Dados do Trabalho

Title

Methods of fertility preservation in female teenagers: A systematic review.

Objective

Main objective: Define which are the main methods for fertility preservation during the adolescence of young women.
Secondary objective: Indicate what are the most frequent motivation for fertility preservation among female teenagers.

Methods

This systematic review followed the updated Preferred Reporting Items for Systematic Review (PRISMA) guidelines, with the aim of evaluating and identifying the most appropriate methods for fertility preservation in adolescent girls. A systematic search was conducted in the electronic databases of BVS/Lilacs, PubMed/Medline, SciELO and Cochrane, on June13th, 2023. The final syntax was obtained using the Boolean operators AND and OR for multiple combinations of the search terms: adolescent [MeSH terms], fertility preservation [MeSH terms] and Therapeutic Uses [MeSH Terms]. Articles were included following PICOS strategy, being considered for inclusion clinical trials, systematic reviews, case-control, and cohort studies that addressed the theme in the female population. Editorials, author’s opinions, books, and in vitro rehearsals were excluded. Articles written in English and Portuguese were included.

Results

: 2918 articles were founded, of which 2904 were excluded. Of the 14 remaining studies, ovarian tissue cryopreservation was the most common recommendation for fertility preservation in this population, being the indicated method for 10 of these studies. This procedure is advantageous because it does not require additional hormonal stimulation and can be performed immediately without interfering with other treatments, such as oncological therapy. However, because the procedure is performed laparoscopically under general anesthesia, there are risks such as bleeding, infection, and reinsertion of malignant cells, that should be considered, especially, for patients with leukemia, lymphoma or neuroblastoma. The procedure is indicated for women who don’t have a sexual partner, don’t want to use a sperm donor, or have religious concerns about freezing embryos. It’s also a dispendious technique that requires long-term maintenance. Similarly, embryo cryopreservation was recommended by the studies, although, in the scenario of such young patients, the existence of a partner to perform in vitro fertilization is unlikely, making ovarian tissue cryopreservation more suitable for this age group.
However, 9 of the selected articles discussed alternative methods for secondary options of treatment, such as hormonal suppression with a GnRH agonist, which in the scenario of cancer patients, reduces exposure to chemotherapy at the uterine and ovarian levels, thereby reducing gonadotoxicity. In vitro maturation, oophoropexy and other techniques for ovarian preservation were also mentioned.
The most common motivation for adolescent fertility preservation, discussed in 12 articles, was its use in the treatment of oncologic diseases like, for instance, leukemia and ovarian cancer. Additionally, two other articles brought to light other distinct events in which fertility preservation is required. One of them dealt with transgender children and teenagers, while the other discussed primary and secondary hypogonadism.

Conclusion

Therefore, most of the articles analyzed point in the direction of ovarian cryopreservation as the best alternative for fertility preservation in adolescent females. However, other techniques were presented as viable alternatives, such as GnRH agonist (GnRH-a), gamete cryopreservation, in vitro maturation, and oophoropexy. Treatment of neoplasms has been the main driver for fertility preservation in adolescent females. However, further clinical trials on this topic are needed, as the available literature lacks significant, well-designed studies on fertility preservation in this age group.

Keywords

Adolescent, Fertility Preservation, Therapeutic Uses, Women