Fertility Preservation in Women with Turner Syndrome: A Comprehensive Review and Practical Guidelines.
In this article we review the existing fertility preservation options for women diagnosed with Turner syndrome and provide practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in women, occurring in approximately 1 in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency and infertility. Although approximately 70%-80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder might possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood because the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, and cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remains investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 years of age and ovarian tissue cryopreservation in affected prepubertal children. However, current efficacy of these approaches is unknown in this cohort. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of the desire for parenting. For those with Turner syndrome-related cardiac contraindications to pregnancy, use of gestational surrogacy allows the possibility of biological parenting using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.
Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York; Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, New York. Electronic address: koktay@fertilitypreservation.org.
Kutluk
K
Oktay
Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York; Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York, New York.
Giuliano
G
Bedoschi
Department of Biochemistry and Molecular Biology and Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Karen
K
Berkowitz
Department of Obstetrics and Gynecology and Pathology, Division of Reproductive Endocrinology, Stony Brook University Medical Center, Stony Brook, New York.
Richard
R
Bronson
Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, Rutgers New Jersey Medical School, Newark, New Jersey.
Banafsheh
B
Kashani
Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, Rutgers New Jersey Medical School, Newark, New Jersey.
Peter
P
McGovern
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
Lubna
L
Pal
Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
Gwendolyn
G
Quinn
Department of Pediatrics, Division of Pediatric Endocrinology, Connecticut Children's Medical Center, Hartford, Connecticut and University of Connecticut School of Medicine, Farmington, Connecticut.
Karen
K
Rubin
D000293:Adolescent; D015925:Cryopreservation; D019924:Embryo Disposition; D005260:Female; D059247:Fertility Preservation / Q000379:methods / Q000592:standards*; D006801:Humans; D007246:Infertility / Q000209:etiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000209:etiology; D014424:Turner Syndrome / Q000150:complications*
Adoption; Embryo cryopreservation; Fertility preservation; Oocyte cryopreservation; Ovarian tissue cryopreservation; Turner syndrome