Fertility preservation options are important for cancer patients of reproductive age undergoing treatment. For women, established options include embryo freezing for married patients and oocyte freezing for single patients, both of which require delaying cancer treatment. Ovarian tissue freezing can be done at any age or relationship status and does not delay treatment, but reimplantation success is currently low. For pre-pubertal patients, ovarian tissue or testicular tissue freezing are the only available options. Future methods may allow in vitro gamete maturation or stem cell derived gametes. Multidisciplinary care and individualized counseling are key to help patients preserve their fertility whenever possible before 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.
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.
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
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
Increase incidence of cancer during the reproductive age. Survival and cure rates of cancer are improving. Resulting in Increasing demand for fertility preserving interventions.
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.
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
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
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
ICSI as it is presently performed is far from an ideal solution because the selection of sperm is based on the judgement of an embryologist, who is looking for the most normal appearing sperm available.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
Traditional embryo evaluation systems are simple, non-invasive, cost-effective & mainstay in majority of IVF laboratories. Embryo selection based on combinations of morphology scores at different stages of embryonic development with time may be more effective
It was while performing SUZI that a single spermatozoon accidentally penetrated into the oolemma and provided the hint that a direct sperm injection would be more efficient.
1st successful birth by ICSI took place on Jan 14, 1992.
ICSI as it is presently performed is far from an ideal solution because the selection of sperm is based on the judgement of an embryologist, who is looking for the most normal appearing sperm available.
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.
IVF will remain the solution for infertile couples. But its future will dramatically be directed to fertile couples !!!! This talk will discuss these issues
SHARE, in partnership with Reproductive Medicine Associates of NY, FORCE, and Sharsheret, hold a presentation on fertility and family planning for patients recently diagnosed with cancer and those who are predisposed to hereditary cancer syndromes due to a genetic mutation. The presenter, Dr. Matthew Lederman, is a board-certified reproductive endocrinologist and infertility specialist.
For information of chronic disease
. very common these days and required early detection and cure.
for education purpose
.this is simplify version of very important but complex topic .
This is only prevented by early detection and cure .
By identifying red flags of disease first we can detect high group .by targeting high risk group we will be able to detect and treat disease with less resources.
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
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..!!!
Individualized ovarian stimulation protocols in IVF (1).pptxRaju Nair
Explaining the best protocol for ivf stimulation. How we can optimize the stimulation regimen to get adequate response and there by healthy baby is a challenge
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Francesca Gottschalk - How can education support child empowerment.pptx
Fertility preservation 3
1. Fertility Preservation
in Cancer Patients
Dr. Khaled R Darhouse, MRCOG
Consultant Obstetrician & Gynaecologist
Reproductive Medicine & Assisted Conception
King Abdulaziz University Hospital
Jeddah – Saudi Arabia
2. The Gonads
• The primary function of both ovaries and
testis is REPRODUCTION
• Reproduction is the passage of parental
genetic material onto the next generation
3. Life Expectancy
• In 1900 the average life expectancy of men
was 46.3 years and of women was 48.3 years.
• At the turn of the millennium men now expect
to live to be 73.8 and women to be 79.5 years
old.
• In a hundred years life expectancy has nearly
doubled.
5. Longer life
• The longer the people live the more they’ll
expect to get cancer.
• Advantages in cancer treatment over the past
two decades have led to remarkable
improvements in survival rates.
• Indeed, during the past 5 years, the overall
death rates from cancer have fallen by more
than 1.6% per year.
6. General Fertility Preservation
• Women are increasingly postponing
childbearing to later in life for social,
career or financial reasons
• Incidence of most cancers increase with age
7. Cancer Fertility Preservation
• In women, ~10% of cancers occur in those <45
years old. Chemotherapy, radiotherapy and
bone marrow transplantation can cure >90%
of girls and young women with diseases that
require such treatments.
• However, these treatments can result in
premature ovarian failure, depending on the
follicular reserve, the age of the patient and
the type and dose of drugs used.
10. Cure for Children but at a Cost
• Sustain and improve survival rates
• Minimise late effects
• Treatment is in conflict with normal childhood
growth and development
11. Risk Assessment for Fertility
Preservation
• Intrinsic Factors
• Health status of the patient
• Consent of patient or parents
• Assessment of ovarian reserve
• Extrinsic Factors
• Nature of planned treatment
• Available time
• Availability of expertise
Wallace H, Critchley H and Anderson R JCO
2012
13. Infertility Risk Factors
• Radiotherapy
• Irradiation of field of ovaries or testis
• Total body irradiation
• Chemotherapy
• Busulphan
• Cyclophosphamide
• Melphalan
• Mustine
• Procarbazine
14. Gonadotoxicity
Presentation Copyright: Dr. Khaled R Darhouse
Cytotoxic agents according to the degree of gonadotoxicity
High risk Intermediate risk Low/no risk
Cyclophosphamide Doxorubicin Methotrexate
Busulfan Cisplatin Bleomycin
Melphalan Carboplatin 5-Fluorouracil
Chlorambucil Actinomycin-D
Dacarbazine Mercaptopurine
Procarbazine Vincristine
Ifosfamide
Thiotepa
Nitrogen mustard
Reference: Lobo R; N Engl J Med2005 353,64–73.
