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Objective: To evaluate the use of cryopreserved ovarian tissue in the Danish fertility preservation cohort., Design: Retrospective cohort study., Setting: University hospitals and fertility clinics., Patient(s): Ovarian tissue cryopreservation (OTC) was performed for 1,186 Danish girls and women from 1999-2020, of whom 117 subsequently underwent ovarian tissue transplantation (OTT). Subgroup 1 included 759 patients with a follow-up period of >5 years. Out of these, OTT rates were further analyzed for those patients who were alive and aged >24 years in July 2020 (subgroup 2; n = 554)., Intervention(s): OTC and OTT., Main Outcome Measure(s): OTT, death, donation of tissue., Result(s): In subgroup 1, 14% of the patients had undergone OTT, 18% had died, 9% had donated their tissue for research, and 59% still had their tissue stored. In subgroup 2, 19% had undergone OTT and for most diagnoses the OTT rates ranged from 15% to 22% with benign hematologic diseases having the highest OTT rate (35%). On the basis of the entire cohort, stratified age analysis indicated that women aged ≥30 years at OTC were more likely to return for OTT than women aged 18-29 years at OTC; mean storage times were 3.7 and 3.6 years, respectively. Only 4% of the girls aged <18 years at OTC had undergone OTT., Conclusion(s): The OTT rates depended on the diagnosis, age at OTC, and follow-up time. Specific criteria are needed for reporting and comparing OTT rates. Six out of 10 patients still had their cryopreserved tissue stored and longer follow-up is needed, especially for younger girls., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: A rapid development in assisted reproductive technology (ART) has led to a surge in its popularity among target couples. However, elucidation on the molecular mechanism and effective solutions for a common problem posed by ART, namely transfer failure, is still lacking. The new therapeutic potential of cyclosporin A (CsA), a typical immunosuppressant widely used in the treatment of rejection after organ transplantation, in recurrent pregnancy loss (RPL) patients may inspire some novel transfer failure therapies in the future. To further explore the clinical effects of CsA, this study investigated whether its application can improve clinical pregnancy outcomes in patients with a history of unexplained transfer failure in frozen-thawed embryo transfer (FET) cycles., Methods: Data from a retrospective cohort investigation (178 frozen-thawed embryo transfer cycles in 178 patients) were analysed using binary logistic regression to explore the relationship between CsA treatment and clinical pregnancy outcomes; the odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated as a measure of relevancy. Implantation rate was the main outcome measure., Results: There was no difference in the fine adjusted OR (95 % CI) of the implantation rate [1.251 (0.739-2.120)], clinical pregnancy rate [1.634 (0.772-3.458)], chemical pregnancy rate [1.402 (0.285-6.909)], take-home baby rate [0.872 (0.423-1.798)], multiple births rate [0.840 (0.197-3.590)], preterm birth [1.668 (0.377-7.373)], abnormal birth weight [1.834 (0.533-6.307)] or sex ratio [0.956 (0.339-2.698)] between the CsA-treated group and control group. No birth defects were observed in the present study., Conclusions: Although CsA does not affect infant characteristics, it has no beneficial effects on the clinical pregnancy outcomes in patients with a history of unexplained transfer failure in FET cycles.

