Fertility Preservation Consultation Research Articles

Comprehensive fertility preservation can be offered in a timely manner around gonadotoxic therapy in children and adolescents.

Treatment for certain childhood cancers and nonmalignant conditions can lead to future infertility and gonadal failure. The risk of treatment delay must be considered when offering fertility preservation (FP) options. We examined the timeline from FP referral to return to treatment (RTT) in pediatric patients who underwent FP due to iatrogenic risk for infertility. A retrospective review was performed of patients with FP consultation due to an increased risk of iatrogenic infertility at Ann & Robert H. Lurie Children's Hospital of Chicago from 2018 to 2022. Data on diagnosis, age, treatment characteristics, and procedure were collected. A total of 337 patients (n=149 with ovaries, n=188 with testes) had an FP consultation. Of patients with ovaries, 106 (71.1%) underwent ovarian tissue cryopreservation (OTC), 10 (6.7%) completed ovarian stimulation/egg retrieval (OSER), and 33 (22.1%) declined FP. Of the patients with testes, 98 (52.1%) underwent testicular tissue cryopreservation (TTC), 48 (25.5%) completed sperm banking (SB), and 42 (22.3%) declined FP. Median time from referral to FP consultation was short (ovaries: 2days, range: 0-6; testes: 1day, range: 0-5). OSER had a significantly longer RTT versus OTC and no FP (52.5 vs.19.5 vs. 12days, p=.01). SB had a significantly quicker RTT compared to TTC or no FP (9.0 vs. 21.0 vs. 13.5days; p=.008). For patients who underwent OTC/TTC and those who declined FP, there was no significant difference in time from consultation to treatment. It is feasible to promptly offer and complete FP with minimal delay to disease-directed treatment.

Fertility outcomes several years after urgent fertility preservation for patients with breast cancer

To study the fertility outcomes of women who tried to conceive after breast cancer (BC) treatment and fertility preservation. Retrospective observational, bicentric cohort study. University hospital. Patients with BC. All patients who had undergone fertility preservation before BC treatment between January 2013 and July 2019 were included (n = 844). The endpoint date was March 1, 2022. Patients with missing data on pregnancy attempts after a cancer diagnosis (n = 195) were excluded from the pregnancy analysis. Cumulative incidences of pregnancy and live birth (LB) were calculated. For women who became pregnant, the time to conception was calculated between the first fertility preservation consultation and the estimated day of conception. For those who did not conceive, we considered the time between the first fertility preservation consultation and the endpoint date, or the date of patient death. A Cox regression model was used to study the predictive factors for pregnancy and LB. Among the 649 patients with available data on pregnancy attempts after BC diagnosis, 255 (39.3% [35.5-43.2]) tried to conceive (median follow-up of 6.5 years). Overall, 135 (52.9% [46.6-59.2]) of these patients achieved a pregnancy, mainly through unassisted conception (79.3% [72.8-84.8]), and 99 reported an LB (representing 38.8% of patients who attempted conception). In our cohort, 48 months after the first fertility preservation consultation, the cumulative incidence of pregnancy was 33.1% ([27.6-37.9]). After adjustment for age, parity, type of chemotherapy administration, and endocrine therapy, only multiparity at diagnosis and absence of chemotherapy were positive predictive factors of pregnancy after cancer. Of the 793 patients who had vitrified oocytes and embryos, 68 used them (27% [21.3-32.5] of the patients who tried to conceive), resulting in 8 LBs (11.8% [5.2-21.9]). Women who used their cryopreserved oocytes and embryos were older at the first consultation of fertility preservation (hazard ratio 1.71 [1.42-2.21]), and chose more often to vitrify embryos (hazard ratio 1.76 [1.28-2.23]). Although pregnancy rates after fertility preservation for patients with BC are low, most conceptions are achieved without medical assistance. Our findings provide useful information to advise women on the different techniques of fertility preservation, their efficacy, and safety, as well as the relatively high chances of unassisted conception.

Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman.