20. Effect and mean ovarian sterilizing
doses of radiotherapy at increasing age
• On a 7 years old 19 Gy
are needed to
completely deplete the
primordial follicle and
sterilize the patient
• At the age of 42 only 11
Gy are needed to
render the patient
sterile
Wallace H et al IJRBP (2005)
22. Uterine function after
cancer treatment
• Uterine damage, manifest by impaired growth
and blood flow, is likely a consequence of
pelvic irradiation.
• Uterine volume correlates with age at
irradiation.
• Exposure to pelvic irradiation is associated
with increased miscarriage, mid-trimester
pregnancy loss, preterm labour low birth
weight and post-partum haemorrhage.
23. Sex Hormone Therapy for Childhood
Cancer Survivors
• The most appropriate dose and route of
administration of sex hormone replacement to
young women with ovarian failure after pelvic
irradiation that provides adequate
concentrations of oestrogen to ensure optimal
uterine growth during adolescence has not yet
been established
25. OPTIONS OF FERTILITY PRESERVATION
• In pre-pubertal men testicular tissue
cryopreservation is experimental, but is the
only option currently available
• Sperm cryopreservation is a well established
and successful method routinely used.
27. OPTIONS OF FERTILITY PRESERVATION
• Ovarian function suppression
• Oral contraceptive pills
• GnRHa
• Embryo cryopreservation
• Well-established with good success
• Married
• Post-pubertal
• Delay in cancer treatment
• Legal issues
28. OPTIONS OF FERTILITY PRESERVATION
• Oocyte cryopreservation
• Mature oocytes
• Immature oocytes with IVM
• Post-pubertal
• Delay in cancer treatment
• Ovarian tissue cryopreservation
• Pre-pubertal / Post-pubertal
• No delay in cancer treatment
• Expertise
29. Mature Oocyte Cryopreservation
• Need for a stimulated cycle
• Tailored stimulation protocols
• GnRHa trigger
• Should not delay chemo/radiotherapy
• Disastrous consequences with complications
• Harvest of good quality oocytes should be
expected
• Not recommended after chemotherapy is
initiated
30. Mature Oocyte Cryopreservation
• Survival rate of vitrified oocytes is now
approximately 96.9%
• Pregnancy rates after oocyte vitrification
• 10 oocytes = 40%
• 12 oocytes = 60%
• 20 oocytes = 90%
31. Ovarian Tissue Cryopreservation
• Percentage of patients undergoing OTC:
• 96.2% of patients were < 35 years
• 52.5% of patients were < 24 years
• 17.2% of patients were < 14 years
32. Ovarian Tissue Cryopreservation
• Harvesting by laparotomy or laparoscopy
• How much of the ovarian cortex should be
removed?
• Size and thickness of cortical strips
• Cellular injury and damage
• Hypoxia
• Dehydration
• Freezing
• Slow freezing or vitrification?
33. Ovarian Tissue Cryopreservation
• Re-implantation could be either orthotopic or
hetrotopic
• More than 50% of primordial follicles are lost
due to hypoxia
• Thawing process injury
• High FSH and low AMH deplete surviving
primordial follicles
39. Ovarian Tissue Cryopreservation
• It is unknown how many cases of
reimplantation were carried out throughout
the world
• In a series of 60 reported cases the live birth
rate is 23%
• Young children are the ideal candidates
• No pregnancies reported following the
reimplanation of ovarain tissue harvested pre-
pubertally
40. The Future
• In vitro follicular maturation after ovarian
tissue culture
• Isolated primordial follicle culture in the lab
• Artificial ovaries
41. The Future
• Stem cell gamete production
• Experimental success in producing both eggs and
sperms
• Successful in producing normal and fertile mice
• Must pass rigorous testing
• Might be available in at least 10 years
• Lyophilization and Freeze-Drying
• Eggs
• Sperms
• Embryos
42. Conclusion
• Fertility preservation has become an
established branch of reproductive medicine.
• Multidisciplinary team approach and
individualisation of cases are key to its
success.
• Fertility preservation should be discussed with
men and women in the fertile age group who
are about to embark in cancer treatment
43. Conclusion
• Fertility preservation gives hope in future
reproduction and hope of a life after cancer.
• Embryo freezing is most successful method to
date.
• For prepubertal men and women gonadal
tissue freezing is the only available method
availlable.
• Many new promising methods wil be available
in the near future.
44. Thank You
Dr. Khaled R Darhouse, MRCOG
Consultant Obstetrician & Gynaecologist
Reproductive Medicine & Assisted Conception
King Abdulaziz University Hospital
Jeddah – Saudi Arabia
