Prevention and treatment of iatrogenic premature ovarian insufficiency:r interpretation of the first Chinese guideline on ovarian tissue cryopreservation and transplantation

In recent years,with the rapid development of medical research,cancer diagnosis and treatment technology have significantly improved young cancer patient’s survival rate.Anticancer therapy such as chemotherapy,radiotherapy,or hematopoietic stem cell transplantation can lead to premature ovarian insufficiency.The endocrine and reproductive function of the ovary is critical to women’s physical and mental health.Ovarian tissue cryopreservation and transplantation can protect not only female fertility but also preserve ovarian endocrine function.This paper interprets the guidelines for ovarian tissue cryopreservation and transplantation issued by the Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology.The purpose of this guideline’s interpretation is to promote more medical workers to understand the technology of ovarian tissue cryopreservation and transplantation,which can provide patients with more choices of fertility protection methods and improve their quality of life.

Testis tissue cryopreservation may be considered in boys with cryptorchidism

This study assessed the feasibility of testis tissue cryopreservation (TTC) for fertility preservation in prepubescent boys with cryptorchidism. From January 2014 to December 2022, the University Hospital of Copenhagen (Rigshospitalet, Copenhagen, Denmark) implemented TTC for 56 boys with cryptorchidism to preserve their reproductive potential. Testis tissue samples were collected during orchiopexy (32 cases) or at subsequent follow-up procedures (24 cases), necessitated by an increased risk of infertility as indicated by hormonal assessments and/or findings from initial surgical biopsies. Testis samples were procured for TTC and pathological analysis. The cohort had an average age of 1.3 (range: 0.3–3.8) years at the time of orchiopexy, with 91.1% presenting bilateral cryptorchidism. The study revealed a median germ cell count of 0.39 (range: 0–2.88) per seminiferous tubule, with germ cells detected in 98.0% of the bilateral biopsies and 100% of the unilateral, indicating a substantial potential for fertility in these immature tissues. A dark spermatogonia (Ad) was detected in 37 out of 56 patients evaluated, with a median Ad spermatogonia count of 0.027 (range: 0.002–0.158) per seminiferous tubule. A total of 30.2% of the samples lacked Ad spermatogonia, indicative of potential gonadotrophin insufficiency. The median hormone levels measured were as follows: follicle-stimulating hormone (FSH) at 0.69 (range: 0.16–2.5) U l−1, luteinizing hormone (LH) at 0.21 (range: 0.05–3.86) U l−1, and inhibin B at 126 (range: 17–300) pg ml−1. Despite early orchiopexy, 20%–25% of boys with cryptorchidism remain at risk for future infertility, substantiating the necessity of TTC as a precaution. The study highlights the need for refined predictive techniques to identify boys at higher risk of future infertility.

Assessing fertility preservation strategies: A scoping review

Objective:To describe the various options available for preserving female and/or male fertility,taking into account both social and medical aspects,and to identify the effects of different natural products on male infertility extracted from plants.Methods:We reviewed the literature and included full-text publications in English provided by international biomedical databases,including Sciences Direct,Google Scholar,OVID,PubMed,and MEDLINE between 2016 and 2023.Search terms,such as fertility preservation,in vitro maturation,cryopreservation,plants for the treatment of male infertility,were taken from Medical Subject Headings(MeSH)and Boolean operators were used to improve sensitivity.Results:112 papers were identified in the initial search,of which 18 were excluded due to duplication.After reviewing titles and abstracts,70 papers were finally included.The main findings of this study are presented under three key themes:gametogenesis,fertility preservation techniques,and plant-based alternatives.Regarding gametogenesis,significant progress has been made in understanding oocyte and sperm maturation,with optimized conditions improving maturation rates and motility.For fertility preservation,techniques such as rescue in vitro maturation and cryopreservation have shown the enhanced outcomes,particularly in maintaining gamete quality.Lastly,plant-based alternatives,including extracts and essential oils,have demonstrated potential in reducing oxidative stress,improving sperm motility,and supporting oocyte development,thus providing a promising complementary approach to conventional methods.Conclusions:Fertility preservation is achieved in a variety of ways,including oocyte and embryo vitrification and sperm cryopreservation,and the use of plant-based treatment of male infertility.

Female Fertility： Is it Safe to Freeze.

Objective： To evaluate the safety and risk of cryopreservation in female fertility preservation. Data sources： The data analyzed in this review were the English articles from 1980 to 2013 from journal databases, primarily PubMed and Google scholar. The criteria used in the literature search show as tbllowing： （ 1 ） human; embryo; cryopreservation/freezing/vitrification, （2） human; oocyte/immature oocyte; cryopreservation/freezing/vitrification, （3） human; ovarian tissue transplantation; cryopreservation/ freezing/vitrification, （4） human; aneuploidy/DNA damage/epigenetic; cryopreservation/freezing/vitrification, and （5） human; fertility preservation; maternal age. Study selection： The risk ratios based on survival rate, maturation rate, fertilization rate, cleavage rate, implantation rate. pregnancy rate. and clinical risk rate were acquired from relevant meta-analysis studies. These studies included randomized controlled trials or studies with one of tile primary outcome measures covering cryopreservation of human mature oocytes, embryos, and ovarian tissues within the last 7 years （from 2006 to 2013. since the pregnancy rates of oocyte vitrification were significantly increased due to the improved techniques）. The data involving immature oocyte cryopreservation obtained from individual studies was also reviewed by the at, thors. Results： Vitrifications of mature oocytes and embryos obtained better clinical outcomes and did not increase the risks of DNA damage, spindle configuration, embryonic aneuploidy, and genomic imprinting as compared with fresh and slow-freezing procedures, respectively. Conclusions： Both embryo and oocyte vitrifications are safe applications in female fertility preservation.

Chinese expert consensus on clinical practice of female fertility preservation

Many female fertility preservation-related technologies have recently been developed in response to increasing demand for such treatments. To establish standard practices of female fertility preservation in China, the Chinese Maternal and Child Health Association Affiliated Fertility Preservation Professional Committee assembled specialists to construct a consensus, referring to the current clinical guidelines of some countries combined with clinical practice and expert opinions. The consensus includes two parts: (1) indications for female fertility preservation and related techniques, in which we sought to be inclusive regarding the indications for fertility preservation;and (2) practical guidance for the clinical application of the female fertility preservation technologies.

Fertility Preservation in Cancer Patients

Traditional radiotherapy and chemotherapy often cause irreversible damage to the fertility and endocrine function of cancer patients.The current methods of fertility preservation include freezing the sperms of adult and adolescent males after puberty;freezing the embryos,oocytes,and ovarian tissue of females;and drug intervention and fertility preservation surgery.This article reviews fertility preservation in cancer patients with respect to current methods,indications,and some more recently developed methods that remain under investigation.