This study aimed to (1) determine differences in depression, anxiety, body image, quality-of-life (QOL), and decision regret scale (DRS) scores in transgender individuals undergoing fertility preservation (FP) compared to those who decline and (2) determine if DRS score following FP varies between transgender individuals and cisgender women. Sixteen transgender birth-assigned (BA) females and 13 BA males, undergoing FP consultation at an academic center between January 2016 and November 2019, were compared to each other and cisgender cohorts with pre-existing data: 201 women undergoing elective oocyte cryopreservation (EOC) between 2012 and 2016 and 44 women with cancer undergoing FP between 1993 and 2007. Outcomes included demographics; validated scales for depression, anxiety, body image, QOL (see below) in the trans cohort; DRS score in all three cohorts. Of 29 transgender individuals participating, 10 BA females (62%) and 12 BA males (92%) underwent FP. Beck Depression Inventory II, Hospital Anxiety and Depression Scale, Body Image Scale for Transsexuals, Satisfaction with Life Scale, Short Form Health Survey-36, and DRS scores were not significantly different between trans individuals who underwent FP and those who declined. On univariate modeling, regret was significantly lower in transpeople undergoing FP compared to those who did not (OR 0.118, p = 0.03). BA female and BA male transpatients undergoing FP reported DRS median scores 5 (mean 9) and 7.5 (mean 15), respectively, both were not significantly different from cisgender women (p = 0.97, p = 0.25) nor from each other (p = 0.43). Depression, anxiety, body image, and QOL, in a group of individuals presenting for FP consultation, appear similar between transpeople undergoing FP and not, while regret is significantly lower in those choosing FP. FP is an option for transgender individuals without significant differences in regret compared to cisgender women.

Sexual and Reproductive Health Care after Gonadotoxic Treatment in Females at a Tertiary Pediatric Hospital

Study ObjectivesRecommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. MethodsFollow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. ResultsWe included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. ConclusionThis study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.

A 10-year experience in testicular tissue cryopreservation for boys under 18 years of age: What can be learned from 350 cases?

A growing number of centers worldwide are preserving testicular tissue (TT) of young boys at risk of fertility loss to preserve their fertility. Data in this regard are scarce and experience sharing is essential to the optimization of the process. This report of our 10-year activity of pediatric fertility preservation (FP) has the objective to (1) improve knowledge regarding the feasibility, acceptability, safety, and potential usefulness of the procedure; (2) analyze the impact of chemotherapy on spermatogonia in the cryopreserved TT. For this retrospective study of data prospectively recorded, we included all boys under 18 years of age referred to the FP consultation of our academic network between October 2009 and December 2019. Characteristics of patients and cryopreservation of testicular tissue (CTT) were extracted from the clinical database. Univariate and multivariate analyses were used to assess factors associated with the risk of absence of spermatogonia in the TT. Three hundred and sixty-nine patients (7.2 years; 0.5-17.0) were referred to the FP consultation for malignant (70%) or non-malignant (30%) disease, of whom 88% were candidates for CTT, after a previous chemotherapy exposure (78%). The rate of recorded immediate adverse events was 3.5%, with painful episodes dominating. Spermatogonia were detected in the majority of TTs: 91.1% of those exposed to chemotherapy and 92.3% of those not exposed (p=0.962). In multivariate analysis, the risk of absence of spermatogonia was almost three-fold higher in boys>10 years of age ([OR] 2.74, 95% CI 1.09-7.26, p=0.035) and four-fold higher in boys exposed to alkylating agents prior to CTT ([OR] 4.09, 95% CI 1.32-17.94, p=0.028). This large series of pediatric FP shows that this procedure is well accepted, feasible, and safe in the short term, strengthening its place in the clinical care pathway of young patients requiring a highly gonadotoxic treatment. Our results demonstrate that CTT post-chemotherapy does not impair the chance to preserve spermatogonia in the TT except when the treatment includes alkylating agents. More data on post-CTT follow-up are still required to ensure the long-term safety and usefulness of the procedure.

