Abstract
Objective: The aim of the present study is to report our experience on elective women fertility preservation before cancer treatment.Study Design: This is a single-center retrospective observational study, including all patients who underwent elective fertility preservation before oncological treatment between January 2001 and March 2019 at our Institute.Results: Of a total of 568 women who received fertility counseling, 244 (42.9%) underwent 252 oocyte retrieval cycles after controlled ovarian stimulation for cryopreservation. The majority of patients were diagnosed with breast cancer (59.9%), followed by women affected by Hodgkin's and non-Hodgkin's lymphoma (27.4%). A minority comprised patients diagnosed with other malignancies that affected soft tissues (2.8%), ovary borderline type (2.4%), digestive system (1.6%), leukemia (1.6%), uterine cervix (1.2%). The remaining 3.1% were affected by other cancer types. The mean age of the cohort was 31.3 ± 6.4 years and the mean oocyte retrieval was 13.5± 8.4. Of 11 women who returned to attempt a pregnancy, three performed two thawed cycles. We obtained four pregnancies from 24 embryo transfers (Pregnancy Rate 36.4% for couple): two miscarriages and two live births. Overall, 95.7% of oocytes are still in storage.Conclusions: A close collaboration between Cancer and Fertility Center in a tertiary care hospital is essential to provide a good health service in oncological patients. Offering fertility preservation is no longer considered optional and must be included in every therapeutic program for women who receive an oncological diagnosis in their reproductive age. Oocyte cryopreservation appears to be a good opportunity for fertility preservation. Our results, although they are obtained in a small sample, are encouraging, even if only 4.5% of patients returned to use their gametes.
Highlights
Worldwide the incidence of cancer in women between the age of 15 and is 48.7/100,000, and in women aged between and 44 it is 180.1/100,000 [1], representing 13% of all newly diagnosed neoplasias
Strategies to preserve fertility in women undergoing gonadotoxic treatment include embryo cryopreservation (EC), oocyte cryopreservation (OC) and others still considered experimental in many countries and according to several professional organizations as ovarian tissue cryopreservation (OTC) [8], ovarian transposition and ovarian suppression by gonadotropin-releasing hormone (GnRH) agonist [9,10,11]
We propose OTC laparoscopic approach only in cases in which the oncologists don’t allow the 10–14 days needed to ovarian stimulation and oocyte retrieval or in cases of pre-pubertal or very young women
Summary
Worldwide the incidence of cancer in women between the age of 15 and is 48.7/100,000, and in women aged between and 44 it is 180.1/100,000 [1], representing 13% of all newly diagnosed neoplasias. A reproductive plan need to implemented and one option not exclude another one: Gn-RH analog can be considered in breast cancer patients, but without excluding oocyte and/or ovarian tissue preservation [13, 14]. Oocyte survival rate is sub-optimal with no significant differences in implantation or pregnancy rates between embryos obtained from cryopreserved mature oocytes and fresh oocytes only in selected populations OC requires ∼2 weeks, since a controlled ovarian hyperstimulation (COH) is needed prior to the procedure. It is not an option for patients with aggressive cancers that must be treated immediately nor in pre-pubertal children. The aim of the present study is to report our experience on elective fertility preservation (FP) before cancer treatment in order to increase clinicians’ knowledge of the current state of oocyte vitrification as a mean to safeguard oncological patients’ fertility and to improve their awareness toward such matter
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