Fertility preservation in patients with haematological disorders: a retrospective cohort study

Abstract

This study investigated the factors associated with utilization of fertility preservation and the differences in treatments and outcomes by prior chemotherapy exposure in patients with haematological diseases. This study included all 67 women with haematological diseases seen for fertility preservation consultation at two university hospitals between 2006 and 2011. Of the total, 49% had lymphoma, 33% had leukaemia, 7% had myelodysplastic syndrome and 4% had aplastic anaemia; 46% had prior chemotherapy; and 33% were planning for bone marrow transplantation, 33% pursued ovarian stimulation and 7% used ovarian tissue banking; and 48% of patients did not pursue fertility preservation treatment. All five cycle cancellations were in the post-chemotherapy group: three patients with leukaemia and two with lymphoma. Patients with prior chemotherapy had lower baseline antral follicle count (10 versus 22) and received more gonadotrophins to achieve similar peak oestradiol concentrations, with no difference in oocyte yield (10.5 versus 10) after adjustment for age. Embryo yield was similar between those who had prior chemotherapy and those who had not. Half of the patients with haematological diseases who present for fertility preservation have been exposed to chemotherapy. While ovarian reserve is likely impaired in this group, oocyte yield may be acceptable.Women with haematological diseases, particularly haematological cancers, may need therapies that can impact fertility. In this study, women with haematological diseases who presented for fertility preservation consultation were evaluated to assess what factors were associated with the fertility preservation treatments chosen and the outcomes of ovarian stimulation for egg or embryo banking. Of the total patients, 46% had already had prior chemotherapy at the time of consultation, and one-third elected to pursue ovarian stimulation. Women who had prior chemotherapy had lower antral follicle counts and received more gonadotrophins to achieve similar peak oestradiol concentrations suggesting that ovarian reserve is likely impaired after chemotherapy in these women, consistent with the findings of other studies. However, there was no difference in oocyte or embryo yield in women undergoing ovarian stimulation before chemotherapy compared with those undergoing stimulation after chemotherapy, after adjusting for age. Thus while ovarian reserve may be impaired, response to ovarian stimulation and IVF may be acceptable for these women.