Ovarian stimulation and egg retrieval in the acutely ill patient: special considerations
- PDF / 261,635 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 117 Downloads / 163 Views
ASSISTED REPRODUCTION TECHNOLOGIES
Ovarian stimulation and egg retrieval in the acutely ill patient: special considerations Kaitlyn Wald 1 & Joseph Letourneau 1,2 & Rachel Eshima-McKay 3 & John Monks 3 & Evelyn Mok-Lin 1 & Marcelle Cedars 1 & Mitchell Rosen 1 Received: 24 May 2019 / Accepted: 2 August 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Introduction Over the past decades, assisted reproductive care has become increasingly safe and more widely applied. Egg retrieval has become an outpatient procedure, with ultrasound guidance, and stimulations have increasingly become less aggressive and safer with more individualization and safer trigger options. With this improvement in care, these treatments are considered low risk and applied more widely, including fertility preservation for elective reasons (so-called social egg freezing). However, it is incumbent upon providers to realize the application of even “simple” treatments, in a high-risk population, may have serious consequences. As long-term survival rates have improved among patients diagnosed with cancer and life-threatening disease, and with these improved survival rates, post-treatment quality of life has gained increased attention [1]. Among this growing population with life-threatening illness and greater survival expectation are women of reproductive age, and for that reason, an increasing number of such patients seek fertility treatment [2]. Oocyte and embryo cryopreservation prior to chemotherapy for fertility preservation have been associated with improved quality of life [3]. Thus, the American Society for Reproductive Medicine advises that all women recommended potentially gonadotoxic therapies should be counseled on the
impact of these treatments on their future fertility and their options for fertility preservation prior to initiation of gonadotoxic treatment [4]. Fertility preservation is increasingly accepted as an independent discipline within oncology and reproductive medicine [5]. Approximately 1000 research papers will be published this year on the topics of oncofertility and fertility preservation [6]. Previous studies have demonstrated that these preservation methods can be completed without significant delays in cancer treatment when a random-start approach is used [7]. There is a single publication discussing the potentially serious complications that can occur in sickle cell patients undergoing ovarian stimulation [8]. Few, if any papers, have ever focused on medical complications that have arisen during ovarian stimulation or oocyte retrieval related to an underlying cancer. Nor has any prior publication, to our knowledge, addressed the unique considerations and challenges physicians must address in this population to assure a safe and successful treatment. Addressing these challenges is crucial in maximizing each patient’s chance for future family building, avoiding delay in the treatment of disease, and most importantly in doing no harm to this unique patient population.
Case presentations * Kaitl
Data Loading...
