Questions concerning fertility preservation during transition in girls with Turner syndrome: review of the literature

Abstract

Loss of fertility is one of the most important concerns facing Turner syndrome (TS) patients as they transition into adult health care. Due to the limited a nd rapidly decreasing ovarian reserve, many TS patients require fertility preservation (FP) t echniques to preserve their reproductive potential until they are ready to pursue pro creation. One has to also remember about the additional risks connected with pregnancy in TS patients. In order to determine the optimal time for introducing FP techniques and de crease the chance of an unnecessary intervention, markers and procedures assessing ovarian reserve have been developed. The exposure to potential cardiovascular complications should be determined before FP to avoid unnecessary procedures in patients with pote ntial contraindications to pregnancy. The aim of the present review is to answer the fo llowing three questions important for successful preservation of fertility and safe pre gnancy in TS: which markers of ovarian reserve should be used as selection criteria for FP? Which methods of FP are the safest and most effective? Are there any cardiovascular contrain dications to FP? For each of those questions, separate literature searches have been cond ucted. A total of 86 articles have been included in this review: 34 for the first question, 35 for the second, and 17 for the third. Ovarian reserve markers and cardiovascular contraind ications to pregnancy should be established before FP; hoverer, there are no unambiguous indicators as to which patients should be disqualified from the FP and more evidence is needed in this subject.

Keywords

• turner syndrome
• fertility preservation
• ovarian reserve
• cardiovascular risk