A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

Abstract

Introduction In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary‐care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients’ choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications. Material and methods Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi‐square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications. Results Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre‐pubertal (n = 48) and 73% of post‐pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002). Conclusions Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications.

Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center

“…Our pediatric patient cohort is the largest so far reported undergoing OTC for fertility preservation. 5,7,16 The median age of the patients in our cohort is also below that reported by other authors, usually >10 years; the median age in our previous published series in 2002 was 5 years 3 and in our current series is 6.9 years. The percentage of patients aged 0-12 years varies according to the series from 16% to 87%; 7,14 it is 77.7% in our current series.…”

“…Additionally, the isolation of oocytes during tissue preparation for OTC in girls was performed in a smaller series of patients. Our pediatric patient cohort is the largest so far reported undergoing OTC for fertility preservation …”

“…and 5 years, have been reported in several series. [5][6][7]16 The most frequent types of cancer presented in young patients in those cohorts are leukemias, 5,[8][9][10][11]15,16 bone tumors (Ewing's sarcoma and osteosarcomas), [4][5][6][7]12 Hodgkin lymphoma 5,13 and neuroblastoma. 14 Ovarian tissue cryopreservation may advantageously be coupled with freezing of isolated oocytes either punctured within the visible antrum follicles on the surface of the ovary or collected in the ovary preparation medium when dissecting the ovary.…”

Endometriosis, the great imitator – a successful case of fertility preservation in a woman receiving sterilizing treatment due to a diagnosis of rectosigmoid carcinoma

“…Also, the 50.4 Gy given to the pelvis, entails risk that the uterus cannot support the growth of a pregnancy until full-term, and even a risk for uterine rupture which necessitates thorough surveillance during the pregnancy. Pregnancy success under these circumstances supports the practice of fertility preservation in women with cancer who face multimodal treatments with surgery, radio-and chemotherapy [18], and also in women with chronic conditions impending their fertility, such as advanced stages of endometriosis [19].…”

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

“…Follow-up data after using fertility-preservation methods are still sparse. The first major study of long-term follow-up after fertility preservation was published only recently [8]. The data presented in this article show a follow-up after fertility preservation counselling in a single fertility centre in Germany.…”