Selection of patients before and after anticancer treatment for ovarian cryopreservation.
BACKGROUND
Although ovarian cryopreservation in patients with cancer should ideally be performed before the initiation of therapy, cryopreservation from such patients often becomes an option only later. The justification for the procedure needs to be elucidated.


METHODS
Eighteen cancer patients before chemotherapy and 23 others after chemotherapy participated in the study. Freshly dissected ovarian samples were prepared for light microscopy to demonstrate follicular numbers and apoptosis, transmission electron microscopy to enhance intracellular changes, and staining with fluorescent markers (calcein AM, rhodamin 123 and ethidium homodimer) to test for viability.


RESULTS
High numbers of preantral follicles were detected in ovaries of patients < or =20 years. No antral follicles were detected. All the follicles were viable and not apoptotic. Deterioration in follicular quality was observed after chemotherapy, manifested mainly as an increase in abnormal granulosa cell nuclei (P < 0.05-0.0001) and in oocyte vacuolization (P < 0.0001).


CONCLUSIONS
Our study stresses the importance of prechemotherapy ovarian cryopreservation. However, the large number of viable, non-apoptotic follicles in ovaries of younger patients (age < or = 20 years) indicates that ovarian cryopreservation might be considered after treatment in this age group. Further studies of ovarian samples from women aged 20-30 years are needed to determine the exact age margin wherein postchemotherapy ovarian cryopreservation can be suggested.
Abir
Ronit
R
Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ronita@clalit.org.il
Ben-Haroush
Avi
A
Felz
Carmela
C
Okon
Elimelch
E
Raanani
Hila
H
Orvieto
Raoul
R
Nitke
Shmuel
S
Fisch
Benjamin
B
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D015925:Cryopreservation; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D006080:Ovarian Follicle / Q000166:cytology / Q000187:drug effects; D010053:Ovary / Q000166:cytology* / Q000187:drug effects*; D018579:Patient Selection
D000970:Antineoplastic Agents