Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy

Hodgson, David C.; Pintilie, Melania; Gitterman, Leah; DeWitt, Beth; Buckley, Carol-Ann; Ahmed, Sameera; Smith, Katherine; Schwartz, A. K.; Tsang, Richard W.; Crump, Michael; Wells, Woodrow; Sun, Alexander; Gospodarowicz, Mary K.

doi:10.1002/hon.802

Cited by 129 publications

(76 citation statements)

References 30 publications

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“…It is striking that four out of five reported successful pregnancies were in patients with lymphomas, and data on cryopreservation in an extensive series of such patients have recently been published (Meirow et al 2007). Treatment regimens for lymphoma may be less gonadotoxic in women than previously (Clark et al 1995, Hodgson et al 2007, whereas the increasing use of taxanes in, for example, breast cancer may be associated with increased gonadotoxicity .…”

Section: Patient Outcomesmentioning

confidence: 99%

Ovarian cryopreservation for fertility preservation: indications and outcomes

Anderson¹,

Wallace²,

Baird³

2008

Reproduction

121

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Female fertility preservation provides significantly different challenges to that for the male, with the only established method being cryopreservation of embryos thus necessitating the involvement of a male. Other, experimental, options include oocyte or ovarian tissue cryopreservation. The latter has been regarded as a potential method for more than a decade, but has resulted in the birth of only five babies. It is not possible to be certain how many women have had ovarian tissue cryopreserved. Oocyte cryopreservation also remains experimental, but w100-fold more babies have been born through this technique over the last two decades. Ovarian tissue cryopreservation has the potential advantages of preservation of a large number of oocytes within primordial follicles, it does not require hormonal stimulation when time is short and indeed may be appropriate for the pre-pubertal. Disadvantages include the need for an invasive procedure, and the uncertain risk of ovarian contamination in haematological and other malignancies. We here review this approach in the context of our own experience of 36 women, highlighting issues of patient selection especially in the young, and uncertainties over the effects of cancer treatments on subsequent fertility. Of these 36 women, 11 have died but 5 have had spontaneous pregnancies. So far, none have requested reimplantation of their stored ovarian tissue. Ovarian cryopreservation appears to be a potentially valuable method for fertility preservation, but the indications and approaches best used remain unclear.Reproduction (2008) 136 681-689

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Section: Patient Outcomesmentioning

confidence: 99%

Ovarian cryopreservation for fertility preservation: indications and outcomes

Anderson¹,

Wallace²,

Baird³

2008

Reproduction

121

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“…with a high incidence of ovarian toxicity, while regimens such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) are associated with less risk [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

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Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.

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“…Although the number of achieved pregnancies and childbirths is sometimes reported in small series (Schilsky et al, 1981;Whitehead et al, 1983;Bonadonna et al, 1984;Anselmo et al, 1990), the selection of survivors attempting parenthood is not reported, with a few exceptions (Aisner et al, 1993;Hodgson et al, 2006).…”

mentioning

confidence: 99%

Post-treatment parenthood in Hodgkin's lymphoma survivors

Kiserud

Fosså²,

Holte³

et al. 2007

Br J Cancer

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Attempted and achieved post-treatment parenthood, with or without use of assisted reproduction techniques (ARTs), was assessed in Hodgkin's lymphoma survivors treated from 1971 -1998, aged below 50 (females) or 65 (males) at diagnosis, aged 18 to 75 at survey. Four treatment groups were constructed: radiotherapy only, low -, medium -and high gonadotoxic chemotherapy (with or without radiotherapy in the three chemotherapy groups). Using Kaplan -Meier estimates, log-rank tests and Cox regression analyses, factors influencing post-treatment parenthood were investigated, with birth of the first child after treatment as the end point. Fortyfive per cent (120/269) of males and 50% (91/184) of females reported attempted post-treatment parenthood. Of these, 76 (63%) males and 68 (75%) females had a child without use of ARTs. In addition 10 males and one female achieved post-treatment parenthood with use of ARTs. Treatment group was significantly associated with post-treatment parenthood, with highest probabilities after radiotherapy only and low gonadotoxic chemotherapy. In univariate analyses, age at diagnosis was a significant factor related to post-treatment parenthood in females.

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Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy

Cited by 129 publications

References 30 publications

Ovarian cryopreservation for fertility preservation: indications and outcomes

Ovarian cryopreservation for fertility preservation: indications and outcomes

Outcomes of ovarian stimulation after treatment with chemotherapy

Post-treatment parenthood in Hodgkin's lymphoma survivors

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