P-449 Live birth rates after breast cancer among women who desired a child: a French regional study

Abstract Study question What are the live birth rates after breast cancer (BC) among women who desired a child? Summary answer In our cohort, after treatment for a BC, a live birth is achieved for 36.2% of woman who desire a child. What is known already In France, BC is the most common cancer among women under the age of 40. From 38 to 70% of women have not fulfilled their parental plans at the time of diagnosis. The gonadotoxicity of the treatments and the follicular physiological decline linked to age can become an obstacle to this project. Many studies on the subject do not take into account the desire for pregnancy or are interested in the pregnancy rate rather than the birth rate. Study design, size, duration In our retrospective, descriptive and observational study, 386 patients treated for BC at the regional BC treatment center (CGFL) between January 2011 and December 2018 (at least 4 years after their treatments), were identified. A total 192 patients met the inclusion criteria (aged 18-39 years old and histologically proven breast cancer). We excluded metastatic cancers, cancer in situ and pregnant patients at diagnosis. In January 2022, eligible participants were contacted. Participants/materials, setting, methods A total of 124 patients agreed to participate in the study. The included patients filled out a self-questionnaire concerning information about their desire for pregnancy after the breast cancer treatments, live births after breast cancer treatments and the place of fertility preservation. Data were collected from the patient’s electronic medical and therapeutic records. The primary endpoint of this study was the live birth rate. Main results and the role of chance The patient participation rate was 64.6%. The mean age at diagnosis was 33.7 years old. Fertility was preserved by oocyte cryopreservation in 13.8% of patients (17/124). Among women who desired a child after BC and in whom pregnancy had been approved, the overall rate of live births was 36.2% (21/58). Most achieved pregnancies were spontaneous (90.5%). No factor was significantly associated with the absence of obtaining birth (i.e. the BC biological subtype or the different BC treatments received). Of these 21 patients, 3 had cryopreserved their oocytes but none used them. Among 23 patients who had a fertility preservation consultation, 17 preserved via oocyte cryopreservation. Only one patient (5.9%) used her preserved oocytes resulting in a miscarriage. When patients were medically allowed to start a pregnancy the median time to conception in patients who received chemotherapy was 8 months [1.0 - 60.0] vs 2 months [1.0 - 7.0] in women who did not receive chemotherapy. Limitations, reasons for caution Even though our BC-patients’ cohort is a good reflection of the all-French population of one region (Burgundy) since all patients are treated almost exclusively at the CGFL, the main limitations are the retrospective nature, the declarative character, and a short follow-up for the last included patients. Wider implications of the findings The non-negligible proportion of live births following spontaneous pregnancy after breast cancer allows us to be reassuring for patients. However, the emergence of new chemotherapy protocols whose consequences on long-term gonadotoxicity are still not well known requires further studies and prompts the promotion of fertility preservation as a precautionary measure. Trial registration number sans objet

O-084 Fertility outcomes several years after urgent fertility preservation (FP) for breast cancer

Abstract Study question What are the fertility outcomes of women who tried to conceive after breast cancer treatment and FP? Summary answer Three to-ten years after FP for breast cancer, less than half of patients tried to conceive but 39% of them had a child, mainly spontaneously. What is known already Breast cancer is the most common cancer in women of childbearing age. Because of the gonadal toxicity of treatments and temporary contraindication to pregnancy, fertility after cancer treatment is often impaired. Different FP techniques can be offered. Although it is well established that pregnancy in breast cancer survivors is safe, little is known on the incidence of pregnancies after breast cancer treatments in women having undergone FP, the way those patients conceived and outcomes. Study design, size, duration This is a retrospective observational, bicentric cohort study. All patients having undergone FP before breast cancer treatment (oocyte and/or embryo vitrification after controlled ovarian stimulation (COS) or in vitro maturation and/or ovarian tissue cryopreservation) between January 1, 2013 and July 31, 2019 were included (n = 844). Patients for whom data on post-cancer pregnancy attempt was missing (n = 195) were excluded from the analysis of pregnancies.The cut-off date was March 1, 2022. Participants/materials, setting, methods For women who got pregnant, the time to conception was calculated between the 1st FP consultation (CS1) and the day of the estimated conception. For those who did not conceived, we considered the time between the CS1 and the cut-off date or the date of patient’s death. Cumulative incidences of pregnancy and live birth were calculated. A logistic regression Cox model was performed to study the predictive factors of pregnancy and live birth. Main results and the role of chance Among the 649 patients with available data on post-cancer pregnancy attempt, 255 (39.3%) tried to conceive. Overall, 135 (52.9%) of them achieved a pregnancy, mainly spontaneously (79.3%), and 99 (38.8%) reported a live birth. At the CS1, 76.3% of women were in couple and 42.3% already had at least a child. The mean age at CS1 was 32±4.2 years. Invasive ductal carcinoma was the diagnosis in 95.8% of women and 45.7% had COS for FP. In our cohort, 48 months after CS1, the cumulative incidence of pregnancy was 33.1% (CI95% [27.6-37.9]). After adjustment on age, parity, type of chemotherapy and hormonotherapy, only multiparity at diagnosis and absence of chemotherapy were found to be positive predictive factors of pregnancy after cancer. Only multiparity was found to be negatively associated with live birth (RR0.47 [0.33-0.67]). Of the 793 patients who vitrified oocytes/embryos, 68 reused them (26.6% of the patients who tried to conceive) and obtained 8 live births. Women using their cryopreserved biological material were older at CS1, had lower ovarian reserve parameters and had vitrified embryos. Ovarian reserve parameters and number of cryopreserved oocytes were higher while age at CS1 was lower in patients reporting a live birth after oocyte/embryo thawing. Limitations, reasons for caution Due to the retrospective nature of the study, some data is missing. Even if the median follow-up is more than 4 years, a longer follow-up is necessary Wider implications of the findings Although pregnancy rates after breast cancer are reduced, most of conceptions are achieved spontaneously. Our findings provide useful information to advise women on the different techniques of FP, their efficacy and safety. Trial registration number Not applicable

