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

Abstract

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.

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

“…Very recently, Cardozo et al also published their data on IVF outcomes of cancer patients undergoing fertility preservation, covering exactly the same 17-year period (1997-2014) as in our study [11]. They obtained a relative high utilization rate, as 21/63 (33 %) patients returned for frozen embryo transfer.…”

“…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].…”

“…Very little has been published on the efficacy and utilization rates of long-term embryo cryopreservation in cancer patients [9][10][11].…”

IVF for fertility preservation in breast cancer patients—efficacy and safety issues

“…There are scant reports based on small series which present reassuring live born rates in cancer patients who have returned for thawed embryo transfer [18][19][20][21]. The largest series, which include 21 cancer patients, display that pregnancy and live born rates achieved per transfer of thawed embryos, do not differ between fertility preservation patients and infertile (tubal/male factor) patients [22].…”

Innovative fertility preservation strategies and programs for young adults with cancer

“…8 The technique has good yield for cancer survivors: in many studies, the number of oocytes frozen following stimulation is equivalent for cancer survivors and age-matched infertile controls without cancer. [43][44][45] Oocyte retrieval rates vary according to diagnosis, with higher retrieval rates in women with breast and gynecological cancers compared to those with hematologic malignancies. 46,47 Ovarian stimulation protocols take 10-14 days to complete and can be started at any time of the menstrual cycle.…”