Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors

Abstract

Purpose Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes. Methods Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome.Results From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte+zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12±2 days with 14±11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded. Conclusions Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-oflife marker for survivors.

Successful Oocyte Cryopreservation in Reproductive-Aged Cancer Survivors

“…Commensurate with their higher estradiol response, those with hematologic malignancies had more oocytes retrieved (22, interquartile range 13-30), oocytes cryopreserved (19, interquartile range 10-30), and metaphase II oocytes cryopreserved Because the gynecologic cancer group represented a heterogeneous blend of patients, and because this group is the oncologic patient population for which gynecologists provide care, we subdivided the oocyte yield outcomes of these patients to assess differences. These data are also shown in Table 2 [8][9][10][11][12][13][14][15][16][17][18][19][20]. Compared with the expected value for age, patients with ovarian, uterine, and cervical malignancies had a median of 27 (interquartile range 214 to 1), +12 (interquartile range 23 to 13), and +4 (interquartile range 28 to 8) oocytes retrieved, respectively.…”

“…Per the American Society of Clinical Oncology, it is now standard of care to offer reproductive-aged patients with cancer a fertility preservation consult before administering gonadotoxic therapies. 19 This discussion is crucial because fertility preservation can be accomplished with minimal to no delay in cancer treatment 17,20 and many cancer treatments decrease fertility. 21 Interestingly, nearly half of surveyed oncologists would accept 1-5% decreased survival in exchange for increased fertility.…”

“…Our cryopreservation protocols have been previously reported. 17 For oocyte thaw cycles, all surviving metaphase II oocytes were fertilized through intracytoplasmic sperm injection with resultant embryos cultured 3 (n54) or 5 (n57) days before transfer. Embryos were placed in the uterus under abdominal ultrasound guidance using a Wallace transfer catheter.…”

Preserving fertility in patients undergoing treatment for breast cancer: current perspectives

“…On the other hand, institutions offering FP services should be able to provide rapid access to FP counseling by an interdisciplinary medical team consisting of oncologists, reproductive endocrinologists, and reproductive surgeons 53. Patients facing fertility-threatening treatments might also need additional help from mental health professionals during a difficult decision-making process43 and from financial counselors for tackling the high costs if medical insurance coverage is lacking 54. Genetic counseling is recommended for young BC patients carrying the breast cancer susceptility genes BRCA1 or BRCA2 to discuss the potential risks of transmission to their offspring and the possibility of preimplantation genetic diagnosis of BRCA mutations in the embryo before embryo transfer 55.…”

Discussing reproductive health in spinal care, part II: fertility issues

“…Many diseases jeopardize reproductive health and as a result, fertility issues arise in several medical fields. Oncology care has been among the first to urge the need for discussing fertility, initially by running surveys among doctors and patients to expose the lack of discussion about fertility [2,3], later by developing guidelines regarding the options for fertility preservation (FP) and the initiation of this topic in clinical practice, leading to a new field of ''oncofertility'' [4][5][6][7][8]. In spinal care, patients are faced with potential hazards to fertility and reproduction as well [9].…”