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Guideline
. 2018 Jan;297(1):257-267.
doi: 10.1007/s00404-017-4595-2. Epub 2017 Nov 27.

Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques

Michael von Wolff  1   2 , A Germeyer  3 , J Liebenthron  4 , M Korell  5 , F Nawroth  6
Affiliations
Guideline

Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques

Michael von Wolff et al. Arch Gynecol Obstet. 2018 Jan.

Abstract

Purpose: In addition to guidelines focusing on scientific evidence, practical recommendations on fertility preservation are also needed.

Methods: A selective literature search was performed based on the clinical and scientific experience of the authors. This article (Part II) focuses on fertility preservation techniques. Part I, also published in this journal, provides information on disease prognosis, disease-specific therapy, and risks for loss of fertility.

Results: Ovarian stimulation including double stimulation and freezing of oocytes is the best-established therapy providing live birth chances in women < 35 years with high ovarian reserve of around 30-40%. Ovarian tissue freezing is especially useful in young women with good ovarian, if spontaneous conception is favoured and if < 1 week until chemotherapy is provided. Data on success rates are still limited, but this further evolving technique will possibly reach similar success rates as ovarian stimulation. GnRH agonists seem to reduce the risk of premature ovarian failure up to 50%; however, the effect is possibly not long-lasting. Ovarian transposition can easily be combined with freezing of ovarian tissue and is the preferred technique before pelvic radiotherapy. Other techniques, such as in vitro maturation, are limited to women with high ovarian reserve and remain less effective. In addition, procedures such as in vitro growth of follicles, etc. are still experimental.

Conclusions: Fertility preservation in women provides realistic chances of becoming pregnant. The choice of technique needs to be based on the time required, the woman's age, its risks and efficacy, and the individual preference of the patient.

Keywords: Fertility preservation; GnRH agonists; Oocyte ovarian stimulation; Ovarian tissue.

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Conflict of interest statement

Conflict of interest

None of the authors have a conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Figures

Fig. 1
Fig. 1
Ovarian stimulation in the early, mid, late follicular, and luteal phases ([5], modified)
Fig. 2
Fig. 2
Combination of the three main techniques to preserve fertility before gonadotoxic therapy
Fig. 3
Fig. 3
Transplantation of ovarian tissue I: subperitoneally in the ovarian fossa (Ic: 12 months later), II: into the ovary, and III: onto the ovary (University women’s hospital, Bern, Switzerland)
See this image and copyright information in PMC

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