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In Vitro Maturation Is an Efficient Technique to Generate Oocytes and Should Be Considered in Combination With Cryopreservation of Ovarian Tissue for Preservation of Fertility in Women

Coordinator of the German Network on Fertility Preservation in Cancer Patients, and Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany

Thomas Strowitzki

Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany

Hans van der Ven

Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital Bonn, University of Bonn, Germany

Markus Montag

German Network on Fertility Preservation in Cancer Patients, and Department of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital Bonn, University of Bonn, Germany

To the Editor:

We read with interest the article by Lee et al¹ concerning the recommendations of the American Society of Clinical Oncology on fertility preservation in cancer patients. Lee and colleagues should be congratulated for their systematic analysis and for the recommendations of therapeutic options to preserve fertility in cancer patients. The recommendations of the German Network on Fertility Preservation in Cancer Patients are basically in line with the recommendations of the American Society of Clinical Oncology.

There is no doubt that the collection of mature oocytes (IVF) and the cryopreservation of embryos or oocytes is still the option with the best chance to achieve pregnancy. However, as this procedure requires approximately 14 days for ovarian stimulation and oocyte collection, this option often cannot be performed. Furthermore, the high dosage of gonadotrophins needed for ovarian stimulation carries the risk of developing an ovarian hyperstimulation syndrome, which might result in further delay of chemotherapy.

We have therefore successfully integrated the in vitro maturation (IVM) technique in our catalogue of fertility-preserving techniques in cancer patients. Those patients who cannot perform a regular IVF are offered the combination of the collection and maturation of immature oocytes (IVM), the laparoscopic removal of ovarian tissue, and the treatment with gonadotrophin-releasing hormone (GnRH) agonists and antagonists. As IVM requires only a few days of ovarian stimulation, the chemotherapy can frequently be started within 1 week after the diagnosis has been made. The transvaginal collection of the oocytes is combined with the simultaneous laparoscopic removal and cryopreservation of ovarian cortex tissue. After the removal of oocytes and ovarian tissue, the patients receive GnRH agonists, which are initially combined with GnRH antagonists to reduce the endogenous flare up of follicle-stimulating hormone.

This procedure combines the collection and cryopreservation of oocytes with the still experimental cryopreservation of ovarian tissue and GnRH analog treatment. It therefore offers a realistic chance to achieve pregnancy after chemotherapy to those patients who can not perform a regular ovarian stimulation to collect mature oocytes (IVF). We are fully aware that the cumulative pregnancy rates after IVM are lower than after regular IVF. IVM will result in two fertilized eggs on average,^2,3 whereas IVF can generate approximately six fertilized eggs.⁴ However, as the collection of immature eggs can be combined with laparoscopic removal of ovarian tissue, this procedure offers an important additional chance for patients to achieve pregnancy after chemotherapy.

Currently, the German Network on Fertility Preservation in Cancer Patients systematically trains all German Women's University Hospitals in IVM and organizes the centralized cryopreservation of ovarian tissue under optimized conditions. We therefore strongly recommend adding the IVM procedure to the list of fertility preservation options, and to offer this procedure to all patients who cannot receive regular IVF treatment, but who can have chemotherapy postponed for 1 week.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Lee SJ, Schover LR, Partridge AH, et al: American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24 : 2917 -2931, 2006[Abstract/Free Full Text]

2. Soderstrom-Anttila V, Makinen S, Tuuri T, et al: Favourable pregnancy results with insemination of in vitro matured oocytes from unstimulated patients. Hum Reprod 20 : 1534 -1540, 2005[Abstract/Free Full Text]

3. von Wolff M, Eberhardt I, Strowitzki T: In vitro maturation: Indications, risks and chances of a new assisted reproductive technique. Zentralbl Gynacol (in press)

4. German IVF register. http://www.deutsches-ivf-register.de

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by von Wolff, M. Articles by Montag, M. Search for Related Content PubMed PubMed Citation Articles by von Wolff, M. Articles by Montag, M. Social Bookmarking                            What's this?