Oncofertility Care in Young Women and the Outcomes of Pregnancy Over the Last 5 Years

Takahashi, Sayuri; Horie, Akihito; Yamamura, Sachi; Kawamura, Akeo; Yamaguchi, Ken; Sunada, Masumi; Tani, Hirohiko; Mogami, Haruta; Hamanishi, Junzo; Kondoh, Eiji; Mandai, Masaki

doi:10.2144/fsoa-2020-0169

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…analyzed the data of 67 Japanese women aged < 43 years who underwent oncofertility care. The study indicated that as spontaneous pregnancies were more common than ART pregnancies, pregnancy via not only ART, but also via the non-ART method is a viable option for young cancer survivors [14]. In our study, 40 live births were reported, and three patients had live births from pregnancies induce via embryo transfer.…”

Section: Discussionmentioning

confidence: 65%

“…In recent times, post-treatment life events, such as pregnancy and childbirth, have been considered an essential part of treatment planning for adolescent cancer patients because advances in cancer therapy have substantially increased the long-term survival rate of adolescent and young adult cancer survivors [14]. However, this issue remains unclear because there is insu cient data, especially in thyroid cancer patients with DM.…”

Section: Introductionmentioning

confidence: 99%

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Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

et al. 2022

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There is no su cient data about the clinical course and outcome in thyroid cancer patients who become pregnant after diagnosis of distant metastasis (DM). The current study was conducted to collect information regarding the clinical and reproductive characteristics, and outcomes in thyroid cancer patients who became pregnant after being diagnosed with DM. MethodsRecords of 125 differentiated thyroid cancer (DTC) patients with age ≤ 45 years at DM diagnosis who had visited Ito Hospital from January 2005 to June 2021 were retrospectively reviewed. Among those 125 patients, 28 who became pregnant after DM diagnosis were classi ed as pregnant group, and the remained 97 patients were classi ed as comparator group. ResultsIn pregnant group, the median age at malignancy diagnosis, DM diagnosis, and rst pregnancy after DM diagnosis was 25 years (range, 4-41 years), 27 years (range, 11-41 years), and 32 years (range, 25-45 years), respectively. Fifty-ve pregnancies and 40 live births were reported. Three patients had live births by embryo transfer. Other pregnancy outcomes were miscarriage (n = 14) and induced abortion (n = 1). No one died during the follow-up period in this study. The 10-year progression free survival (PFS) rates of pregnant and comparator group were 92.1% and 74.4%, respectively. ConclusionDTC patients who became pregnant after DM diagnosis had good survival. Our results add to the information required for counseling thyroid cancer patients who have concerns about their fertility in the future.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

et al. 2022

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“…The establishment of pregnancy after breast cancer treatment is greatly affected by patient age; most of pregnancies are established within a short period of time after the woman is permitted to attempt conception or infertility treatment. It is also important information that spontaneous pregnancy can be expected after treatment for breast cancer if the patient is under 35 years of age as reported previously; it is important for patients over 35 years of age to move toward ART in a timely manner 20 . Therefore, we deem it desirable to determine the optimal duration of TAM therapy for patients with breast cancer who wish to become pregnant when oocyte/embryo was not preserved.…”

Section: Discussionmentioning

confidence: 89%

“…It is also important information that spontaneous pregnancy can be expected after treatment for breast cancer if the patient is under 35 years of age as reported previously; it is important for patients over 35 years of age to move toward ART in a timely manner. 20 Therefore, we deem it desirable to determine the optimal duration of TAM therapy for patients with breast cancer who wish to become pregnant when oocyte/embryo was not preserved. This study was analyzed by grouping by age at the end of breast cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

