 |
|
New ovarian stimulation technique offers more cancer patients the chance to preserve their fertility
July 08, 2008Researchers have shown for the first time that it is possible to stimulate a woman's ovaries to produce eggs for collection during the final phase of the menstrual cycle. The finding offers the chance for more women who have been diagnosed with cancer to restore their fertility following chemotherapy or radiotherapy - cancer treatments that can seriously damage the ovaries, often permanently. The findings were presented at the 24th annual meeting of the European Society of Human Reproduction and Embryology in Barcelona today (Monday).
At present, women who have been diagnosed with cancer may want to have some of their eggs collected and frozen in order to give them an opportunity of having children once their cancer treatment has finished. However, conventional protocols involve starting ovarian stimulation only at the beginning of a woman's menstrual cycle (the day that menstruation starts). Therefore, if the cancer diagnosis is made at any other time in the cycle, a woman could wait up to six weeks before it would be possible to collect eggs (or oocytes) after ovarian stimulation. For many women, six weeks is too long to wait before starting cancer treatment.
Dr Michael von Wolff, vice-director of the Department of Gynaecological Endocrinology and Reproduction Medicine at the University of Heidelberg, Germany, told a conference news briefing: "Depending on what phase of her menstrual cycle a woman is in when she receives a cancer diagnosis, it can take between two and six weeks to start ovarian stimulation and collect oocytes. Two weeks is an acceptable amount of time in many diseases to wait before starting a cancer treatment such as chemotherapy, but three to six weeks is far too long."
The researchers conducted a pilot study in 40 women in 2007 to see whether it would be possible to initiate ovarian stimulation during the luteal phase (the phase in the menstrual cycle from ovulation to the start of the next menstruation), without first having to give drugs to stop the luteal phase.
"Although other research has looked at giving medication to stop the luteal phase and then starting regular IVF treatment a few days later, to my knowledge, nobody has ever started ovarian stimulation immediately, without delay, in the luteal phase, either for IVF or for cancer patients," said Dr von Wolff. "This is because, in traditional IVF, ovarian stimulation has to be started at the beginning of the menstrual cycle, otherwise the endometrium is inadequately developed and a fertilised oocyte would be unable to implant successfully."
The researchers started ovarian stimulation in 28 patients in the proliferative phase of their cycle (the time from the start of menstruation to ovulation) using standard stimulation medications (GnRH-analogues and human menopausal gonadtropin, HMG, or follicle stimulation hormone, FSH). In a second group of 12 women they started stimulation during the luteal phase, using GnRH-antagonists and recombinant FSH (a synthetic form of FSH) in order to hasten the end of the luteal phase (luteolysis) and promote the development of new follicles containing oocytes.
The average time of ovarian stimulation was 10.3 days in the first group and 11.4 days in the second group. A mean average of 13 oocytes were collected from the first group and 10 from the second group. Nearly 77% and 73% of the oocytes were mature in the respective groups, and after intracytoplasmic sperm injection (ICSI), 70% and 75% of the oocytes were fertilised respectively.
The researchers found that if ovarian stimulation was started in the second group during ovulation, then the luteal phase stopped after five days, and if stimulation was started in the mid-luteal phase, then it stopped within two days, enabling new follicles to start maturing.
Dr von Wolff said: "We found that the ovarian stimulation regime for patients in the luteal phase was successful in triggering the end of the luteal phase and the recruitment of a new cohort of follicles. The number of oocytes obtained after stimulation in the luteal phase was slightly but not significantly lower than those obtained after stimulation in the proliferative phase. However the oocyte quality was the same in both groups. This pilot study demonstrates for the first time that mature oocytes can be obtained before cancer therapy within a time frame of two weeks.
"This new protocol would enable patients with cancers such as breast cancer and Hodgkin lymphoma to have ovarian stimulation and oocyte collection. Waiting for two weeks before they start cancer treatment is acceptable for most patients while this process happens. For breast cancer patients, this technique can be combined with the anti-oestrogen drug letrozole. Furthermore, this protocol allows the combination of freezing and storing both ovarian tissue and oocytes, which results in the women having a higher chance of achieving pregnancy if their cancer treatment causes ovarian failure."
