FP

Question 1

indications for FP

Answer 1

Oncologic disease
Non-oncologic disease (SLE, Endometriosis, POI)
Social Reasons

Question 2

MOA ovarian destruction

Answer 2

1) alkylating agents that may directly deplete follicular pool.

2) Vascular toxicity may mediate end-organ (i.e. ovarian) damage and has been illustrated in anthracycline-treated mice by live high-resolution imaging.

3) Direct cellular effects on various components:

taxane - cytoskeleton
anthracyclin/platinum - DNA, oxidative stress

Question 2

deadliest chemo

Answer 2

alkylating agent - cyclophosphamide

Anthracycline chemotherapy medicines are:Adriamycin (chemical name: doxorubicin)

Taxane: paclitaxel, docetaxel, cabazitaxel, and abraxane.

Question 3

risk of gonadotoxicity

Answer 3

chemotherapy
radiotherapy
surgery
disease itself

Question 4

edinburgh criteria

Answer 4

<35
realistic survival after 5 years
high risk for POI
no chemo after 15 or mild chemo but less than 15yo
informed consent
no sti
not pregnant and no children

Question 4

modified edinburgh

Answer 4

reproductive
high risk of POI
ovarian reserve

primary disease aspects
no ovarian CA/with a remaining ovary
intact uterus
no abdominal tumor
in remission

safety aspects
primary physician knows
realistic 5 yr survival rate
informed consent
not frail or can withstand surgery
psychologically ok

Question 4

high risk for reseeding ca

Answer 4

leukemia
neuroblastoma
burkitts lymphoma
ovaCA

Question 5

ovarian transposition location

Answer 5

lower paracolic gutters
anterior to psoas muscle
intrabdominal paracolic gutters

Question 6

complications of ovarian transposition

Answer 6

cyst formation
abdominal pain
bleeding/hemorrhage
tubal ligation
ischemia

Question 7

GnRHa MOA

Answer 7

dec ovarian blood supply –> dec gonadotoxic effects reaching ovary

pre-pubertal state/not actively dividing/ HPO axis off

direct effect to ovary

Question 8

ovarian radiation cut off doses

Answer 8

18.4 Gy at 10 years
16.5 Gy at 20 years
14.3 Gy at 30 years

sa speroff 2Gy >50% sira and 6Gy sure deads

sa boys >6Gy impaired spermatogenesis na

Question 9

Advantages of OTC

Answer 9

Cycle independent procedure
No male partner needed
No stimulation/hormones needed
No exposure to hormones for those with hormone-sensitive tumors
No treatment delay
Numerous follicles preserved vs finite oocytes in OPU

Question 10

Disadvantage of oocyte/embryo cryopreservation

Answer 10

Cycle dependent procedure male partner needed
COS with risk of OHSS treatment delay
Exposure to hormones for those with hormone-sensitive tumors
Finite # of follicles preserved

Question 11

Process of otc

Answer 11

Retrieve ovary
Get cortex
Freeze and store
Thaw
Transplant (orthotopic v heterotopic)

Question 12

Process of otc

Answer 12

Retrieve ovary
Get cortex
Freeze and store
Thaw
Transplant (orthotopic v heterotopic)

Question 13

High risk for tx induced amenorrhea (>80%)

Answer 13

Cyclophosphamide for breast ca > 40

Conditioning for stem cell transplant OR TBI in hema disease

Abdominal and pelvic radiation (as in gyne cancers)