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Fertiprotekt

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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.

Aims

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]

Background

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]

Activity

The Fertiprotekt network has carried out international pioneering work in four areas:

  • National, comprehensive care structures in the area of fertility conservation have been created, which also serve as a role model for other countries.[1]
  • Treatment recommendations have been created, which allow a standardised and scientific approach.[7]
  • So-called luteal phase stimulation has been introduced, which allows hormonal stimulation to collect oocytes to be started at any time during the menstrual cycle. The procedure of egg-cell collection is therefore considerably shortened, and chemotherapy can be started earlier.[8]
  • The combination of ovarian tissue cryopreservation, directly followed by hormonal stimulation to collect egg cells for oocyte cryopreservation was first performed by centres in the network. This technique allows a significant increase in the chance of pregnancy.[9]
  • The first birth after transposition of ovarian tissue, which was transported to a central cryobank by overnight transport immediately after removal, was achieved by the network. This demonstrated that removed ovarian tissue can be centrally prepared and stored in specialised centres.[10][11]

Network seminars take place annually. The centres involved are obliged to regularly take part in these annual conferences.

Problems

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]

References

  1. ^ a b Michael von Wolff, Markus Montag: 6 Jahre FertiPROTEKT – Eine Zwischenbilanz. Gynäkologische Endokrinologie. 2 (2012), 86-90, doi:10.1007/s10304-011-0454-6. (in German language)
  2. ^ Fertiprotekt network’s code of ethics (in German language)
  3. ^ Matthias W. Beckmann, Helge Binder, Ralf Dittrich, Klaus Friese, Bernd Gerber, Gerald Gitsch, Walter Jonat, Manfred Kaufmann, Marion Kiechle, Rolf Kreienberg, Klaus Diedrich, Diethelm Wallwiener, Martin Wilhelm, Wolfgang Würfel, Olaf Ortmann: Konzeptpapier zur Ovarprotektion. Frauenarzt 47 (2006), p. 604-616, online (PDF; 214 kB) (in German language)
  4. ^ Del Mastro, Lucia; Ceppi, Marcello; Poggio, Francesca; Bighin, Claudia; Peccatori, Fedro; Demeestere, Isabelle; Levaggi, Alessia; Giraudi, Sara; Lambertini, Matteo; D'Alonzo, Alessia; Canavese, Giuseppe; Pronzato, Paolo; Bruzzi, Paolo (Jun 2014). "Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: Systematic review and meta-analysis of randomized trials". Cancer Treat Rev. 40 (5): 675–83. doi:10.1016/j.ctrv.2013.12.001. PMID 24360817.
  5. ^ Donnez, Jacques; Dolmans, Marie-Madeleine; Pellicer, Antonio; Diaz-Garcia, Cesar; Sanchez Serrano, Maria; Tryde Schmidt, Kristen; Ernst, Erik; Luyckx, Valérie; Yding Andersen, Claus (2013). "Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation". Fertil Steril. 99: 1503–13. doi:10.1016/j.fertnstert.2013.03.030.
  6. ^ Irtan, Sabine; Orbach, Daniel; Helfre, Sylvie; Sarnacki, Sabine (2013). "Ovarian transposition in prepubescent and adolescent girls with cancer". Lancet Oncol. 14: 601–8. doi:10.1016/S1470-2045(13)70288-2.
  7. ^ Michael von Wolff, Markus Montag, Ralf Dittrich, Dominik Denschlag, Frank Nawroth, Barbara Lawrenz: Fertility preservation in women - a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin's lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT. Archives of Gynecology and Obstetrics, 284 (2011), pp. 427-435, doi:10.1007/s00404-011-1874-1.
  8. ^ Michael von Wolff, Christian J. Thaler, Torsten Frambach, Cosima Zeeb, Barbara Lawrenz, Roxana M. Popovici, Thomas Strowitzki: Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril. 92 (2009), pp. 1360-5, doi:10.1016/j.fertnstert.2008.08.011.
  9. ^ Cosima Huober-Zeeb, Barbara Lawrenz, Roxana M. Popovici, Thomas Strowitzki, Ariane Germeyer, Petra Stute, Michael von Wolff: Improving fertility preservation in cancer, ovarian tissue cryobanking followed by ovarian stimulation can be efficiently combined. Fertil Steril. 95 (2011), pp. 342-4, doi:10.1016/j.fertnstert.2010.07.1074.
  10. ^ Ralf Dittrich, Laura Lotz, Gudrun Keck, Inge Hoffmann, Andreas Mueller, Matthias W. Beckmann, Hans van der Ven, Markus Montag: Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation. Fertil Steril. 97 (2012), pp. 387-90, doi:10.1016/j.fertnstert.2011.11.047.
  11. ^ Andreas Müller, Katja Keller, Jennifer Wacker, Ralf Dittrich, Gudrun Keck, Markus Montag, Hans van der Ven, David Wachter, Matthias W. Beckmann, Wolfgang Distler: Retransplantation of Cryopreserved Ovarian Tissue: the First Live Birth in Germany. Dtsch Arztebl Int 109 (2012), pp. 8-13, doi:10.3238/arztebl.2012.0008.
  12. ^ Kinderwunsch und Krebs. In: Die blauen Ratgeber. 49, brochure of the German Cancer Aid (Deutsche Krebshilfe), p. 37, ISSN 0946-4816, online (PDF; 1,44 MB) (in German language)

Further reading

  • Michael von Wolff, Darius Dian: Fertility preservation in women with malignant tumors and gonadotoxic treatments. Dtsch Arztebl Int. 109 (2012), pp. 220–6, doi:10.3238/arztebl.2012.0220
  • Dominik Denschlag: Fertilitätsprophylaxe. In: Christoph Keck: Kinderwunschbehandlung in der gynäkologischen Praxis: Sinnvolle Diagnostik- und Therapiestrategien für Frauenärzte. Georg Thieme Verlag, 2013, ISBN 3-131-71681-9, pp. 286–292 (in German language)
  • Michael von Wolff, Petra Stute: Netzwerk FertiPROTEKT. in: Michael von Wolff, Petra Stute: Gynäkologische Endokrinologie und Reproduktionsmedizin: Das Praxisbuch. chapter 36.5, pp. 399–400, Schattauer Verlag, Stuttgart 2013, ISBN 3-794-52792-5 (in German language)
  • Kinderwunsch und Krebs. In: Die blauen Ratgeber. 49, brochure of the German Cancer Aid, online (PDF-file; 1,44 MB) (in German language)
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