The Fertiprotekt network is a cooperation of university centres, hospitals and practices. It was founded in Germany in 2006. [1] The network now extends to all German-speaking countries and currently units ca. 100 institutions in Germany, Austria and Switzerland.
The aim of the network is to offer men and women the possibility of seeking advice about scientific information regarding their fertility before and after Chemo- or radiotherapy, and to undergo procedures to protect their fertility. The advice about and the performance of fertility-conserving procedures according to the network’s code of ethics is non-profit oriented. [2]
As a result of today’s significantly improved prognosis for patients with cancer, quality of life is increasingly important after overcoming treatment of the disease. Fears about fertility preservation play an important role for young men and women. The most common types of cancer diagnosed under the age of 40 years are breast cancer, melanoma, cervical cancer, non-Hodgkin’s lymphoma and leukaemia. One of the biggest problems in women who have to undergo chemo- or radiotherapy is premature ovarian failure (premature ovarian insufficiency) and its associated infertility. [3] For breast cancer alone, it is assumed that there are ca. 200 patients a year in Germany who wish to conceive. In men, chemotherapy can result in permanent damage to the testicular tissue. Due to advances in reproductive medicine, a variety of fertility-protective methods are now available. These techniques include administration of GnRH-agonists, [4] ovarian stimulation with cryoconservation of fertilised or unfertilised oocytes, as well as cryoconservation of ovarian tissue. [5] Relocation of the ovaries by surgically moving them out of the pelvis (ovarian transposition) to protect them from damage caused by radiotherapy is also possible. [6]
The Fertiprotekt network has carried out international pioneering work in four areas:
Network seminars take place annually. The centres involved are obliged to regularly take part in these annual conferences.
Some methods, such as cryoconservation of sperm and in-vitro fertilisation (IVF) are well established. Others have only been introduced over the last few years, such as cryoconservation of ovarian tissue prior to chemotherapy for later transplantation and the cryoconservation of unfertilized egg cells. These services are therefore not fully covered by statutory health insurance in Germany. [12]
The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary found on each side of the body. The ovaries also secrete hormones that play a role in the menstrual cycle and fertility. The ovary progresses through many stages beginning in the prenatal period through menopause. It is also an endocrine gland because of the various hormones that it secretes.
Cryobiology is the branch of biology that studies the effects of low temperatures on living things within Earth's cryosphere or in science. The word cryobiology is derived from the Greek words κρῧος [kryos], "cold", βίος [bios], "life", and λόγος [logos], "word". In practice, cryobiology is the study of biological material or systems at temperatures below normal. Materials or systems studied may include proteins, cells, tissues, organs, or whole organisms. Temperatures may range from moderately hypothermic conditions to cryogenic temperatures.
An ovarian follicle is a roughly spheroid cellular aggregation set found in the ovaries. It secretes hormones that influence stages of the menstrual cycle. At the time of puberty, women have approximately 200,000 to 300,000 follicles, each with the potential to release an egg cell (ovum) at ovulation for fertilization. These eggs are developed once every menstrual cycle with around 450–500 being ovulated during a woman's reproductive lifetime.
Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options available for men.
Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs as well as the bladder, the adnexa, and the recto-uterine pouch. The procedure may lead to other medically relevant findings in the pelvis.This technique is useful to detect myomas or mullerian malformations.
Growth/differentiation factor 9 is a protein that in humans is encoded by the GDF9 gene.
Human oocyte cryopreservation is a procedure to preserve a woman's eggs (oocytes). This technique has been used to enable women to postpone pregnancy to a later date – whether for medical reasons, or for social reasons. Several studies have shown that most infertility problems are due to germ cell deterioration related to aging. The intention of the procedure is that the woman may choose to have the eggs thawed, fertilized, and transferred to the uterus as embryos to facilitate a pregnancy in the future. The procedure's success rate varies depending on the age of the woman, with odds being higher in younger, adult women.
In vitro maturation (IVM) is the technique of letting the contents of ovarian follicles and the oocytes inside mature in vitro. It can be offered to women with infertility problems, combined with In Vitro Fertilization (IVF), offering women pregnancy without ovarian stimulation.
Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer, ageing and other health conditions effect reproductive health and preservation options are growing. Specifically sparked in part by the increase in the survival rate of cancer patients.
Cryopreservation or cryoconservation is a process where biological material - cells, tissues, or organs - are frozen to preserve the material for an extended period of time. At low temperatures any cell metabolism which might cause damage to the biological material in question is effectively stopped. Cryopreservation is an effective way to transport biological samples over long distances, store samples for prolonged periods of time, and create a bank of samples for users. Molecules, referred to as cryoprotective agents (CPAs), are added to reduce the osmotic shock and physical stresses cells undergo in the freezing process. Some cryoprotective agents used in research are inspired by plants and animals in nature that have unique cold tolerance to survive harsh winters, including: trees, wood frogs, and tardigrades.
The Spiegelberg criteria are four criteria used to identify ovarian ectopic pregnancies named after Otto Spiegelberg.
Ovarian tissue cryopreservation is cryopreservation of tissue of the ovary of a female.
Semen cryopreservation is a procedure to preserve sperm cells. Semen can be used successfully indefinitely after cryopreservation. It can be used for sperm donation where the recipient wants the treatment in a different time or place, or as a means of preserving fertility for men undergoing vasectomy or treatments that may compromise their fertility, such as chemotherapy, radiation therapy or surgery. It is also often used by transgender women prior to medically transitioning in ways that affect fertility, such as feminizing hormone therapy and orchiectomies.
Oocyte selection is a procedure that is performed prior to in vitro fertilization, in order to use oocytes with maximal chances of resulting in pregnancy. In contrast, embryo selection takes place after fertilization.
Induction of final maturation of oocytes is a procedure that is usually performed as part of controlled ovarian hyperstimulation to render the oocytes fully developed and thereby resulting in optimal pregnancy chances. It is basically a replacement for the luteinizing hormone (LH) surge whose effects include final maturation in natural menstrual cycles.
Ovarian follicle activation can be defined as primordial follicles in the ovary moving from a quiescent (inactive) to a growing phase. The primordial follicle in the ovary is what makes up the “pool” of follicles that will be induced to enter growth and developmental changes that change them into pre-ovulatory follicles, ready to be released during ovulation. The process of development from a primordial follicle to a pre-ovulatory follicle is called folliculogenesis.
Cryopreservation of testicular tissue is an experimental method being used to preserve fertility in pre-pubescent males, or males who cannot produce sperm, to allow them the option of having biological children.
An artificial ovary is a potential fertility preservation treatment that aims to mimic the function of the natural ovary.
Dmitri Dozortsev is a Russian-American physician scientist, inventor and researcher. Dozortsev's contributions in research and publications are mostly in the areas of human reproductive medicine and biology. In particular, he is best known for his studies of in vitro fertilisation and embryo transfer. Dozortsev currently serves as President of the American College of Embryology and as Director of Omni-Med laboratories.
Ovarian stem cells are oocytes formed in ovarian follicle before birth in female mammals. They do not form post-natally, and are depleted throughout reproductive life. In humans it is estimated that 500,000–1,000,000 primordial follicles are present at birth, decreasing rapidly with age until roughly age 51 when ovulation stops, resulting in menopause. The origin of these oocytes remains under discussion. The publication of a study in 2004 proposing germ cell renewal in adult mice sparked a debate on the possibility of stem cells in the postnatal ovary. An increasing number of studies suggest that stem cells exist within the mammalian ovary and can be manipulated in vitro to produce oocytes, but whether such ovarian stem cells have the potential to differentiate into oocytes remains uncertain.