Survey of young women with breast cancer to identify rates of fertility preservation (FP) discussion and barriers to FP care.

To identify the proportion of reproductive age women with breast cancer that engaged in a fertility preservation discussion and reproductive endocrinology and infertility (REI) consultation. This cross-sectional survey recruited women 18-42 years who were diagnosed with breast cancer from 2006 to 2016 by phone or email and asked them to complete an online survey. Demographic characteristics, barriers to FP, utilization of FP consultation, and FP procedures (oocyte and embryo cryopreservation) were analyzed. A majority of women (64%) did not have FP discussed by any provider. Older women and those who were parents at the time of diagnosis were less likely to engage in a FP discussion. However, there were no significant differences in partner status or cancer stage between women with or without FP discussions. Of the women who desired future children prior to the cancer diagnosis, 93% received chemotherapy; however, only 34% of these women had a consultation with an REI. The most common reasons for declining FP consultation were already having their desired number of children (41%), financial barriers (14%), and concern about delaying cancer treatment and cancer recurrence (12%). Forty percent of women who desired future children and met with an REI pursued FP procedures. Younger women were more likely to receive FP counseling. FP consultations and procedures were low even in women who desired future fertility, with the predominant barriers being cost, fears concerning a delay in cancer treatment, and future cancer recurrence.

Knowledge, attitudes, and behaviors toward fertility preservation in patients with breast cancer: A cross-sectional survey of physicians.

Fertility is an important issue for young women with breast cancer, but studies about physicians' knowledge, attitudes, and practices toward fertility preservation (FP) are largely based on Western populations and do not reflect recent international guidelines for FP. In this international study, we aimed to assess the knowledge, attitudes, and practices of physicians from South Korea, other Asian countries, and Latin America toward FP in young women with breast cancer, and identify the related barriers. The survey was conducted anonymously among physicians from South Korea, other Asian countries, and Latin America involved in breast cancer care between November 2020 and July 2021. Topics included knowledge, attitudes, and perceptions toward FP; practice behaviors; barriers; and participant demographics. We grouped related questions around two main themes-discussion with patients about FP, and consultation and referral to a reproductive endocrinologist. We analyzed the relationships between main questions and other survey items. A total of 151 physicians completed the survey. Most participants' overall knowledge about FP was good. More than half of the participants answered that they discussed FP with their patients in most cases, but that personnel to facilitate discussions about FP and the provision of educational materials were limited. A major barrier was time constraints in the clinic (52.6%). Discussion, consultations, and referrals were more likely to be performed by surgeons who primarily treated patients with operable breast cancer (FP discussion odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.24-6.79; FP consultation and referral OR: 2.98; 95% CI: 1.14-7.74). Participants' knowledge and attitudes about FP were significantly associated with discussion, consultations, and referrals. Physicians from South Korea, other Asian countries, and Latin America are knowledgeable about FP and most perform practice behaviors toward FP well. Physicians' knowledge and favorable attitudes are significantly related to discussion with patients, as well as consultation with and referral to reproductive endocrinologists. However, there are also barriers, such as limitations to human resources and materials, suggesting a need for a systematic approach to improve FP for young women with breast cancer.