Dr von Wolff said information about these new techniques needed to be disseminated to oncologists so that they were aware of the options available to their patients to help them preserve their fertility. National networks of specialised centres capable of carrying out these techniques should be established, he concluded.
European Society for Human Reproduction and Embryology
The researchers conducted a pilot study in 40 women in 2007 to see whether it would be possible to initiate ovarian stimulation during the luteal phase (the phase in the menstrual cycle from ovulation to the start of the next menstruation), without first having to give drugs to stop the luteal phase.
"Although other research has looked at giving medication to stop the luteal phase and then starting regular IVF treatment a few days later, to my knowledge, nobody has ever started ovarian stimulation immediately, without delay, in the luteal phase, either for IVF or for cancer patients," said Dr von Wolff. "This is because, in traditional IVF, ovarian stimulation has to be started at the beginning of the menstrual cycle, otherwise the endometrium is inadequately developed and a fertilised oocyte would be unable to implant successfully."
The researchers started ovarian stimulation in 28 patients in the proliferative phase of their cycle (the time from the start of menstruation to ovulation) using standard stimulation medications (GnRH-analogues and human menopausal gonadtropin, HMG, or follicle stimulation hormone, FSH). In a second group of 12 women they started stimulation during the luteal phase, using GnRH-antagonists and recombinant FSH (a synthetic form of FSH) in order to hasten the end of the luteal phase (luteolysis) and promote the development of new follicles containing oocytes.
The average time of ovarian stimulation was 10.3 days in the first group and 11.4 days in the second group. A mean average of 13 oocytes were collected from the first group and 10 from the second group. Nearly 77% and 73% of the oocytes were mature in the respective groups, and after intracytoplasmic sperm injection (ICSI), 70% and 75% of the oocytes were fertilised respectively.
The researchers found that if ovarian stimulation was started in the second group during ovulation, then the luteal phase stopped after five days, and if stimulation was started in the mid-luteal phase, then it stopped within two days, enabling new follicles to start maturing.
Dr von Wolff said: "We found that the ovarian stimulation regime for patients in the luteal phase was successful in triggering the end of the luteal phase and the recruitment of a new cohort of follicles. The number of oocytes obtained after stimulation in the luteal phase was slightly but not significantly lower than those obtained after stimulation in the proliferative phase. However the oocyte quality was the same in both groups. This pilot study demonstrates for the first time that mature oocytes can be obtained before cancer therapy within a time frame of two weeks.
"This new protocol would enable patients with cancers such as breast cancer and Hodgkin lymphoma to have ovarian stimulation and oocyte collection. Waiting for two weeks before they start cancer treatment is acceptable for most patients while this process happens. For breast cancer patients, this technique can be combined with the anti-oestrogen drug letrozole. Furthermore, this protocol allows the combination of freezing and storing both ovarian tissue and oocytes, which results in the women having a higher chance of achieving pregnancy if their cancer treatment causes ovarian failure."
Dr von Wolff said information about these new techniques needed to be disseminated to oncologists so that they were aware of the options available to their patients to help them preserve their fertility. National networks of specialised centres capable of carrying out these techniques should be established, he concluded.
European Society for Human Reproduction and Embryology
Ovarian Stimulation Current Events and Ovarian Stimulation News RSSFertility procedures need not delay breast cancer treatment for younger women
A new study published in the November issue of the Journal of the American College of Surgeons shows that breast cancer patients under 40 years old who undergo fertility preservation do not face a significant delay in the treatment of their disease when their care is coordinated in a timely fashion.
First case of successful ovarian tissue transplantation between two, nonidentical sisters
A woman, whose ovaries had failed due to damage caused by chemotherapy and radiotherapy, has received a successful ovarian transplant from her genetically non-identical sister.
Dopamine agonist can prevent ovarian hyperstimulation syndrome in IVF patients
A class of drug widely used in a number of gynaecological conditions can prevent ovarian hyperstimulation syndrome (OHSS), an infrequent but serious complication of assisted reproduction treatments.
Egg donation for stem cell research — balancing the risks and benefits
In the wake of the scandal involving fraudulent cloning research, concerns about the welfare of women donating eggs for research purposes have arisen.
