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Hum. Reprod. Advance Access originally published online on February 8, 2008
Human Reproduction 2008 23(4):869-877; doi:10.1093/humrep/dem413
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Selection of patients before and after anticancer treatment for ovarian cryopreservation

Ronit Abir1,5, Avi Ben-Haroush1, Carmela Felz1,2, Elimelch Okon2, Hila Raanani1,3, Raoul Orvieto1,4, Shmuel Nitke1 and Benjamin Fisch1

1 Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 2 Department of Pathology, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 3 Present address: IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center 52621, Tel-Hashomer, Israel 4 Present address: infertility and IVF Unit, Brazilai Medical Center, Ashkelon and Ben Gurion University, School of Medicine, Beer Sheva, Israel

5 Correspondence address. Tel: +972-3-9377618; Fax: +972-3-9240533; E-mail: ronita{at}clalit.org.il

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 ≤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 ≤ 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.

Key words: follicles/chemotherapy/transmission electron microscopy/apoptosis/viability

Submitted on June 16, 2007; resubmitted on November 15, 2007; accepted on November 30, 2007.


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