Fertility preservation in Turner syndrome
Fertility preservation in patients with Turner syndrome represents an important issue even if it is particularly complex due to the rapid and profound exhaustion of the pool of follicles.
Michaël Grynberg, M.D., Ph.D., Maud Bidet, M.D., Julie Benard, M.D., Marine Poulain, Pharm.D., Ph.D., Charlotte Sonigo, M.D., Isabelle Cédrin-Durnerin, M.D., Ph.D., Michel Polak, M.D., Ph.D.
Volume 105, Issue 1, Pages 13-19
Premature ovarian insufficiency is a relatively rare condition that can appear early in life. In a non-negligible number of cases the ovarian dysfunction results from genetic diseases. Turner syndrome (TS), the most common sex chromosome abnormality in females, is associated with an inevitable premature exhaustion of the follicular stockpile. The possible or probable infertility is a major concern for TS patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The severely reduced follicle pool even during prepubertal life represents the major limit for fertility preservation and is the root of numerous questions regarding the competence of gametes or ovarian tissue cryobanked. In addition, patients suffering from TS show higher than usual rates of spontaneous abortion, fetal anomaly, and maternal morbidity and mortality, which should be considered at the time of fertility preservation and before reutilization of the cryopreserved gametes. Apart from fulfillment of the desire of becoming genetic parents, TS patients may be potential candidates for egg donation, gestational surrogacy, and adoption. The present review discusses the different options for preserving female fertility in TS and the ethical questions raised by these approaches.