Female cancer survivors are low responders and have reduced success compared with other patients undergoing assisted reproductive technologies

Abstract

To investigate the effect of prior chemotherapy and radiation on assisted reproductive technology (ART) outcomes. Retrospective cohort study. University-based infertility clinic. Female cancer survivors who had received chemotherapy or radiation and all other women undergoing first-fresh IVF/intracytoplasmic sperm injection (ICSI) cycles. Survivors' ART outcomes were compared with all women undergoing first-fresh IVF/ICSI cycles and those with male-factor infertility only. Multivariate logistic and Poisson regression analyses were used to estimate the effect of cancer therapy on ART outcomes. Number of oocytes retrieved and embryos obtained; odds of cycle cancelation, clinical pregnancy, and live birth. Compared with others undergoing IVF/ICSI, survivors had significantly fewer oocytes retrieved and embryos available for transfer. In addition, survivors were significantly more likely to be canceled (odds ratio [OR] 5.60, 95% CI 2.94-10.66) and had lower pregnancy and live birth rates (OR 0.30, 95% CI 0.13-0.68; and OR 0.27, 95% CI 0.10-0.69; respectively). Odds ratios were stronger when the comparison group was restricted to those with male-factor infertility only. Women who have received systemic therapy for malignancy should be considered to be low responders and counseled that their per-cycle live birth rate is lower than that of their peers. These data strongly support offering fertility preservation before cancer therapy when possible.