Fertility in Turner syndrome

Authors

  • Jacqueline K. Hewitt,

    Corresponding author
    1. Murdoch Childrens Research Institute, Melbourne, Vic., Australia
    2. University of Melbourne, Melbourne, Vic., Australia
    • Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
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  • Yasmin Jayasinghe,

    1. University of Melbourne, Melbourne, Vic., Australia
    2. Department of Gynaecology, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
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  • David J. Amor,

    1. Murdoch Childrens Research Institute, Melbourne, Vic., Australia
    2. University of Melbourne, Melbourne, Vic., Australia
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  • Lynn H. Gillam,

    1. University of Melbourne, Melbourne, Vic., Australia
    2. Children's Bioethics Centre, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
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  • Garry L. Warne,

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
    2. Murdoch Childrens Research Institute, Melbourne, Vic., Australia
    3. University of Melbourne, Melbourne, Vic., Australia
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  • Sonia Grover,

    1. University of Melbourne, Melbourne, Vic., Australia
    2. Department of Gynaecology, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
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  • Margaret R. Zacharin

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Vic., Australia
    2. Murdoch Childrens Research Institute, Melbourne, Vic., Australia
    3. University of Melbourne, Melbourne, Vic., Australia
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Correspondence: Dr Jacqueline Hewitt, Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, Vic. 3052, Australia. Tel.: +61 3 9345 5951; Fax: +61 3 9345 6240; E-mail: jackyhewitt@gmail.com

Summary

There is increasing interest in fertility and use of assisted reproductive technologies for women with Turner syndrome (TS). Current parenting options include adoption, surrogacy, and spontaneous and assisted reproduction. For women with TS, specific risks of pregnancy include higher than usual rates of spontaneous abortion, foetal anomaly, maternal morbidity and mortality. Heterologous fertility assistance using oocytes from related or unrelated donors is an established technique for women with TS. Homologous fertility preservation includes cryopreservation of the patient's own gametes prior to the progressive ovarian atresia known to occur: preserving either mature oocytes or ovarian tissue containing primordial follicles. Mature oocyte cryopreservation requires ovarian stimulation and can be performed only in postpubertal individuals, when few women with TS have viable oocytes. Ovarian tissue cryopreservation, however, can be performed in younger girls prior to ovarian atresia – over 30 pregnancies have resulted using this technique, however, none in women with TS. We recommend consideration of homologous fertility preservation techniques in children only within specialized centres, with informed consent using protocols approved by a research or clinical ethics board. It is essential that further research is performed to improve maternal and foetal outcomes for women with TS.

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