Fertility Preservation Shows Promise for Patients with Cancer

The first long-term record of how patients with cancer made use of their stored eggs and embryos after cancer treatment was presented at the 36th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE).

Overall, the results demonstrated how successful fertility preservation can be in patients with cancer, especially those with breast cancer.

“Oocyte freezing is usually offered to young women, and with our vastly improved freezing techniques, provides a good chance of future pregnancy,” first author Dalia Khalifé, MD, of Guy’s and St. Thomas’ Hospital (GSTT) in London, UK, said in a press release. “Ovarian tissue cryopreservation, though still not widely available, is undertaken in selected cases where time is urgent. This technique also now provides an option for the prepubertal female, where previously none existed.”

In this prospective cohort study, 879 young women diagnosed with cancer who sought out fertility preservation counseling at the Assisted Conception Unity at GSTT between January 2000 and December 2019 were included. The primary outcome measure for the study was total livebirth rate (LBR). Key secondary outcomes were return and utilization rates, which were calculated as the number of patients who returned for follow-up and those who had undergone embryo transfer.

Notably, of the study participants, breast cancer was the most common malignant disease, accounting for 63.1% of the cases. The mean age, AMH, and BMI were 33.8 ± 7.8 years, 18.8 ± 20.5 pmol/L, and 23.7 ± 4.2 kg/m2, respectively. Moreover, a total of 373 patients (42.4%) underwent fertility preservation, including 40.7 % who opted for embryo cryopreservation, 53.4% who opted for oocyte cryopreservation, 5.1% who had both, and 0.76% who opted for ovarian tissue cryopreservation in a different facility.

In regard to the return rate, 33.8% (297/879) of patients with cancer returned for follow-up for assessment of ovarian function, menopausal symptoms, hormone replacement therapy, and fertility treatment. As of the data analysis, the utilization rate among those who had frozen gametes was 16.4 % (61/373) and the overall LBR was 72.1% (44/61), of which 9.1% (4/44) were twin births. Further, the miscarriage rate was 12.2% (8/61).

Overall, the mean time to follow-up was 21.2 ± 19 months (range 1-132 months), with 66% of returning patients doing so within 2 years after cancer diagnosis.

"The results are a demonstration of how fertility preservation in these cases can be effective," Khalife explained. "Around 1 in 6 of those who stored their gametes had a good outcome."

Ultimately, the researchers indicated that patients with breast cancer were more likely to return to use their gametes (27/61: 44.3%) and had significantly higher LBR (19/27; 70.3%) compared to those with lymphoma (3/8; 37.5%; P < 0.001).

Importantly, though investigators are confident that the outcomes of those who had fertility treatment were captured, they indicated that they cannot be as certain of capturing all births resulting from natural conception. In addition, a proportion of patients may need a longer time to be able to attempt pregnancy, therefore the calculated LBR may be underestimated.

“It is our hope today that all young women diagnosed with cancer and good prognosis are referred for fertility consultation,” said Khalife. “Success of such a service requires close work with our oncology colleagues, rapid access, and clear referral pathways to enable a large number of young patients to be treated.”

“We do believe that a fertility preservation service must be integral to a modern cancer care pathway,” Khalife continued. “Fertility preservation with eggs and embryos has been beyond experimental for some time. And it's important that clinicians across the world continue to collect and share data on long-term outcome for all methods, including ovarian tissue preservation, to provide patients with robust information.”

References:

1. Khalife D, Ali S, Reddy N, Kopeika J. Live birth rate and utilization rate of eggs and embryos following fertility preservation (FP) in 879 female cancer patients over 19 years. Presented at: ESHRE 2020 Annual Meeting. Abstract O-036.

2. Cancer treatment in young women need not mean the end of their fertility [news release]. Published July 6, 2020. eshre.eu/ESHRE2020/Media/2020-Press-releases/Khalife. Accessed July 16, 2020.