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.

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.