Risk of recurrence and pregnancy outcomes in young women with breast cancer who do and do not undergo fertility preservation.

To assess the impact of fertility preservation (FP) requiring ovarian stimulation on breast cancer outcomes and pregnancy after breast cancer. Women aged ≤ 40years diagnosed with stage I-III breast cancer between 2007 and 2018 and referred for FP consultation prior to systemic therapy were identified from a British Columbia fertility center database. The primary endpoint was invasive breast cancer-free survival (iBCFS) and secondary endpoints were overall survival (OS) and achievement of pregnancy. Survival and pregnancy endpoints were compared using Cox and logistic regression analyses, respectively, for patients who did and did not undergo FP. The study included 153 patients, with 71 (46%) in the FP group and 82 (54%) in the non-FP group. Patients who underwent FP were more likely to be ECOG 0 (99% vs. 88%, p = 0.011) and receive chemotherapy (93% vs. 67%, p < 0.001), but had similar ER positivity status to non-FP patients (70% vs. 79%, p = 0.21). Over a median follow-up of 4.1years, there were no differences in iBCFS (HR 1.006, 95% CI 0.416-2.438, p = 0.988) or OS (HR 0.789, 95% CI 0.210-2.956, p = 0.725) between FP and non-FP groups. Patients who underwent FP had higher odds of conceiving at least once (OR 3.024, 95% CI 1.312-6.970, p = 0.008). At a median follow-up of 4.1years, FP did not impact iBCFS or OS, supporting its safety in young women with breast cancer. In addition, patients who underwent FP were more likely to become pregnant after breast cancer, highlighting the value of pre-oncologic treatment FP in survivorship family planning.

Implementing A National Fertility Preservation and Reproductive Late Effects Database to Improve Outcomes

Background: Advancements in cancer treatments have improved five-year survival to 85% for pediatric, adolescents, and young adults, creating opportunities to optimize quality of life in survivorship. Some cancer therapies place patients at risk of infertility. Guidelines recommend fertility preservation (FP) consultation for all reproductive age patients at risk for infertility; however, disparities persist. We describe the implementation of a national database at two pilot sites with plans for national expansion and research to improve care.

Fertility preservation in transgender and non-binary adolescents and young adults

Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.

Fertility preservation in women with haematological malignancies

The incidence of haematological malignancies is increasing in women of childbearing age. Survival rates accompany this increase, making it essential to assess the impact of treatments on their future quality of life, evaluate the impact of each treatment on ovarian reserve and define the fertility preservation techniques used by women with haematologic malignancies. A retrospective study was conducted after data collection from 61 women diagnosed with haematological malignancies and followed-up in a fertility preservation centre between January 2008 and June 2019. Cancer treatments caused a decrease in ovarian reserve, demonstrated by an increase in FSH levels and a decrease in AMH levels. When assessing which treatments have the greatest impact on AMH levels, we found that the BEACOPP regimen, and the agents vincristine, etoposide, procarbazine, prednisone and the haematopoietic stem cell transplantation were mainly responsible. Regarding pregnancy after oncological treatments, of the eleven women who became pregnant, ten did so spontaneously. This study reinforces the importance of referring patients to a fertility preservation consultation before starting oncological treatment, as most of them opt to preserve fertility. This work also helps to clarify the impact of each chemotherapeutic agent on the ovarian reserve.

Fertility preservation in cancer patients

Introduction: Fertility preservation or oncofertility is a relatively new interdisciplinary field dealing with the preservation of female and male reproductive functions before the administration of gonadotoxic therapy. Despite recommendations from different international scientific bodies, Hungary still does not have a national fertility preservation network, patient referral is unorganised. Objective: As the first step towards establishing a national fertility preservation program, a study was designed to evaluate the Hungarian oncologists' knowledge, attitudes and practice in the field of oncofertility. Method: A national online survey was sent to the physician members of the Hungarian Society of Clinical Oncology between November 2020 and February 2021. The survey was completed by 94 physicians and the results were analysed statistically. Results: The majority of the oncologists (77%) discusses reproductive health issues before starting gonadotoxic therapy. However, almost half of these physicians do not refer patients for fertility preservation consultation or treatment. Physicians report lack of organised fertility preservation network, lack of knowledge and clinical practice guidelines as major barriers in referring their patients for fertility preservation. The majority (86%) proposes that a better col-laboration between cancer and fertility centers needs to be organized in Hungary. Conclusion: This study is the first nationwide survey to assess oncologists' attitude, knowledge and practice in the field of oncofertility in Hungary. It highlights the need for more education and increased collaboration between oncologists and reproductive specialists. This is an important step towards the establishment of a national fertility preservation network which is our ultimate goal.