Case‐based survey: The impact of breast‐cancer treatment on fertility in Japan

Yamazaki

Ono

Sugie

et al. 2021

J of Obstet and Gynaecol

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Aim To assess the impact of breast‐cancer treatment on fertility. Methods We conducted a retrospective, case‐based survey of treatments administered for infertility and pregnancy outcomes after patients underwent treatment for breast cancer. Surveys were distributed to breast oncology facilities and reproductive endocrinology and infertility (REI) facilities. Results As high as 60% of the pregnancies in women under the age of 35 years occurred spontaneously. Additionally, the fertility rates decreased as age increased (under 35 years of age: 40%, 35–39 years of age: 21%, 40–44 years of age: 10%, respectively). In women who became pregnant after treatment for breast cancer, conception was achieved within 1 to 3 years after beginning to try for pregnancy. Conclusions After treatment for breast cancer, women can expect spontaneous pregnancy, especially if they are under 35 years of age. It is important for patients 35 years of age and older to commence assisted reproductive technology in a timely manner when pursuing fertility after treatment for breast cancer.

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“…6 The process of controlled ovarian hyperstimulation takes approximately 14 days, but the time required has neither been shown to significantly delay treatment initiation, nor increase rates of cancer mortality or recurrence. 7,8 To effectively provide FP services in a streamlined manner for patients diagnosed with cancer, guidelines recommend that physicians who are treating reproductive-age patients with cancer have rapid access to a point of contact for FP referral, an interdisciplinary medical team of adolescent and young adult specialists, oncologists, and reproductive specialists, a year-round experienced embryology laboratory qualified for cryopreservation, and counselors for mental health, genetics, and finances. 5 Female cancer survivors who receive fertility counseling prior to initiating gonadotoxic therapy have been shown to have decreased regret and improved quality of life, highlighting the importance of FP care in optimizing longterm care in cancer survivors.…”

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confidence: 99%

A Geospatial Analysis of Disparities in Access to Oncofertility Services

et al. 2023

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ImportanceFertility preservation (FP), including oocyte and embryo cryopreservation prior to gonadotoxic therapy, is an urgent and essential component of comprehensive cancer care. Geographic proximity to a center offering FP is a critical component of ensuring equitable access for people with cancer desiring future fertility.ObjectiveTo characterize the distribution of centers offering FP services in the US, quantify the number of self-identified reproductive-age female individuals living outside of geographically accessible areas, and investigate the association between geographic access and state FP mandates.Design, Setting, and ParticipantsThis cross-sectional analysis calculated 2-hour travel time isochrone maps for each center based on latitude and longitude coordinates. Population-based geospatial analysis in the US was used in this study. Fertility clinics identified through the 2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Report were defined as oncofertility centers by meeting 4 criteria: (1) offered oocyte and embryo cryopreservation, (2) performed at least 1 FP cycle in 2018, (3) served people without partners, and (4) had an accredited laboratory. County-level data were obtained from the 2020 US Census, with the primary at-risk population identified as reproductive-age female individuals aged 15 years to 44 years. The analysis was performed from 2021 to 2022.ExposuresLocation outside of 2-hour travel time isochrone of an oncofertility center.Main Outcomes and MeasuresOncofertility centers were compared with centers not meeting criteria and were classified by US region, state FP mandate status, number of assisted reproductive technology cycles performed, and number of FP cycles performed. The number and percentage of at-risk patients, defined as those living outside of accessible service areas by state, were identified.ResultsAmong 456 Centers for Disease Control and Prevention–reporting fertility clinics, 86 (18.9%) did not meet the criteria as an oncofertility center. A total of 3.63 million (5.70%) reproductive-age female individuals lack geographic access to an oncofertility center. States with FP mandates have the highest rates of eligible female patients with geographic access (98.54%), while states without active or pending legislation have the lowest rates (79.57%). The greatest disparities in geographic access to care are most concentrated in the Mountain West and West North Central regions.Conclusions and RelevancePatients face numerous barriers to comprehensive cancer care, including a lack of geographic access to centers capable of offering FP services. This cross-sectional study identified disparities in geographic access and potential opportunities for strategic expansion.

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Oncofertility Care in Young Women and the Outcomes of Pregnancy Over the Last 5 Years

Cited by 5 publications

References 28 publications

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

Case‐based survey: The impact of breast‐cancer treatment on fertility in Japan

A Geospatial Analysis of Disparities in Access to Oncofertility Services

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