First frozen egg baby born in Canada
The McGill University Health Center (MUHC) in Montreal is pleased to announce the first successful birth in Canada resulting from frozen eggs.
Egg-sharing does not damage a donor's own chance of a baby say UK researchers
Women who take part in egg sharing programmes run by fertility clinics are not compromising their chance of having a baby by donating some of their eggs, according to UK research published today (Thursday 30 October) in Europe's leading reproductive medicine journal Human Reproduction[1]. The Lister Fertility Clinic in London, a private clinic that has been running a formal egg sharing scheme since January 1998[2], has evaluated 276 egg sharing cycles involving 192 women who agreed to share their eggs, 274 recipient cycles involving 246 women who received eggs and 1,098 non-sharing standard IVF or ICSI cycles involving 718 women. The participants were divided into three groups - egg sharers,
New role for tamoxifen as fertility drug for breast cancer patients?
US fertility experts have discovered a potential new role for the wonder drug tamoxifen - helping breast cancer patients to have babies by IVF. In a study published today (Wednesday 8 January) in Europe's leading reproductive medicine journal Human Reproduction [1], researchers from New York's Cornell University report the first IVF pregnancy to result from the use of tamoxifen as an ovarian stimulant. In a study of 12 breast cancer survivors they found that stimulating the ovaries with a short, carefully timed course of tamoxifen boosted the number of eggs they could retrieve. Every patient had one or more embryos either for freezing for later attempts at pregnancy, or for immediate transf
Multiple pregnancies: Vienna meeting reveals new research
The continuing high rate of multiple pregnancies in assisted reproduction is a major medical, psychosocial and economic problem. But it could be solved overnight if only doctors weren't too hesitant to act, a leading Swedish specialist in reproductive medicine told a news briefing today (Monday 1 July) at the annual meeting of the European Society of Human Reproduction and Embryology in Vienna. Dr Karl Nygren, Associate Professor of Obstetrics and Gynaecology at Sofiahemmet Hospital in Stockholm, said that the natural rate of multiple births was around one percent but was between 20% and 40% for women who used assisted reproductive techniques - either ovarian stimulation or IVF, or a combina
Fertility experts urge clinics to consider 'natural cycle' IVF instead of routine use of ovarian stimulants
A team of UK fertility experts wants IVF clinics to consider taking advantage of a woman's natural cycle during infertility treatment instead of routinely using drugs to stimulate ovaries into producing extra eggs. A study published today (Wednesday 31 January) in Europe's leading reproductive medicine journal, Human Reproduction*, has found that for the majority of women the chances of pregnancy are just as good if doctors rely on the woman's natural menstrual cycle. The researchers' view is that, in 60% to 70% of cases, a series of treatment cycles without using ovarian stimulation would be safer, less stressful and mean fewer multiple births. It also costs only a fifth of the price of cu
More Ovarian Stimulation Current Events and Ovarian Stimulation News Articles
|
Fertility & Sterility november 2003: a turbulent arena; choice of ovarian stimulation regimens in assisted reproduction by American Soc. for Reproductive Medicine (Author) | |
 |
Ovulation Induction and Controlled Ovarian Stimulation: A Practical Guide by Roy Homburg (Author) A rapidly advancing field, ovulation induction and controlled ovarian stimulation lie at the very heart of infertility treatment. A concise and accurate practical guide to what are undoubtedly very complicated topics, this clearly written text provides the busy clinician with a reliable overview of the principles involved and the management needed in this area. Including an exploration of the history of ovulation induction and stimulation, as well as discussion of future possibilities and developments, the main body of the text is built on logical evidence and evidence-based solutions. A number of highly useful algorithms and explanatory tables reinforce this approach, ensuring that the reader is presented with easy-to-grasp, well-presented... |
|
Ovulation Induction and Controlled Ovarian Stimulation by Roy Homburg (Author) | |
|
The effect of colchicine on the increase in ovarian weight and phospholipids at gonadotrophic stimulation (Acta physiologica Scandinavica) by Lennart Claesson (Author) |
| © 2009 BrightSurf.com |