Endocrine Abstracts

The advances in cancer therapy over the past two decades have led to remarkable improvements in survival rates, but treatments such as chemotherapy, radiotherapy and/or surgery can induce premature ovarian insufficiency (POI) in some circumstances. Fertility preservation (FP) is therefore a key challenge for these women. At diagnosis, all women affected by cancer should benefit from an informed consultation on the threat of compromising their fertility with planned cancer treatment. In case of total body irradiation, pelvic irradiation, bone marrow transplantation and aggressive chemotherapy with high dose of alkylating agents, the risk is considered to be very high. However, only a small fraction of patients is actually referred to specialists to discuss FP prior to cancer treatments. The decision-making process is especially problematic since the long-term effects of cancer treatment have not been fully elucidated. The prevalence of subfertility is nevertheless known to be increased, even when ovarian function is maintained. The main issue is that health care workers are unfamiliar with the rapid advances taking place in FP research and their implementation in clinical practice. The question of FP in Turner syndrome (TS) was recently shared. While some experts still consider the technique experimental in Turner patients, we have always believed that they could be candidates for OTC, as long as there is a reasonable Journal Pre-proof 4 chance of finding primordial follicles in their ovarian tissue. In our opinion, OTC should be performed before puberty (at least before age 12) to avoid depletion of the ovarian reserve as best we can. We also agree with Dunlop et al. and Nadesapillai et al. that young patients should be psychologically prepared for OTC, as they need to make a decision they may not be emotionally or mentally ready for.

Some related references:1. Donnez J, Dolmans MM. Fertility preservation in women. Nat Rev Endocrinol.2013;9:735-49.2. Jadoul P, Dolmans MM, Donnez J. Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed? Hum Reprod Update. 2010;16:617-30.3. Dolmans MM, Donnez J, Cacciottola L. Fertility Preservation: The Challenge of Freezing and Transplanting Ovarian Tissue. Trends Mol Med. 2021 Aug;27(8):777-791.4. Dolmans MM, von Wolff M, Poirot C, Diaz-Garcia C, Cacciottola L, Boissel N, Liebenthron J, Pellicer A, Donnez J, Andersen CY. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers. Fertil Steril. 2021 May;115(5):1102-1115.5. Dolmans MM, Donnez J. Fertility preservation in women for medical and social reasons: Oocytes vs ovarian tissue. Best Pract Res Clin Obstet Gynaecol. 2021 Jan;70:63-80.6. Donnez J, Dolmans MM. Fertility preservation in Turner girls: to do or not to do? Fertil Steril. 2023 Sep 1:S0015-0282(23)01821-6.7. Nadesapillai S, van der Velden J, van der Coelen S, Schleedoorn M, Sedney A, Spath M, Schurink M, Oerlemans A, IntHout J, Beerendonk I, Braat D, Peek R, Fleischer K. TurnerFertility trial: Fertility preservation in young girls with Turner syndrome by freezing ovarian cortex tissue - a prospective intervention study. Fertil Steril. 2023 Aug 5:S0015-0282(23)00727-6.8. Dunlop CE, Jack SA, Telfer EE, Zahra S, Anderson RA. Clinical pregnancy in Turner syndrome following re-implantation of cryopreserved ovarian cortex. J Assist Reprod Genet. 2023 Aug 11.