Top

Journal of Assisted Reproduction and Genetics

Published in:

01-11-2013 | Fertility Preservation

Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation

Authors: J. Barcroft, N. Dayoub, K. J. Thong

Published in: Journal of Assisted Reproduction and Genetics | Issue 11/2013

Abstract

Purpose

Determine the outcome of embryo cryopreservation in female oncology patients

Methods

The outcomes of IVF/ICSI cycles in oncology patients over 15 years in a University Teaching Hospital.

Results

Forty-two oncology patients (mean 31.9 ± 3.9 years) underwent embryo cryopreservation treatment (n = 33 IVF, n = 6 ICSI). Controlled ovarian stimulation with GnRH antagonist protocol (n = 34; 81 %) yielded fewer oocytes than GnRH agonist protocol (n = 8; 19 %) (9.4 ± 6.3 vs. 15.3 ± 8.9; p = 0.04) respectively. There was no significant difference in mean (±SD) duration of ovarian stimulation (11.6 ± 2.6 vs.10.6 ± 2.7), median gonadotrophin dose (1950 vs. 1670 IU), median day 5–6 oestradiol level (1124 vs.1129 pmol/l) or embryo yield (6.2 ± 4.1 vs. 8.8 ± 4.3; p = 0.07) between GnRH antagonist and agonist treatment cycles respectively. Thirty-nine patients cryopreserved embryos and three had their cycle cancelled. During this study period, of those who cryopreserved embryos, 5 patients underwent 9 frozen-thaw cycles (13 %), resulting in 2 live births (1 twin, 1 singleton, live birth rate 22 %). Six patients died (15 %), 3 conceived naturally (8 %) and 2 couples separated (5 %). Fourteen patients discarded their embryos (36 %). Twenty-two patients’ (56 %) have embryos remaining in storage.

Conclusions

This study demonstrates that embryo cryopreservation in female oncology patients gives a satisfactory live birth rate. However, there are concerns regarding cost-effectiveness, resulting from high disposal/non-usage of embryos, and further studies are required.

Al-Inany H, Aboulghar M. GnRH antagonist in assisted reproduction: a cochrane review. Hum Reprod. 2002;17:874–85.PubMedCrossRef

Al-Inany HG, Youssef MAFM, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, et al. GnRH antagonists are safer than agonists: an update of a Cochrane review. Hum Reprod Update. 2011;17:435.PubMedCrossRef

Azim Jr HA, Peccatori FA, de Azambuja E, Piccart MJ. Motherhood after breast cancer: searching for la dolce vita. Expert Rev Anticanc. 2011;11:287–98.CrossRef

Baynosa J, Westphal LM, Madrigrano A, Wapnir I. Timing of breast cancer treatments with oocyte retrieval and embryo cryopreservation. J Am Coll Surg. 2009;209:603–7.PubMedCrossRef

Berger BM, Ezcurra D, Alper MM. Gonadotropin releasing hormone (GnRH) antagonist (cetrorelix) versus GnRH agonist treatment—an age and gonadotropin matched study in young normal responders. Fertil Steril. 2004;82:S235–6.CrossRef

Besse D, Bellavia M, de Ziegler D and Wunder D. Psychological support in young women who contemplate emergency assisted reproductive technologies (ART) prior to chemo- and/or radiation-therapy. Swiss Med Wkly. 2010;140.

Brzyski RG. Efficacy of postal communication with patients who have cryopreserved pre-embryos. Fertil Steril. 1998;70:949–51.PubMedCrossRef

Cobo A, Kuwayama M, Pérez S, Ruiz A, Pellicer A, Remohí J. Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method. Fertil Steril. 2008;89(6):1657–64.PubMedCrossRef

Das M, Shehata F, Moria A, Holzer H, Son W-Y, Tulandi T. Ovarian reserve, response to gonadotropins, and oocyte maturity in women with malignancy. Fertil Steril. 2011;96:122–5.PubMedCrossRef

10.

De Bree E, Makrigiannakis A, Askoxylakis J, Melissas J, Tsiftsis DD. Pregnancy after breast cancer. A comprehensive review. J Surg Oncol. 2010;101:534–42.PubMedCrossRef

11.

Duffy CM, Allen SM, Clark MA. Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol. 2005;23:766–73.PubMedCrossRef

12.

Edgar DH, Gook DA. A critical appraisal of cryopreservation (slow cooling vs vitrification) of human oocytes and embryos. Hum Reprod Update. 2012;in press.

13.

Fasouliotis SJ, Schenker JG. Cryopreservation of embryos: medical, ethical, and legal issues. J Assist Reprod Gen. 1996;13:756–61.CrossRef

14.