Surgeon and Patient Reports of Fertility Preservation Referral and Uptake in a Prospective, Pan-Canadian Study of Young Women with Breast Cancer.

Prompt referral by their surgeon enables fertility preservation (FP) by young women with breast cancer (YWBC) without treatment delay. Following a FP knowledge intervention, we evaluated surgeon and patient reports of fertility discussion, FP referral offer and uptake, and FP choices and reasons for declining FP among patients enrolled in the Reducing Breast Cancer in Young Women, prospective pan-Canadian study. Between September 2015 and December 2020, 1271 patients were enrolled at 31 sites. For each patient, surgeons were sent a questionnaire inquiring whether: (1) fertility discussion was initiated by the surgical team; (2) FP referral was offered; (3) referral was accepted; a reason was requested for any "no" response. Patients were surveyed about prediagnosis fertility plans and postdiagnosis oncofertility management. Surgeon questionnaires were completed for 1068 (84%) cases. Fertility was discussed with 828 (84%) and FP consultation offered to 461 (47%) of the 990 YWBC with invasive disease. Among the 906 responding YWBC, referral was offered to 220 (82%) of the 283 (33%) with invasive disease who stated that they had definitely/probably not completed childbearing prediagnosis. Of these, 133 (47%) underwent FP. The two most common reasons for not choosing FP were cost and unwillingness to delay treatment. Although the rates of surgeon fertility discussion and FP referral was higher than most reports, likely due to our previous intervention, further improvement is desirable. FP should be offered to all YWBC at diagnosis, regardless of perceived childbearing intent. Cost remains an important barrier to FP uptake.

Fertility preservation discussions, referral and follow-up in male-to-female and female-to-male adolescent transgender patients

The number of patients seeking transgender healthcare is growing, and there is a potential impact of gender-affirming therapies on fertility. The use of fertility preservation (FP), particularly among transgender adolescents, has been limited. We aimed to examine differences in FP counselling, referral and utilisation between male-to-female (MtF) and female-to-male (FtM) transgender adolescents. A retrospective review of the medical records of patients ages 12–17 seen at an academic medical centre between 2012 and 2017 with a diagnosis of gender dysphoria was conducted. A total of 22 MtF and 45 FtM adolescents were included. The counselling on the potential fertility impact of gender-affirming therapy was documented in 55%, and of those counselled, 73% were counselled before receiving medication. There was no significant difference between the timing of counselling for MtF versus FtM adolescents. Of patients with documented reproductive wishes, 77% reported either desire for adopted children or no desire for biological children. Among patients offered FP referral, 2 (22.2%) MtF and 3 (12.5%) FtM patients accepted; both MtF patients cryopreserved sperm. While most adolescents were counselled on the fertility impact of gender-affirming therapy, there is room for improvement as 45% of patients had no documented counselling. The rate of transgender adolescents pursuing FP consultation and gamete cryopreservation was low, consistent with prior studies in this population.

Cryopreservation of paediatric ovarian tissue with an updated version of the Edinburgh criteria for appropriate patient selection

