Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation

Abstract

Purpose Determine the outcome of embryo cryopreservation in female oncology patients Methods The outcomes of IVF/ICSI cycles in oncology patients over 15 years in a University Teaching Hospital. Results Forty-two oncology patients (mean 31.9±3.9 years) underwent embryo cryopreservation treatment (n=33 IVF, n=6 ICSI). Controlled ovarian stimulation with GnRH antagonist protocol (n=34; 81 %) yielded fewer oocytes than GnRH agonist protocol (n=8; 19 %) (9.4±6.3 vs. 15.3±8.9; p=0.04) respectively. There was no significant difference in mean (±SD) duration of ovarian stimulation (11.6±2.6 vs.10.6±2.7), median gonadotrophin dose (1950( vs. 1670, median day 5-6 oestradiol level (1124 vs.1129 pmol/l) or embryo yield (6.2±4.1 vs. 8.8± 4.3; p=0.07) between GnRH antagonist and agonist treatment cycles respectively. Thirty-nine patients cryopreserved embryos and three had their cycle cancelled. During this study period, of those who cryopreserved embryos, 5 patients underwent 9 frozen-thaw cycles (13 %), resulting in 2 live births (1 twin, 1 singleton, live birth rate 22 %). Six patients died (15 %), 3 conceived naturally (8 %) and 2 couples separated (5 %). Fourteen patients discarded their embryos (36 %). Twenty-two patients' (56 %) have embryos remaining in storage. Conclusions This study demonstrates that embryo cryopreservation in female oncology patients gives a satisfactory live birth rate. However, there are concerns regarding costeffectiveness, resulting from high disposal/non-usage of embryos, and further studies are required.

Ovarian tissue cryopreservation followed by controlled ovarian stimulation and pick-up of mature oocytes does not impair the number or quality of retrieved oocytes

“…Barcroft et al recently published their 15-year follow-up of patients undergoing embryo cryopreservation for FP, obtaining 2 live births and 1 miscarriage after 9 embryo transfers in 5 patients [16]. …”

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

“…No matter what method of FP is chosen, there is a dramatic lack of data on success rates of FP in patients with BC or other types of cancer. One single study focusing on the long-term outcome of FP and based on a small number of patients (of which more than half were BC patients) reported very low utilization of frozen embryos after FP 51. BC patients who want to preserve their fertility should be referred by their oncologist to a fertility specialist at diagnosis and preferably before or very shortly after surgery in order to decrease the time delay and increase the number of women who can feasibly undergo FP 52.…”

Fertility after breast cancer treatment

“…It is reasonable to assume that the preservation of future fertility is likely to be a priority for women desiring pregnancy under the age of 40 years. Therefore, there are currently several potential options for women facing premature ovarian failure and desiring preservation of fertility, including all available assisted technologies, such as in-vitro fertilization and embryo transfer (IVF-ET), in vitro maturation, oocyte and embryo cryopreservation, and cryopreservation of ovarian tissue [16,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

“…Currently, embryo and mature oocyte cryopreservation following IVF are the only techniques endorsed by the American Society of Reproductive Medicine, and other methods are still considered to be investigational [52]. The outcome of the various fertility preserving options used in cancer patients is presented in Table 2 [51,53,54]. In clinical situations for which chemotherapy needs to be started for young patients facing premature ovarian failure, ovarian tissue preservation seems to be a promissing option of restoring fertility, in conjuction with other options, like immature oocyte retrieval, in-vitro maturation of oocytes, oocyte vitrification, or embryo cryopreservation.…”