cortical tissue which would require a laparoscopic approach is an experimental process. This could be done immediately, independent of the woman’s menstrual cycle but does involve the risk of laparoscopy and general anesthesia. The ultimate replacement of the cortical strips or maturation of the oocytes from the cortical strips after thawing has been successful in a small number of cases worldwide.
**To what detail should we describe these procedures?
ASCO Guidelines: “ To offset this relatively large loss [due to ischemia], typically the cortex from an entire ovary is cryopreserved in adults.”
“Ovarian cryopreservation and transplantation procedures should only be performed in centers with the necessary expertise under IRB-approved protocols that include follow-up for recurrent cancer.
In ovarian cortical tissue cryopreservation,
Basic steps…..
Additional Notes:
Woodruff: “Freezing sections of ovarian cortex or freezing wither mature or immature oocytes, still have more limited availability, though with time and increased interest in these techniques both success and availability will increase.”
**Include this topic briefly or no?
To discuss with this slide:
Assess uterus and hormones. Goal: mature endometrium
Not all embryos and oocytes survive thaw
Embryos and oocytes graded for quality
Implantation rate per embryo a bit lower than fresh embryos
Oocytes?
Studies indicate no higher rate of birth defects
But greater risk for low birth rate (other greater risks?)
Additional notes:
Woodruff: “At the time of the patient’s choosing, embryos can be thawed and transferred into either the patient’s own uterus, providing that her uterus is viable for pregnancy, or that of another woman (gestational surrogate).