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Logistics – who, when and how

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Presentation on theme: "Logistics – who, when and how"— Presentation transcript:

1 Logistics – who, when and how
Milton Ka Hong Leong MDCM DSc(McGill) FRCS(C) FRCOG FACOG FHKCOG Director, IVF Centre HK Sanatorium & Hospitals Specialist in Reproductive Medicine Adjunct Professor, Department Obstetrics & Gynecology McGill University,Montreal, CANADA

2 Breast Cancer Patients
Clinical Summaries

3 Patient RT age 37 Cancer: Left Stage II ductal carcinoma
microinvasive in ¼ SLN dissection Date of surgery Day seen (LMP ) EC: one natural cycle 2 letrazole cycles – , 3 eggs total collected (0, 1, 2) 3 eggs vitrified

4 Patient WM Age 32 Cancer: right breast stage 2A
Date of surgery Day seen (LMP ) EC: natural cycle unstimulated on day 9 11 immature oocytes 4 fertilized 3 embryo frozen

5 Patient TW age 36 Cancer: right breast 2.1 cm Stage IIa
0/7 sentinel node positive ERO PRO Day of surgery Day seen (LMP ) Couple had 2 IVF treatments in London Stimulated cycle low dose FSH, 10 oocytes, 7 fertilized , 6 embryos frozen Antagonist treatment following egg collection

6 Patient WM age 35 Cancer: right breast 1.2 cm Gr III ductal carcinoma
3/24 axillary nodes positive Day surgery Day seen (LMP ) U/S showed follicles 17, 10 and 8 mm EC immature eggs, fertilized 2 embryos frozen

7 Patient TP age 36 Cancer: left breast 2.6 cm Gr III ductal carcinoma
0/6 axillary lymph nodes positive Date surgery: Date seen: (LMP ) U/S – small follicles. EC planned but patient had to settle business at home. When return preovulatory with large single follicle. Patient choose to delay chemotherapy Stimulated cycle 3/07: low dose FSH – antagonist given immediately 13 oocytes - 10 fertilized, 9 embryos frozen

8 Patient WY age 35 Cancer: stage IIB Left 4 cm Grade I ductal carcinoma
2/30 axillary node positive Date surgery Date seen (LMP ) U/S multiple antral follicles 4-7 mm EC oocytes obtained IVM 10/18 matured 6 embryos frozen

9 Patient BY Age 38 Cancer: left breast 1.4 GRII ductal carcinoma
0/3 axillary node positive Date surgery Day seen Patient refused chemotherapy ??? for pregnancy Patient has history of subfertility, and 3 IVF at QMH, poor responder IVM, no stimulation, 3 oocytes 2 embryos frozen embryos thawed and replaced, no pregnancy

10 What We can Learn From Case Reports
Breast cancer patients all Lead time 2-3 weeks Not optimised (cycle restriction)

11 Female Patients Cycle timing can make difference
2 collections v.s. 1 or none in the window between OT and Chemotherapy

12 Preservation Of Fertility
Male cancer patients Semen collection – no time restriction Prepuberty – needs surgery No proof effective

13 Testicular Tissue Freezing
Valid technique (Fischer Hamburg HKSH Data) For patients who has too low sperm count in ejaculate

14 Preservation of Fertility
Female Patients Respect menstrual cycle Timing is critical

15 Preservation of Fertility
Female patients Cryopreservation eggs Cryopreservation embryos Cryopreservation ovarian tissue Protection of ovaries from irradiation

16 Sperm cryopreservation for Cancer patients
Year Total no. cases 57 Age range 15-40 Outcome Still freezing 35 cases Thawed and used 3 cases Case 1- IVF twin with live birth Case 2- IVF singleton with live birth Case 3- Undergoing 1st IVF treatment Discarded Patient request - Patient diseased *14 cases 5 cases *Most have normal SA post Ca treatment

17 Oocyte cryopreservation slow freezing
Year Female Age (mean) 37.3 years No. oocyte freezing cases 13 - - all for unexpectedly failed sperm collection on day of OR No. oocyte thawing cases 10 No. oocyte thawing cycles 11 No. ET cycles 9 - total 12 embryos Survival rate 63.8% (44/69) Fertilization rate 46.5% (20/43) No. embryos transfer (mean) 1.3 Pregnancy rate per thawed oocyte 2.9% (2/69) Pregnancy rate per ET 22.2% (2/9)* Implantation rate 16.7% (2/12) * 1st live-birth in HK from cryopreserved oocyte Tjer et al Fert Steril 2005

18 HKSH experience Breast cancer patients: 7 Embryos cryopreservation: 6
Oocyt cryopreservation: 1 Used: 0 Semen cyropreservation for cancer patient: 9 Used: 1 Pregnancy: 1

19 Wish List An integrated comprehensive service which will coordinate and triage cancer patients’ need with treatment plan. Treatment plan will have full consideration of fertility preservation if patient so desires.

20 What can we do 24/7/365 Hotline or call no.
Immediate counseling appointment Coordinate cycle, integrating cancer therapy and fertility treatment Public awareness

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