title: Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents.
abstract: OBJECTIVE
  To describe a case series of seven women with SLE and other systemic autoimmune rheumatic diseases (SARDs) who required cyclophosphamide therapy and underwent fertility preservation treatments.
  
  
  METHODS
  Of the seven patients reported here, five women had SLE with nephritis, the sixth had immune thrombocytopenia purpura (ITP) and the seventh had microscopic polyangiitis (MPA) with renal involvement. All women were nulliparous and younger than 35 yrs.
  
  
  RESULTS
  Patients with SLE underwent in vitro maturation (IVM) of immature oocytes aspirated during a natural menstrual cycle followed by vitrification of the matured oocytes if a male partner was not available, or vitrification of embryos if one was available. The patient with ITP and the patient with MPA underwent gonadotropin ovarian stimulation followed by oocyte or embryo vitrification. All women completed fertility preservation treatment successfully and mature oocytes or embryos (36 and 13, respectively) were vitrified. No complications were associated with this treatment and cytotoxic therapy was initiated as scheduled in all cases.
  
  
  CONCLUSIONS
  Oocyte or embryo cryopreservation should be considered for fertility preservation in young women with SARDs who face imminent gonadotoxic treatment. In patients, where gonadotropin ovarian stimulation is deemed unsafe, IVM of immature oocytes, aspirated during a natural menstrual cycle, followed by vitrification or fertilization of the mature oocytes, seems to be safe and feasible. For patients in whom hormonal ovarian stimulation is not contraindicated, this method may be considered depending on the urgency to start cytotoxic therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University Health Center, Quebec, Canada. shai.elizur@gmail.com
authors.forename: S E
authors.initials: SE
authors.lastname: Elizur
authors.forename: R C
authors.initials: RC
authors.lastname: Chian
authors.forename: C A
authors.initials: CA
authors.lastname: Pineau
authors.forename: W Y
authors.initials: WY
authors.lastname: Son
authors.forename: H E G
authors.initials: HE
authors.lastname: Holzer
authors.forename: J Y J
authors.initials: JY
authors.lastname: Huang
authors.forename: Y
authors.initials: Y
authors.lastname: Gidoni
authors.forename: D
authors.initials: D
authors.lastname: Levin
authors.forename: E
authors.initials: E
authors.lastname: Demirtas
authors.forename: S L
authors.initials: SL
authors.lastname: Tan
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000188:drug therapy*; D015925:Cryopreservation / Q000379:methods*; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D004622:Embryo, Mammalian; D005260:Female; D005298:Fertility; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007247:Infertility, Female / Q000139:chemically induced / Q000517:prevention & control*; D008181:Lupus Nephritis / Q000188:drug therapy; D054315:Oocyte Retrieval / Q000379:methods; D009865:Oocytes; D010062:Ovulation Induction / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide