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.
MATERIALS:
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.
CONCLUSION:
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.
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