title: Effect of Previous Chemotherapy on the Quality of Cryopreserved Human Ovarian Tissue In Vitro.
abstract: BACKGROUND
  Cryopreservation of ovarian tissue has been widely accepted as an option for fertility preservation among cancer patients. Some patients are exposed to chemotherapy prior to ovarian tissue cryopreservation. Consequently, assessment of the developmental capacity of human ovarian tissue after chemotherapy is of primary importance.
  
  
  METHODS
  In order to study the impact of previous chemotherapy on in vitro development and viability of ovarian follicles, quality control samples from 34 female cancer patients at median age of 15 years (range 1‒35), cryopreserved for fertility preservation before (n = 14) or after (n = 20) initiation of chemotherapy, were thawed and cultured for 7 days. The morphology and developmental stages of ovarian follicles were studied by light microscopy before and after culture. Possible associations between follicular densities, age and exposure to alkylating agents, expressed as cyclophosphamide equivalent dose (CED) were tested.
  
  
  RESULTS
  Exposure to chemotherapy significantly impaired the survival and development of ovarian follicles in culture. After seven days, significantly higher densities of intermediary, primary and secondary follicles and lower densities of atretic follicles was detected in the samples collected before chemotherapy. Increasing dose of alkylating agents was identified by multivariate linear regression analysis as an independent predictor of a higher density of atretic follicles, whereas increasing age of the patient predicted a better outcome with less follicle atresia and a higher density of maturing follicles.
  
  
  CONCLUSIONS
  This study provides quantitative in vitro evidence of the impact of chemotherapy on developmental capacity of cryopreserved human ovarian tissue. The results indicate that fertility preservation should be carried out, if possible, before initiation of alkylating agents in order to guarantee better in vitro survival of ovarian follicles. In addition, ovarian samples from younger girls show lower viability and fewer developing follicles in culture.
authors.affiliation: Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Babak
authors.initials: B
authors.lastname: Asadi Azarbaijani
authors.affiliation: Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Stockholm IVF, Stockholm, Sweden.
authors.forename: Mona
authors.initials: M
authors.lastname: Sheikhi
authors.affiliation: Faculty of Veterinary Medicine and Bioscience, University of Oslo, Oslo, Norway.
authors.forename: Irma C
authors.initials: IC
authors.lastname: Oskam
authors.affiliation: Department of Physiology and Pediatrics, University of Turku, Turku, Finland.
authors.forename: Mirja
authors.initials: M
authors.lastname: Nurmio
authors.affiliation: Department of Pediatrics, Helsinki University Central Hospital, Helsinki, Finland; Division of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laine
authors.affiliation: Tampere University Central Hospital, Tampere, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Tinkanen
authors.affiliation: The Family Federation of Finland, Fertility Clinic, Helsinki, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Mäkinen
authors.affiliation: Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Tanbo
authors.affiliation: Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: Outi
authors.initials: O
authors.lastname: Hovatta
authors.affiliation: Department of Pediatrics, Helsinki University Central Hospital, Helsinki, Finland; Division of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland; Department of Women's and Children´s Health, Karolinska Institute and University Hospital, Stockholm, Sweden.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Jahnukainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D006080:Ovarian Follicle / Q000187:drug effects*; D046509:Tissue Culture Techniques / Q000379:methods; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents