TOG - Fertility Preservation Flashcards
To what temperature is ovarian tissue frozen?
-196deg C
liquid nitrogen
move towards vitrification as large water content of oocytes
Which chemotherapy regimes seem to be the most gonadotoxic?
Containing alkylating agents (esp cumulative procarbazine and cyclophosphamide)
What is the rate of premature ovarian insufficiency with chemo containing alkylating agents?
20-85%
What type of radiotherapy is particularly high risk for premature ovarian insufficiency and what is the subsequent pregnancy rate?
Total body radiotherapy pre bone marrow transplant
0.6-11%
What is the genetic bckground of Fragile X?
FMR1 premutation
Unstable CGG sequence mutation on long arm X chromosome
Repeats 55-200 copies - 21% will get POI
Which stimulation regime should be used for women with malignancy?
Short GnRH antagonist cycles > downregulation - shortest time i.e. 2/52
Conventionally at beginning of follicular phase but may need to change as delay in chemo
If oestrogen-dependent tumour - for modified stimulation
Which stimulation regime should be used for women with oestrogen-dependent malignancy?
Modified stimulation protocols using aromatase inhibitors or tamoxifen (in breast tissue) - i.e. cause endogenous FSH surge by causing hypo-oestrogenism
What is the alternative to oocyte retrieval that does not require gonadotrophin stimulation?
In vitro maturation of immature oocytes
What is an option for fertility preservation for pre-pubescent girls or women unwilling to undergo stimulation?
Cyropreservation of ovarian tissue and autologous transplantation
How long does ovarian function return after transplantation?
Heterotopic - 12-18/52
Orthotopic - 8-18/52
What is ovarian transposition?
Surgical removal of ovaries and placement outside of radiation field prior to treatment
However radiotherapy may impair uterine function
What are the fertility sparing surgical options for cervical cancer?
1A1 - cone biopsy
1A2 and small 1B1 disease - trachelectomy
What are the fertility sparing surgical options for ovarian cancer?
Unilateral salpingo-oophorectomy well differentiated 1a and 1b disease
