Pregnancy, fertility concerns, and fertility preservation procedures in French breast cancer survivors in the FEERIC national study (on behalf of the Seintinelles research network)

Abstract

Objective To study fertility concerns and oncofertility practices at time of breast cancer (BC) diagnosis. Design The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter study. Setting Web-based collaborative research platform Seintinelles. Patients 517 patients with prior BC diagnosis free from relapse and aged 18 to 43 years at inclusion (from 12th March 2018 to 27th June 2019). Intervention Baseline online self-administered questionnaires. Main Outcome Measure Fertility preservation procedures at BC diagnosis. Results Median age at BC diagnosis was 33.6 years and 424 patients (82.0%) received chemotherapy. Overall, 236 (45.6%) patients were offered specialized oncofertility counseling, 124 (24.0%) underwent one or more FP procedures with material preservation (oocytes n=108, 20.9%; embryos n=31, 6.0%; both oocytes and embryos n=13, 2.5%; ovarian cryopreservation n=6, 1.2%) and 78 patients received gonadotropin-releasing hormone agonists (15.1%). With a median follow-up of 26.7 months after the end of treatments,133 pregnancies (25.7%) had occurred in 85 patients (16.4%), including 20 unplanned pregnancies (15.0%). Most of the pregnancies were spontaneous (n=113, 87.6%), while 16 (12.4%) required medical interventions. Patients who had an unplanned pregnancy were less likely to have received fertility counseling (p=0.02) and contraceptive counseling (p=0.08) at BC diagnosis. Conclusion Most of the patients were not offered proper specialized oncofertility counseling at the time of BC diagnosis. Spontaneous pregnancies after BC were very much more frequent than pregnancies resulting from the use of cryopreserved gametes. Adequate contraceptive counseling seems as important as information about fertility and might prevent unplanned pregnancies.

Pregnancy After Breast Cancer in Young BRCA Carriers

“…A substantial proportion of young women with newly diagnosed breast cancer are interested in future fertility. 1,2 More than 12% of these young patients carry a germline pathogenic variant in the BRCA1 or BRCA2 genes. 3 Reproductive counseling of BRCA carriers is particularly complex considering the psychological fear of transmitting the pathogenic variant to their offspring, 4 the possible negative impact of deficient BRCA function on their ovarian reserve and fertility potential, 5 and the indication to undergo risk-reducing bilateral salpingooophorectomy at a young age due to increased risk of ovarian cancer.…”