Objective: To determine whether the purpose of ovarian stimulation (oocyte cryopreservation [OC] versus in vitro fertilization (IVF) is associated with perceived stress before or after ovarian stimulation; and whether perceived stress is associated with ovarian stimulation outcomes., Design: Prospective cohort study., Setting: Academic practice., Patients: Women undergoing their first ovarian stimulation cycle as part of a randomized clinical trial, the Learning from Online Video Education (LOVE) study (NCT02979990)., Interventions: Questionnaire before and after ovarian stimulation., Main Outcome Measures(s): Perceived stress scale (PSS) scores before and after stimulation. The number of oocytes collected was a secondary measure., Results: After adjustment for age, income, race, education, financial assistance, and fertility diagnosis, the indication for treatment (IVF vs. OC) was a significant predictor of pretreatment PSS scores. IVF participants had higher pretreatment scores (18.01 ± 6.43) than did OC participants (15.62 ± 5.61). Posttreatment PSS scores did not differ between the two groups. IVF participants experienced a decrease of 0.85 ± 2.34 points in PSS scores after treatment, whereas OC participant scores were stable over time. The trajectory of PSS scores differed between the two groups and neared significance. Financial support was a significant predictor of pretreatment and posttreatment PSS scores for the entire cohort. Neither pretreatment nor posttreatment PSS was predictive of the number oocytes collected., Conclusion: Compared with OC patients, IVF patients have higher stress levels, which decrease after ovarian stimulation. Perceived stress does not affect oocyte yield., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To determine the optimal endometrial preparation protocols of frozen-thawed embryo transfer (FET) in young women with regular menstrual cycles., Design: Retrospective cohort study., Setting: Public fertility center., Patient(s): Infertile women with regular menstrual cycles undergoing FET., Intervention(s): Natural cycle (NC) treatment for patients with proven ovulation in previous cycles or who refused medication (n = 308), or hormone treatment (HT) for patients who could not be frequently monitored (n = 1,538)., Main Outcome Measure(s): Live-birth rates., Result(s): The live-birth rates were 61.73% in the NC group and 55.11% in the HT group. The effect size of the endometrial preparation on live-birth rates was evaluated in prespecified and exploratory subgroups in each subgroup, and multivariable logistic regression analysis was used to determine which variables could be independently associated with the live-birth rate. The HT patients had a lower chance of live birth in all subgroups: endometrial thickness on the day of progesterone administration, triple-line endometrial pattern, female age at embryo transfer, fertilization type, and protocol in the fresh cycle. Multivariable analysis showed NC to be associated with an increased likelihood of live birth compared with HT., Conclusion(s): Natural cycle treatment has a higher chance of live birth than HT for endometrial preparation in young women with regular menstrual cycles., (Copyright © 2019 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Protection of fertility shares many of the same concepts as optimization of general health, such as smoking cessation, maintenance of a healthy body weight, and moderation of alcohol intake. Increasing attention has been placed on minimizing exposures to known reproductive toxicants. There are few conclusive data to support specific diet patterns or supplements for fertility. Ovarian reserve testing has been explored as potential diagnostic tests for assessment of reproductive aging with some controversy. Finally, the development of vitrification in the assisted reproduction laboratory has increased the success and, therefore, access to fertility preservation by way of oocyte or embryo cryopreservation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This review focuses on advances in the field of fertility preservation achieved over the past few decades. The main purpose of fertility preservation is to help young cancer survivors retain their fertility by restoring either their ability to procreate or simply their reproductive endocrine function. Although different options are available in this regard, successful fertility preservation is yet to reach its full potential. Herein, we review the most significant work conducted over the past five decades and present new methodologies., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

In vitro activation (IVA) represents a new frontier in the treatment of women with primary ovarian insufficiency as well as patients with cancer desiring fertility preservation. Here, we review the biological basis of IVA and the recent translation of IVA to humans by targeting Hippo and Akt-signaling pathways. We then provide a new integrated viewpoint on IVA, highlighting basic science research on the aspects of follicular development and ovarian tissue transplantation which may potentially optimize future translational research on IVA. Specific topics discussed include cryopreservation techniques, additional IVA pathway targets, the roles of actin polymerization, paracrine and endocrine factors, and the role of mechanical signaling and associated tissue rigidity in controlling ovarian follicular activation. Further research and improved understanding is needed to optimize success of IVA., (© The Author(s) 2016.)

