ESHRE Female Fertility Preservation Guideline Flashcards

Flashcards generated based on the provided lecture notes on female fertility preservation from ESHRE guidelines, focusing on definitions, key concepts, and recommendations for practitioners.

Who developed the current clinical practice guideline?

ESHRE developed the guidelines.

What is the purpose of the ESHRE guideline ?

To improve the quality of healthcare delivery within the European field of human reproduction and embryology.

Does the adherence to clinical practice guidelines guarantee a successful outcome?

Does not guarantee a successful or specific outcome, nor does it establish a standard of care.

Who must make their own clinical decisions on a case-by-case basis?

Healthcare professionals.

Who makes no warranty, express or implied, regarding the clinical practice guidelines?

ESHRE.

What are some examples of clinical care teams?

The oncology team, the rheumatology team, the endometriosis team, the transgender identity team, etc.

Who is responsible for fertility and FP?

The FP team.

What is required prior to fertility preservation interventions?

Patients require an individual assessment of the indications and risks prior to fertility preservation interventions.

Who should provide information to patients regarding the impact of cancer and fertility preservation options?

Clinicians.

What information needs to be provided to women at risk of infertility?

1) impact of cancer, other diseases and their treatments on reproductive function; 2) impact of cancer, other diseases and their treatment on fertility, 3) fertility preservation options; 4) Issues related to cryopreservation storage after FP, 5) infertility and fertility treatments; 6) pregnancy after gonadotoxic treatment or underlying condition; and 7) other childbearing and parenting options.

What tools are recommended to provide better information on fertility preservation options to patients?

Decision aids (DAs).

What tool may healthcare professionals consider for a better provision of information to patients?

A checklist.

What should be offered to patients when dealing with FP decisions?

Psychological support and counselling.

What are the risk factors for psychological distress during FP?

Past psychopathology, maladaptive psychological processes, current exacerbated concerns, or distress regarding future fertility.

What assessment is required during gonadotoxic treatments?

Estimating the individual risk of gonadotoxicity.

What factors should be considered to estimate the individual risk of gonadotoxicity?

The characteristics of the proposed treatment, the patient and the disease.

What is recommended for predicting high and low response to ovarian stimulation?

Antral follicle count (AFC) or anti-Müllerian hormone (AMH).

What can be used to predict post-treatment recovery of ovarian function in premenopausal women with breast cancer or haematological malignancy?

Pre-treatment ovarian reserve.

When should pre-treatment AMH levels NOT be used?

As an indicator of post-treatment fertility.

What factors should be taken into consideration when estimating the risk of post-treatment POI?

Age, proposed gonadotoxic treatment type and dose, as well as pre-treatment AMH levels.

When women have a reduced ovarian reserve, how should advice be given?

Individualized.

What is the recommended ovarian stimulation protocol for women seeking fertility preservation for medical reasons?

The GnRH antagonist protocol.

In urgent fertility preservation cycles, is random-start ovarian stimulation an option in the luteal phase?

Luteal phase.

Why might the addition of letrozole to the antagonist protocol be considered for transgender men?

Reducing estrogenic symptoms.

Oocyte cryopreservation should be offered as __ for fertility preservation.

an established option.

Women with a partner should be offered the option to __.

cryopreserve unfertilized oocytes or to split the oocytes to attempt both embryo and oocyte cryopreservation.

Women considering oocyte cryopreservation for __ should be fully informed regarding the success rates, risks, benefits, costs and the possible long-term consequences.

age-related fertility loss.

is an established option for fertility preservation.

Embyro cryopreservation.

It is recommended to offer OTC in patients undergoing __

moderate/high risk gonadotoxic treatment where oocyte/embryo cryopreservation is not feasible

The GDG considers that OTC is __ for ovarian function and fertility preservation in post pubertal women.

an innovative method

__ should be used for OTC as it is well-established and considered as standard.

slow-freezing protocol

For OTT, __ should be performed as it is considered safe without causing additional surgical risk.

one-step laparoscopy procedure

OTT at the __ is recommended to restore fertility.

orthotopic site.

The decision to perform OTT in oncological patients requires __.

a multidisciplinary approach.

OTC/Ovarian tissue transplantation (OTT) can be considered in patients with POI-associated genetic and chromosomal disorders but __.

requires genetic counselling and should be performed within a research protocol.

It is recommended to evaluate the __ in the ovarian cortex (and in the residual medulla when available) using appropriate techniques in all cancer survivors before OTT and patients should be informed about this risk.

presence of residual neoplastic cells

OTT is not recommended in cases where __.

the ovary is involved in the malignancy.

OTT and pregnancy can be considered in __ such as endometrial cancer treated by fertility-sparing strategy or breast cancer, after complete remission of the disease.

hormone-sensitive tumours

__ should be regarded as an innovative FP procedure.

IVM

There seems to be some benefit of GnRH agonist treatment concurrent with __, with no apparent safety issues

cyclophosphamide

Where pelvic radiotherapy without chemotherapy is planned, women may be offered __ with the aim to prevent premature ovarian insufficiency.

GYN fertility preservation

Before the use of stored material, __ should be thoroughly assessed, taking into account treatment late effects, the age of the patient and the interval since treatment.

fitness for pregnancy

__ and appropriate obstetric monitoring is recommended in women intending to become pregnant after gonadotoxic treatments.

preconception counselling

Healthcare professionals should have a high level of awareness of the risk of __ during and after pregnancy care for transgender men.

depression and increased dysphoria

With regards to storage, a duration of __ is most often reported, and this is mostly extendable.

5 or 10 years

Fertility preservation should be included in basic general education, and in the training of

medical, surgical, radiological, and gynaecological oncologists, rheumatologists, gynaecologists, endocrinologists, haematologists.

Fertility preservation remains a possibility in transgender men, even after starting __-affirming hormone treatment.

testosterone

Urgent referral pathways need to be established allowing patients to be seen by a member of the FP team within __ after referral.

24-48 hours

A follow-up appointment with a FP doctor is recommended approximately __ after treatment for adults, and at an appropriate age for younger adolescents.

1 year

__ can be performed in most IVF centers.

Embryo and oocyte vitrification.

There is a need for a __ clinic environment.

trans-friendly

FP counselling and support services should be standard of care for __.

transgender adolescents and young adults.