Motherhood after cancer: fertility and utilisation of fertility-preservation methods

Abstract

Purpose Due to modern and individualised treatments, women at reproductive age have a high survival rate after cancer therapy. What are pregnancy and birth rates of women after cancer and how often do they use cryopreserved ovarian tissue or gametes? Methods From 2007 to 2015, 162 women aged 26.7 ± 6.9 years were counselled for fertility preservation at a single University Fertility Centre. A questionnaire study was performed in average 3 and 6 years after the diagnosis of cancer. The women were asked about their fertility, partnership, family planning, and pregnancy history. 72 women (51%) answered a written questionnaire in 2016. 59 women were reached again by phone in 2019 (82%). Results The preferred method of fertility preservation was ovarian tissue cryopreservation (n = 36, 50%); none of the women had ovarian hyperstimulation in order to cryopreserve oocytes. About 3 years after treatment, 37 women of 72 women (51%) of the women with a mean age of 29.9 years had a strong wish to conceive. 21/72 (29%) had actively tried to conceive after successful cancer treatment; eight women (11%) were already pregnant or had children. Six years after cancer diagnosis 16/59 (27%) women had ongoing anticancer treatment. 12/59 (20%) were pregnant or had children, while 39% (23/59) had no menstrual cycle. Only one woman used her cryopreserved ovarian tissue, but did not become pregnant. Conclusion After cancer and gonadotoxic treatment, women's desire to have a child is substantial. In this study, the rate of spontaneous pregnancies and births was 20% 6 years after gonadotoxic therapies. Not every woman, however, has the opportunity to conceive: factors impairing fertility include ongoing cancer treatment or persistent disease, no partner, no menstrual cycle, as well as other reasons for infertility.

On Becoming a Mother After Cancer Survival: A Comprehensive Literature Review

“…increasing survival rates in female cancer survivors of reproductive age have led to the development and increased use of several fertility preservation techniques [2]. However, fertility preservation procedures are usually expensive and time-consuming [24].…”

“…in developing countries, over the last decades, cancer is increasingly common in women of childbearing age [1,2]. Breast cancer, cervical cancer, thyroid cancer, non-Hodgkin's lymphoma, and leukemia are the most frequent cancers among women younger than 40 [3].…”

“…Since thousands of cancer patients and survivors are in their reproductive age and the risk of infertility after cancer is a reality that these women must face, discussing fertility after cancer treatment is a subject of great clinical importance. Women should have the opportunity to plan the desired motherhood, given that several methods are already well-established and available [2]. in this context, oncofertility emerges as a clinical specialty that aims to understand cancer patients and survivors' needs regarding their reproductive potential before, during, and after antineoplastic treatments [9].…”

Fertility Preservation in Girls and Women: State of Art and Future Possibilities

“…For this reason, these women should not be discouraged from becoming pregnant. A recent study by Poorvu PD et al [16] demonstrated that many women remain interested in future fertility in the 4 years after a breast cancer diagnosis but only a minority of them attempt to become pregnant and another study reported that 51% of cancer survivors who underwent fertility preservation had a strong wish to conceive about 3 years after treatment but only 29% had tried to conceive [111] and two different studies reported a utilization rate of cryopreserved embryos or oocytes of 8-29% [112] and of 24% [113]. Young cancer survivors may face several barriers to safely and successfully conceiving a pregnancy [22] but a multidisciplinary team should counsel women in the best way to give them adequate information to make conscious choices, knowing the real risks and removing the shadows of fears about what is safe.…”

A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment

“…Therefore, no spontaneous menstruation within a year is frequently associated with permanent ovarian damage and induced menopause [39]. All patients with gonadotoxic therapy for cancer, with temporary ovarian damage, experience premature menopause [96]. The difference depends on the number of remaining primordial follicles.…”