The desire to reproduce is one of the strongest human instincts. Many men and women in our society may experience situations that compromise their future fertility. The past several decades have seen an explosion of technologies that have changed the historical limitations regarding fertility preservation. This review offers an overview of the state of the art within fertility preservation including surgical and medical interventions and therapies that necessitate the need for cryopreservation of eggs, sperm, and embryos. The review also addresses the psychological consequences of banking/not banking materials among patients in need of fertility preservation, particularly in the oncofertility context., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To assess the incidence of P elevation (PE) in natural cycles and evaluate its effect on frozen-thawed embryo transfer cycles performed in natural cycles (FET-NC)., Study Design: Retrospective analysis., Setting: A tertiary assisted reproductive unit., Patient(s): Subfertile woman who did not conceive in their stimulated IVF cycle and underwent the first FET-NC cycle., Intervention(s): Achieved serum samples were assayed for P concentrations from the day of LH surge up to 3 days before the surge. The cutoff level of PE was defined as 5 nmol/L., Main Outcome Measure(s): Clinical and ongoing pregnancy rates., Result(s): The incidence of PE in natural cycles was 173 of 610 (28.4%). There were no significant differences in both clinical and ongoing pregnancy rates (39.0% vs. 37.3% and 32.5% vs. 31.7%) between those with vs. without PE on the day of LH surge. If PE lasted for 2 days or more, there was a significant reduction in the clinical pregnancy rate (39.4% vs. 20.7%). Using multivariate logistic regression, women's age, PE for 2 days or more, and the number of top-quality embryos were the significant factors for clinical pregnancy rates in FET-NC., Conclusion(s): The incidence of PE in FET-NC was similar to that in stimulated cycles. Progesterone elevation for 2 days or more before the LH surge impaired the clinical pregnancy rate of FET-NC, whereas PE on the day of LH surge only did not have such an adverse effect., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To review and summarize data from the scientific literature on ovarian tissue and follicle transplantation as an option for fertility preservation., Design: Review of pertinent literature., Setting: University hospital., Patient(s): Women having undergone ovarian tissue transplantation., Intervention(s): None., Main Outcome Measure(s): Review of the literature., Result(s): Over the last decade, the field of ovarian transplantation and cryopreservation has significantly progressed, becoming applicable in humans. Indeed, fresh and frozen cortical ovarian tissue transplantations have been successfully reported worldwide, resulting in around 28 healthy babies. Although ovarian-tissue harvesting seems to be safe, the risk of reimplantation of cancer from ovarian cortical transplants cannot be estimated at this time. As a consequence, auto-transplantation of ovarian tissue in women having suffered from systemic hematological malignancies is not recommended. In these situations, reimplantation of isolated ovarian follicles might represent an interesting option in the future., Conclusion(s): Although the clinical experience is limited, the robust results obtained open new perspectives for the management of premature ovarian failure resulting or not from gonadotoxic treatments., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: This review covers the medical approach and laboratory guidelines needed for fertility preservation using stored ovarian tissue in cancer patients. Indications, careful patient selection and timing are essential. Techniques for tissue harvesting and storage are evaluated. Up-to-date information on publications reporting on transplantation, recovery of endocrine function, pregnancy and delivery of healthy babies is reviewed as well as relevant data on safety measures to detect cancer cells in stored ovarian tissue., Recent Findings: Recent literature review indicates 12 pregnancies, five deliveries of healthy babies and two ongoing pregnancies after transplantation of ovarian tissue using different methods. To increase the safety of ovarian tissue cryopreservation-reimplantation procedures, algorithm and methods to identify tumor involvement in the ovaries and detection of small numbers of cancer cells in ovarian tissue were recently reported., Summary: Cryopreservation of ovarian tissue has been practiced for over a decade in an attempt to preserve fertility before the commencement of potentially sterilizing chemotherapy. With more than a few recent reports on pregnancies and deliveries after transplantation of ovarian tissue, there will be more patients requesting the storage of ovarian tissue in order to preserve fertility prior to cancer treatments.

The medical treatment of various cancers may, as long-term sequelae, cause infertility in girls and young women. In order to preserve the fertility of such women, techniques to cryopreserve ovarian tissue have gained considerable interest during recent years. The ovarian tissue is cryopreserved before cancer treatment is commenced, and first replaced when the woman has been cured. Based on the successful results from the use of this technique in test animals, where normal live young have been born, cryopreservation of human ovarian tissue has been initiated in a number of fertility clinics worldwide over the last few years. So far, only two women have experienced transplantation of cryopreserved ovarian tissue. Menstrual cycles and oestradiol production were restored in both women, but restoration of fertility have not yet been demonstrated. This review describes the technique and its present possibilities and limitations. The legal aspects in Denmark are presented and some ethical aspects described.