Is fertility preservation suggested in breast cancer patients with BRCA mutations

Abstract

breast cancer are frequently referred for fertility preservation treatment (FPT) consultation. Our objective was to identify predictive factors for FPT and fertility outcomes in breast cancer patients. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We analyzed 126 breast cancer patients, ages 18-42 years old, seen for FPT consultation at an academic fertility center from 2001-2017. We calculated proportions for patient diagnosis, demographics, type of FPT chosen, planned treatment, and in vitro fertilization (IVF) outcomes. Pearson chi-squared and Fisher's exact tests were performed to test for associations. RESULTS: Our cohort included 126 patients with a mean age of 33.6 + 4.9 years. Breast cancer stage, known in 106 patients, included 34.9% (n¼37) Stage 1, 50.0% (n¼53) Stage 2, 8.5% (n¼9) Stage 3, 6.6% (n¼7) Stage 4. At the time of consult, 15.1% (19/126) had prior chemotherapy and 12.7% (16/126) had prior radiation, while 79.4% (100/126) and 64.3% (81/126) had planned to receive chemotherapy and radiation, respectively. After counseling, 61.1% (77/126) underwent FPT. Treatment modalities included embryo cryopreservation 61.0% (47/77), oocyte cryopreservation 29.9% (23/ 77) and half embryo/half oocyte cryopreservation 9.1% (7/77). No patients underwent ovarian tissue cryopreservaton. Mean number of oocytes retrieved was 14.7 + 9.0. Significantly fewer oocytes were retrieved from patients with prior chemotherapy (avg. 5.9 + 6.2 with vs. 15.3 + 9.1 without, p<0.001) or prior radiation (avg. 9.5 + 7.8 with vs. 15.2 + 9.0 without, p<0.001). After FPT, 16.8% (13/77) of women subsequently attempted pregnancy with frozen embryos and no patients returned to utilize their frozen oocytes thus far. The clinical pregnancy rate was 21.7% (5/23) with a live birth rate of 17.9% (4/23) per transfer. Overall, 11 women had a clinical pregnancy (conceived naturally, with intrauterine insemination, or after embryo transfer) and 10 women had live births. Of patients that underwent FPT, 6.5% (5/77) died from breast cancer and did not utilize their frozen eggs or embryos. CONCLUSIONS: In our analysis of breast cancer patients seen for FPT consultation, over half underwent either embryo or oocyte cryopreservation. However, over the 16-year period, less than 20% returned to attempt pregnancy with frozen eggs or embryos and of those there was a less than 20% live birth rate. Further research is needed regarding utilization of FPT services in this group.