ART/IVF and cryopreservation
Michael von Wolff
IVF and ICSI are fully established methods of assisted reproduction which can be used for patients awaiting cytotoxic therapy:
Following the data of the German, Swiss and Austrian network Fertiprotekt (www.fertiprotekt.eu), 164 of 1388 counselled patients have chosen ovarian stimulation and cryopreservation of oocytes as a fertility preservation technique in 20072009. Among those patients 2417 oocytes were collected (Mean: 11.8, Range 041, STD 7.3). In 125 patients oocytes were fertilized and cryopreserved, resulting in an fertilisation rate of 70.5%/aspirated oocyte. Only in one patient, chemotherapy needed to be postponed due to severe ovarian hyperstimulation syndrome.
These data reveal that ovarian stimulation can result in adequate numbers of oocytes. However, they also demonstrate, that this technique is not successful in all patients. Combination with cryopreservation of ovarian tissue should therefore be considered. FertiPROTEKT performed a study in which 50% of one ovary was removed by laparoscopy in 12 patients. Patients received ovarian stimulation around 2 days after the operation. The number of oocytes was on average 12.1 and the fertilization rate 77.1% in comparison to an unoperated control group with 28 patients (13.1 respectively 60.6%). As none complications occurred, this technique can yield a high chance for a later pregnancy due to the combination of both therapies.
Finally, ovarian stimulation can easily be performed in breast cancer and hodgkins lymphoma patients due to the time frame until the onset of the chemotherapy. Ovarian stimulation can be performed in all patients within only 2 weeks if patients receive gonadotropin antagonists in parallel with recombinant FSH, as demonstrated in 12 patients treated in the network Fertiprotekt (Wolff et al. Fertil Steril 2009 92 13601365).