1. Hananel Holzer, MD Medical Director, MUHC Reproductive Center McGill University Health Center Assistant Professor, Dept. of Obstetrics & Gynecology McGill University McGill University McGill University Health Centre

2. A comprehensive approach for fertility preservation

5. Ovarian reserve W. Hamish B. Wallace 2010

6. Ovarian reserve W. Hamish B. Wallace 2010

7. Ovarian reserve W. Hamish B. Wallace 2010

9. Primordial Follicle Count ⇩⇩⇩ Ovarian Reserve ⇩⇩⇩ Early Menopause and Infertility

11. control chemotherapy Apoptosis TUNEL staining of PMF in human ovaries

14. Apoptosis Vascular injury Cortical fibrosis Chemotherapy: Direct and indirect damage cortex medulla

19. Fertility preservation

38. McGill vitrification tool, Cryoleaf Equilibration medium: Vitrification medium:

39. Oocyte vitrification: The McGill experience 38 Patients 31.5 ± 0.5 Mean age 463 (12.2 ± 0.9) Oocytes vitrified and thawed (mean t ±SEM) 383 (81.4 ± 3.7) Oocytes survived (mean % ±SEM) 287 (75.6 ± 3.7) Oocytes fertilized (mean % ±SEM) 133 (3.5 ± 0.2) Embryos transferred (mean ±SEM) 25/133 (19.1 ± 4.2) Implantation per embryo (mean % ±SEM) 17 (44.7) Clinical pregnancy rate per cycle (%) 3 Ongoing pregnancy 7 Singleton pregnancies 5 Twin pregnancies 1 Triplet pregnancies 13 Live births 20 Newborns

43. IVM results 2009—PCOS & PCO Reinblatt 2010

47. Mature oocytes at oocyte collection in IVM cycles 8mm 12mm 14mm

49. Holzer et al ESHRE 2007 Vitrification of IVM oocytes No. of patients 20 Mean age 30.7 ±3.7 No. of mature oocytes retrieved 7 No. of immature oocytes retrieved 295 Mean oocyte maturation rate (%) 67.9+4.1 No. of oocytes vitrified and thawed 215 No. of oocytes survived (mean % + SEM ) 148 (67.5 + 5.8) No. of oocytes fertilized (mean % + SEM) 96 (64.2 + 4.5) No. of embryos transferred (median; range) 64 (3.2; range 1 - 6) No. of implantations (mean % + SEM) 5 (10.3 + 5.7) No. of clinical pregnancies (%) 4 (20.0) No. of live births (%) 4 (20)

54. Oocyte aspiration from excised ovarian tissue

61. Fertility preservation strategies offered at McGill Fertility Preservation Center Chemotherapy can be delayed and hormonal stimulation not contra indicated Chemotherapy cannot be delayed or hormonal stimulation to be avoided IVF Treatment In-vitro maturation of oocytes Male partner No male partner Embryo vitrification Oocyte vitrification Collection of immature oocytes from ovarian tissue Ovarian tissue cryopreservation Laparoscopic ovarian biopsy Mature oocytes

65. TREAT I NG P H Y S C I A N COUNSELLING

68. Disease Categories for those who Froze Oocytes/embryos mean age = 29.7, SD =±5.6 Type of Cancer N=183 Breast cancer 75 Hematological malignancies 47 Brain malignancies 15 Gynecological cancers 14 Sarcoma 11 Desmoid Tumour 5 Autoimmune disease 9 Melanoma 1 Colorectal cancer 5 GIT Malignancy 1

71. Proper counseling and shared decision making Fertility preservation center

72. Thank you

73. Fertility preservation for young patients with cancer Wallace et al. Lancet Oncology 2007

76. Fertility preservation for young patients with cancer Wallace et al. Lancet Oncology 2007