Forbes JF. Long-term effects of adjuvant chemotherapy in breast-cancer. Acta Oncol. 1992;31:243–50.PubMedCrossRef

15.

Forman EJ, Anders CK, Behera MA. Pilot survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. 2009;54(4):203–7.

16.

Hery C, Ferlay J, Boniol M, Autier P. Changes in breast cancer incidence and mortality in middle-aged and elderly women in 28 countries with Caucasian majority populations. Ann Oncol. 2008;19:1009–18.PubMedCrossRef

17.

Holleb AI. Breast cancer and pregnancy. CA Cancer J Clin. 1965;15:182–3.PubMedCrossRef

18.

Janerich DT. The fetal antigen hypothesis: cancers and beyond. Med Hypotheses. 2001;56:101–3.PubMedCrossRef

19.

Kini S, Li HWR, Morrell D, Pickering S, Thong KJ. Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization. J Assist Reprod Gen. 2010;27:449–56.CrossRef

20.

Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24:4888–94.PubMedCrossRef

21.

Lee S, Oktay K. Does higher starting dose of FSH stimulation with letrozole improve fertility cryopreservation outcomes in women with breast cancer? Fert Steril. 2012;98(4):961–4.CrossRef

22.

Nachtigall RD, Mac Dougall K, Lee M, Harrington J, Becker G. What do patients want? Expectations and perceptions of IVF clinic information and support regarding frozen embryo disposition. Fertil Steril. 2010;94:2069–72.PubMedCrossRef

23.

Nagy ZP, Chang CC, Shapiro DB, Bernal DP, Elsner CW, Mitchell-Leef D, et al. Clinical evaluation of the efficiency of an oocyte donation program using egg cryo-banking. Fertil Steril. 2009;92(2):520–6.PubMedCrossRef

24.

Oktay K, Buyuk E, Libertella N, Akar M, Rosenwaks Z. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol. 2005;23:4347–53.PubMedCrossRef

25.

Provoost V, Pennings G, De Sutter P, Gerris J, Van de Velde A, Dhont M. To continue or discontinue storage of cryopreserved embryos? Patients’ decisions in view of their child wish. Hum Reprod. 2011;26:861–72.PubMedCrossRef

26.

Riggs R, Mayer J, Dowling-Lacey D, Chi T-F, Jones E, Oehninger S. Does storage time influence postthaw survival and pregnancy outcome? An analysis of 11,768 cryopreserved human embryos. Fertil Steril. 2010;93:109–15.PubMedCrossRef

27.

Robertson AD, Missmer SA, Ginsburg ES. Embryo yield after in vitro fertilization in women undergoing embryo banking for fertility preservation before chemotherapy. Fertil Steril. 2011;95:588–91.PubMedCrossRef

28.

Sonmezer M, Turkcuoglu I, Coskun U, Oktay K. Random-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles. Fertil Steril. 2011;95(6):2125.PubMedCrossRef

29.

Stadtmauer LA, Duran H, Bocca S, Oehninger S. A comparison between gonadotropin releasing hormone (GNRH) agonist and antagonist protocols in women with good ovarian reserve undergoing IVF. Fertil Steril. 2006;86:S437.CrossRef

30.

Tschudin S, Bitzer J. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update. 2009;15:587–97.PubMedCrossRef

31.

Venn A, Watson L, Bruinsma F, Giles G, Healy D. Risk of cancer after use of fertility drugs with in-vitro fertilisation. Lancet. 1999;354:1586–90.PubMedCrossRef

32.

Yang D, Brown SE, Nguyen K, Reddy V, Brubaker C, Winslow KL. Live birth after the transfer of human embryos developed from cryopreserved oocytes harvested before cancer treatment. Fertil Steril. 2007;87(6):1469.PubMedCrossRef

Title: Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation
Authors: J. Barcroft
N. Dayoub
K. J. Thong
Publication date: 01-11-2013
Publisher: Springer US
Published in: Journal of Assisted Reproduction and Genetics / Issue 11/2013
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-013-0024-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fifteen year follow-up of embryos cryopreserved in cancer patients for fertility preservation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2013

Reproductive implications of psychological distress for couples undergoing IVF

TNF-α haplotype association with polycystic ovary syndrome – a South Indian study

Live birth following serial vitrification of embryos and PGD for fragile X syndrome in a patient with the premutation and decreased ovarian reserve

Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial

Assisted reproduction counseling in women aged 40 and above: a cohort study

Comment on: “Clomiphene Citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial.” by Ghanem et al.