Research questionAre the revised patient selection criteria for fertility preservation of children and adolescents appropriate? DesignA retrospective and prospective observational cohort study implemented at a university hospital approved for fertility preservation by an academic society. The characteristics of children and the process of fertility preservation consultation were investigated. Mortality, the longitudinal course of the endocrine profile and the menstrual cycle were confirmed in patients who underwent ovarian tissue cryopreservation (OTC) before the age of 18 years. ResultsOf the 74 children and adolescents referred for a fertility preservation consultation, 40 (54.1%) had haematological disease, which included patients with rare diseases. The mean age of patients was 11.1 ± 4.3 years (median 12 years, range 1–17 years). In accordance with the revised criteria, 31 (41.9%) patients had their ovarian tissue cryopreserved. Two out of 31 had complications after surgery (infection and drug allergy) and one patient with leukaemia (3.2%) had minimum residual disease on the extracted ovarian tissue. Of the 14 patients (>12 years) who completed treatment, 12 (85.7%) had primary ovarian insufficiency (POI) more than a year after treatment. Two out of 31 (6.5%) died because of recurrence of their underlying disease (median 28 months, range 0–60 months). Oocyte cryopreservation, as an additional and salvage fertility preservation treatment, was suggested to five patients with biochemical status POI (procedures pending). ConclusionThe primary disease and patients’ ages varied in fertility preservation for children and adolescents. Our patient selection criteria might be appropriate over a short follow-up period.

Outcomes of Fertility Preservation Consults for Women at Risk for Primary Ovarian Insufficiency Due to History of Cancer Treatment or Mosaic Turner Syndrome.

Adolescents and young adults (AYAs) at risk of primary ovarian insufficiency (POI) often request fertility preservation consultation. We report consult/treatment outcomes for 21 cancer survivors and 3 mosaic Turner syndrome (TS) patients (mean age 21.6 at consult, 3 with POI). Ten AYAs (9 survivors, 1 mosaic TS) attempted ovarian stimulation; 4 cancelled for poor response. Of completed cycles, mean 3.8 mature oocytes were retrieved, with mean anti-Müllerian hormone 0.653 ng/mL. Ovarian stimulation for mosaic TS AYA and survivors is possible, even with diminished ovarian reserve. Further study is needed to establish guidelines for patient selection, treatment timing, and stimulation protocols.

MORE COVERAGE, MORE CARE: INCREASED FERTILITY PRESERVATION VOLUME BEFORE AND AFTER STATEWIDE INSURANCE MANDATES

As of January 1, 2019, Illinois state law mandates that insurers cover fertility preservation (FP) for patients facing iatrogenic infertility. As of April 2021, 10 states have enacted similar mandates, but only Illinois extended coverage to Medicaid recipients. Few studies have examined the impact of these laws on FP care. Our study aimed to examine FP care at a single large academic medical center in Illinois before and after the enactment of law mandating FP coverage. DESIGN: Retrospective cross-sectional study We analyzed all medically indicated FP consultations and completed cycles performed at our fertility center between January 1, 2017 and December 31, 2020, representing the two years before and after enactment of the insurance mandate. Data were analyzed using Mann-Whitney-U, student’s T test and Fisher’s exact test where indicated (p<0.05). 436 FP consultations were performed, and 282 patients completed 319 cycles at our center over the study period. Minimal change in patient and cycle volume was seen in the first year after the insurance mandate took effect, but there was a sharp increase in consult, patient, and cycle volume in 2020 (Table). More patients with Medicaid insurance were seen after enactment of the mandate (11 vs 28), and more of these completed FP cycles (3 vs 16, p=0.003). Among patients who completed cycles pre- and post-mandate, there was no difference in race or ethnicity (9.3% vs 12.0% identified as Black, and 8.5% vs 9.2% identified as Hispanic or Latinx). Clinical characteristics pre- and post-mandate were similar when comparing age (29.6 vs 29.1, p>0.05) and medical diagnosis, with the most common diagnoses being breast cancer (32% vs 30%, p>0.05) and hematologic malignancies (19% vs 18%, p>0.05). AMH was higher (2.70 vs 3.54, p=0.02) and more oocytes were retrieved per cycle (16±10 vs 20±12, p=0.02) in patients completing FP post-mandate. There was no difference in rates of oocyte cryopreservation and embryo cryopreservation pre- (65%, 36%) and post- mandate (69%, 31%) (p>0.05). Our data from a large academic medical center suggest Illinois legislation may lead to increased FP consultation and cycle volumes and expanded access to FP for publicly insured patients. Further research is needed to examine the how implementation of insurance mandates can maximize access and affordability for patients.

INTERVENTION TO INCREASE FERTILITY PRESERVATION AWARENESS

The purpose of this study is to evaluate the impact of an educational brochure with information regarding fertility preservation and the Reproductive Endocrinology and Infertility (REI) services at one institution on the number of patients seen for fertility preservation consultation.