Fertility preservation for female cancer patients: early clinical experience

Purpose To compare the in-vitro fertilization (IVF) outcomes of cancer patients who underwent oocyte retrieval and embryo/ oocyte cryopreservation prior to gonadotoxic therapy to those of age and time-matched controls with tubal factor infertility. Methods All cancer patients who underwent embryo/oocyte cryopreservation at our institution from 1997 to 2014 were reviewed. Primary outcomes were total dose of gonadotropins used, number of oocytes retrieved, and number of 2pn embryos obtained. Outcomes were compared to age-matched controls with tubal-factor infertility who underwent a fresh embryo transfer within the same relative time period as the IVF cycle of the cancer patient. Results Sixty-three cancer patients underwent 65 IVF cycles, and 21 returned for frozen embryo transfer. One hundred twenty-two age-matched controls underwent IVF cycles with fresh transfer, and 23 returned for frozen embryo transfer. No difference was seen between cancer patients and controls with respect to total ampules of gonadotropin used (38.0 vs. 35.6 respectively; p=0.28), number of oocytes retrieved (12.4 vs. 10.9 respectively; p=0.36) and number of 2pn embryos obtained (6.6 vs. 7.1 respectively; p=0.11). Cumulative pregnancy rate per transfer for cancer patients compared to controls was 37 vs. 43 % respectively (p=0.49) and cumulative live birth rate per transfer was 30 vs. 32 % respectively (p=0.85). Cancer patients had a higher likelihood of live birth resulting in twins (44 vs. 14 %; p=0.035). Conclusions Most IVF outcomes appear comparable for cancer patients and age-matched controls. Higher twin pregnancy rates in cancer patients may reflect lack of underlying infertility or need for cancer-specific transfer guidelines.

Section: Discussionmentioning

confidence: 99%

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience

Cardozo

Thomson

Karmon

et al. 2015

“…However, their study published in 2015 on a series of 57 cancer patients who had embryos cryopreserved, showed a similar LBR per transfer between cancer patients and controls [11]. Hence, even if several other studies have reported lower numbers of retrieved oocytes compared to controls [5,7,19,20], this does not appear to have any impact on the pregnancy rate once the patient is cured [11,21].…”

Section: Pregnancy Ratementioning

confidence: 93%

Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment

Dolmans

Ouderaen

Demylle

et al. 2015

Purpose The aim of this study was to evaluate long-term embryo cryopreservation, utilization, and success rate in patients subjected to gonadotoxic treatments in the context of cancer. Methods This is a retrospective study on patients (n=54) undergoing ovarian stimulation and IVF for fertility preservation between January 1997 and June 2014. Embryos were slowfrozen and stored until the women were cured and able to undergo embryo transfer. Results Fifty-four women underwent 66 oocyte pick-up procedures in total, and embryos were obtained from 52 of the 54 patients. Four patients died before their frozen embryos could be thawed. Of the remaining 48, 9 women returned to use their embryos, resulting in 6 pregnancies (66 % cumulative pregnancy rate), two of which ended in miscarriage. The live birth rate per patient was thus 44 % (4/9). The true come-back rate, calculated after applicable exclusions, was found to be 23 %. Conclusion IVF followed by embryo freezing is a widely established technique for fertility preservation, but little has been published on the outcomes in cancer patients. While we found the number of good-quality embryos to be lower than in a normal population, the cumulative live birth rate was similar to that achieved with fresh embryos in non-cancer patients. The utilization rate of this fertility preservation method can be considered high.

“…In patients who have undergone chemotherapy, one would expect this impairment to be even more pronounced. Few studies to date have assessed the success of assisted reproductive technologies and fertility preservation in patients who have been exposed to chemotherapy [16,18,19]; however, results have been mixed.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.