Fertility preservation is an emerging discipline extending beyond cancer patients: analysis of a large experience

Abstract

OBJECTIVE: Fertility preservation (FP) has in the last decade emerged as a new discipline. What characterizes patients in need of such services and what type of techniques are utilized in attempts at FP has, however, never before been reported, based on large patient volumes. The goal of this study was, therefore, to analyze the experience in a large program for FP. DESIGN: Retrospective. MATERIALS AND METHODS: We analyzed the characteristics of patients who were referred for FP during the years 2000-2008. RESULTS: Data were available for 462 FP referrals. The most common diagnosis was breast cancer (n=308; 66.7%). Of those, 70.5% (217/308) were counseled in regards to FP pre-chemotherapy, and 29.5 % (91/308) after the treatment had begun or was completed. The second most frequent diagnosis were hematologic malignancies (n=70, 15.2%). Twenty-three women (5%) were, however, referred for non-cancerous conditions (table 1).Table 1Diagnosisn%Breast Ca30866.7Hematol. Ca7015.2Gynecol. Ca286.1GI Ca132.8Other Ca204.3Non-Ca235Total462100 Open table in a new tab In 59 patients (12.8%), no FP was recommended, either because treatment had already begun, advanced age/low ovarian reserve, or advanced stage cancer. Two-hundred-forty-one women (52.2%) underwent at least one methodology of FP; amongst those, 6 (2.5%) ended up utilizing more than one. Mean age for women undergoing FP was 33.1±7.4 years (range 4-46). The most common FP method utilized was embryo cryopreservation (EC) (50.6%), with a majority performed for breast cancer (89.3%). Oocyte cryopreservation (OC) was performed in 5.4%, with the most frequent diagnosis also being breast cancer (76.9%). Treatment cycles were cancelled in 23 patients (9.5%), -all due to poor response. Ovarian tissue cryopreservation (OTC) was performed in 64 women (26.6%), with the most frequent indication being hematologic malignancies. Women undergoing OTC were significantly younger than those undergoing EC (26.6±9.6 vs. 34.9±4.3, p <0.05). The least frequently used FP technique was, thus, OC. CONCLUSIONS: Amongst women counseled, a majority chooses to undergo FP. The most common indications for FP are breast cancer and hematological malignancies. While EC is the most common approach, OC is performed least frequently, partly because of the more recent availability of this technique. Because an increasing number of FP referrals are made for non-cancer conditions, the recently suggested acronym “Onco-Fertility” to describe the evolving discipline of FP does not appear inclusive enough.