Introduction In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary‐care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients’ choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications. Material and methods Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi‐square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications. Results Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre‐pubertal (n = 48) and 73% of post‐pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002). Conclusions Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications.
Objective To investigate changes in serum anti‐Müllerian hormone (AMH) concentrations following ovarian cyst surgery, and predictors of these changes. Design Prospective cohort study with follow up at 3 and 6 months. Setting University hospital. Population Women of reproductive age scheduled for ovarian cyst surgery. Methods Women were recruited between March 2011 and March 2012 (n = 75). Serum AMH concentrations were measured preoperatively and at 3 and 6 months postoperatively. Main outcome measures Changes in AMH after surgery and predictors for these changes. Results After surgery, median AMH levels decreased significantly from 2.7 μg/L (0.2–16.9) to 1.6 μg/L (0.2–9.9) at 3 months and were still low, 1.6 μg/L (0.2–8.3) at 6 months (both p < 0.001). In patients with unilateral cysts, a significant and more rapid AMH decrease was seen after enucleation of endometriomas (n = 19) vs. dermoid cysts (n = 22) (p = 0.010). The reduction was long‐lasting at 6 months. In a multivariate regression analysis, a higher baseline AMH concentration was predictive of AMH reduction at 3 [odds ratio (OR) 1.9, 95% CI 1.1–3.1] and 6 months postoperatively (OR 2.5, 95% CI 1.2–5.2). Women with normal or elevated baseline AMH presented with a significant reduction of −23% and −43% at 3 and 6 months, respectively, whereas women with low or very low AMH had minimal or no changes over time. Patient's age, cyst size, duration of surgery or intraoperative bleeding were not predictive of a postoperative AMH decrease. Conclusions Reduction of AMH was of greater magnitude and longer duration after enucleation of endometriomas and in women with normal and high preoperative AMH levels.
In a prospective study, we investigated the impact of anti-Müllerian hormone (AMH) changes following ovarian cyst surgery on the probability to achieve pregnancy and live birth. Women of reproductive age (n = 60) were included before surgery for benign ovarian cysts. Serum AMH concentrations were determined pre- and postoperative at 6 and 24 months. Information regarding pregnancy wish and attempts to conceive were obtained by a questionnaire. At the time of inclusion, 45/60 women reported desire of children. At six months, the levels of AMH decreased significantly in the whole group and further reduction was observed at two years (from 2.7 μg/L to 2.0 μg/L to 1.1 μg/L, respectively, p< 0.008), with a percentage reduction of 42.9%. At two-year follow-up, 36 women reported to have attempted to conceive and 18 achieved pregnancy (50%), with a live birth rate of 33%. The percentage change in AMH at two years did not differ significantly between the women who conceived versus those who did not (p = 0.117). Data reported herein demonstrate that the AMH reduction following ovarian cyst surgery is maintained two years after surgery; however, the postoperative AMH decrease that follows ovarian cyst surgery might not reduce the chances to achieve pregnancy.
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