Live birth with vitrified-warmed oocytes of a chronic myeloid leukemia patient nine years after allogenic bone marrow transplantation

Abstract

In 2010, an estimated 739,930 women were newly diagnosed with cancer. In approximately 9.4% of cases, patients were under 45 years of age [1, 2]. Although the probability of developing invasive cancer under 39 years of age is relatively low for women, the number of survivors at reproductive age are reasonably high, owing to notable improvements since 1975 in the relative 5-year survival rates as a result of earlier diagnosis and improved treatments [2]. Moreover, the 5-year relative survival rate among children under 19 years of age has improved from 61.7% for patients diagnosed between 1975 and 1977 to 82.6% for patients diagnosed between 2001 and 2007 [1]. The improved survival rate has resulted in more focus on patient quality of life, including the ability to preserve fertility as well as survival. Consequently, the demand for fertility preservation in cancer patients has increased in recent years. Although the American Society of Clinical Oncology (ASCO) and American Society of Reproductive Medicine (ASRM) consider sperm and embryo cryopreservation as established procedures for fertility preservation [3, 4], ASRM recently authorized the support of “oocyte cryopreservation as a fertility preservation strategy for women with cancer and other illnesses requiring treatment that pose a serious threat to their future fertility because they may have no other viable option” [5]. Along with the advancement of oocyte cryopreservation technology, ovarian tissue cryopreservation is becoming recognized as a valid strategy, with more than 13 live births reported to date using this technique [6]. However, a number of researchers have expressed concerns about the possible risk of reintroducing cancer cells [7–9]. Additionally, this procedure requires oophorectomy to obtain ovarian tissue, and has a major drawback in that amputation of 50% of the ovarian reserve results in risk of accelerating the process of premature ovarian failure after surgery or treatment. Therefore, the procedure should only be performed on female patients undergoing treatment with a distinct risk of infertility [10]. Oocyte cryopreservation is an attractive strategy to preserve fertility in women, since no surgery is required and there is no risk of cancer cell contamination. In particular, in hematopoietic cancer patients who are single and wish to use their future spouse’s sperm, oocyte cryopreservation is the only way to preserve fertility. Here, we have reported a successful pregnancy and delivery with vitrified-warmed oocytes stored over 9 years, following intracytoplasmic sperm injection (ICSI) and embryo transfer to the patient’s own uterus without a gestational carrier after bone marrow transplantation (BMT) for chronic myeloid leukemia (CML) conditioning with high-dose cyclophosphamide and fractional total body irradiation (TBI) of 1,200 cGy.