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de Guzman GS, Manalo EM, Banal-Silao MJB. Awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation: a cross-sectional survey. BMC Womens Health 2023; 23:285. [PMID: 37231501 DOI: 10.1186/s12905-023-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The demand for fertility preservation has increased substantially over the past decade as more women wish to delay childbearing and with improved survival outcomes of various medical conditions. This study evaluated the awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation. METHODS A cross-sectional survey was conducted among diplomates and fellows of the Philippine Obstetrical and Gynecological Society from September to December 2021. A self-administered questionnaire with 24 items was distributed online. Univariate descriptive statistics were reported as means for continuous variables and frequencies with percentage for categorical variables. Differences in responses were tested using the chi-square test. RESULTS A total of 215 respondents completed the survey. Majority of the respondents were female, general obstetrician-gynecologists practicing in the National Capital Region. There was an overall positive perception of fertility preservation, with 98.60% agreeing that discussions about childbearing intentions should be initiated. Most participants (98.60%) were aware of fertility preservation but had varying levels of awareness of the different techniques. Fifty-nine percent of the respondents were unaware of regulations on fertility preservation. Setting up dedicated centers for fertility preservation and offering it as a public service were viewed as necessary by the respondents. CONCLUSIONS This study underscored the need to increase awareness of fertility preservation techniques among Filipino obstetrician-gynecologists. Meeting the need for comprehensive guidelines and centers is essential to promote fertility preservation in the country. Efficient referral systems and multidisciplinary approaches should be established for holistic care.
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Affiliation(s)
- Glaiza S de Guzman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of the Philippines Manila - Philippine General Hospital, Metro Manila, Philippines.
| | - Eileen M Manalo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of the Philippines Manila - Philippine General Hospital, Metro Manila, Philippines
| | - Maria Jesusa B Banal-Silao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of the Philippines Manila - Philippine General Hospital, Metro Manila, Philippines
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2
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Su H, Zhou X, Zhao Y, Lu Y, Liu D, Zhang J, Yang X. Gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life cross-sectional study. Front Med (Lausanne) 2022; 9:956867. [PMID: 36186762 PMCID: PMC9521594 DOI: 10.3389/fmed.2022.956867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background and objectives Hematopoietic stem cell transplantation (HCT) is a treatment for hematopoietic diseases. However, most cured female patients may suffer from premature ovarian insufficiency (POI) after HCT, which is mainly caused by the pre-HCT conditioning regimen. Hence, this study aims to explore the impact of HCT treatment on reproductive and ovarian functions in female survivors. Methods A total of 55 female participants under the age of 40, who underwent HCT and met the inclusion criteria were enrolled. Data related to blood disease, menstruation, and fertility in the 3 years following HCT were collected. Results The involved patients received transplantation at different age stages, ranging from 8 to 37. All patients, except those with aplastic anemia (AA; 5/55), received a myeloablative conditioning regimen, usually modified total body irradiation/cyclophosphamide (TBI/Cy; 25/55) or modified Busulfan/cyclophosphamide (Bu/Cy; 23/55). Among women (42/55) who menstruated before HCT, 16.67% (7/42) had a spontaneous menstrual relapse and 83.3% (35/42) had amenorrhea after HCT. 72.7% (40/55) could be regarded as having POI. This proportion included 100% (25/25) of women aged 21–40 at the time of HCT, 62.5% (15/24) of those aged 11–20, and 0% (0/6) of those ≤10 years old. Patients with AML were more likely to have POI (95.7%). Patients aged ≤10 years (0%) or 11–20 years (16.7%) at the time of HCT were less likely to have moderate to severe menopause than those 21–40 years old (44%). Conclusion The prevalence of POI following HCT was high and POI was associated with age, conditioning regimen, and type of blood disease.
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Affiliation(s)
- Huina Su
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xinyu Zhou
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yanli Zhao
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
- *Correspondence: Yanli Zhao
| | - Yue Lu
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - DeYan Liu
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Janping Zhang
- Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Xin Yang
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Mayeur A, Puy V, Windal V, Hesters L, Gallot V, Benoit A, Grynberg M, Sonigo C, Frydman N. Live birth rate after use of cryopreserved oocytes or embryos at the time of cancer diagnosis in female survivors: a retrospective study of ten years of experience. J Assist Reprod Genet 2021; 38:1767-1775. [PMID: 33797007 DOI: 10.1007/s10815-021-02168-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the outcomes of frozen oocytes or embryos cryopreserved after controlled ovarian stimulation (COS) or in vitro maturation (IVM) for female cancer patients who underwent a fertility preservation (FP) prior to gonadotoxic therapy. METHODS A retrospective cohort study from 2009 to December 2017 was conducted. Among the 667 female cancer patients who underwent oocytes or embryos cryopreservation for FP, 40 (6%) have returned to the fertility clinic between 2011 and 2019 to use their frozen material after being cured. We compared these thaw cycles outcomes according to the techniques used at the time of cryopreservation. RESULTS Among the 40 women cancer survivors who used their cryopreserved material, thirty patients have benefited from at least one embryo transfer. Ten patients did not have an embryo transfer since the oocytes did not survive after the thawing process or because no embryo was obtained after fertilization. We related three live births following FP using IVM (two from frozen oocytes and one after embryo cryopreservation). Five live births were obtained when COS was performed at the time of FP (one from frozen oocytes and four after embryo cryopreservation). CONCLUSIONS Our preliminary results, although they are obtained in a small sample, are encouraging and show that different FP techniques can be used in female cancer patients and lead to live births. IVM is one of the options available that does not delay the start of chemotherapy or if ovarian stimulation using gonadotropins is contraindicated.
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Affiliation(s)
- Anne Mayeur
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.
| | - Vincent Puy
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
| | - Victoria Windal
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Laetitia Hesters
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France
| | - Vanessa Gallot
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Antoine Béclère Hospital, APHP, Paris-Saclay University, Clamart, 92140, Paris, France
| | - Nelly Frydman
- Reproductive Biology Unit CECOS, Antoine Béclère Hospital APHP, Paris-Saclay University, 157 rue de la porte de Trivaux, Clamart, 92140, Paris, France.,Laboratory of Development of the Gonads, UMRE008 Genetic Stability Stem Cells and Radiation, Paris University, Paris-Saclay University, CEA, F-92265 Fontenay-aux-Roses, Paris, France
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van der Perk MEM, van der Kooi ALLF, van de Wetering MD, IJgosse IM, van Dulmen-den Broeder E, Broer SL, Klijn AJ, Versluys AB, Arends B, Oude Ophuis RJA, van Santen HM, van der Steeg AFW, Veening MA, van den Heuvel-Eibrink MM, Bos AME. Oncofertility care for newly diagnosed girls with cancer in a national pediatric oncology setting, the first full year experience from the Princess Máxima Center, the PEARL study. PLoS One 2021; 16:e0246344. [PMID: 33667234 PMCID: PMC7935241 DOI: 10.1371/journal.pone.0246344] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background Childhood cancer patients often remain uninformed regarding their potential risk of gonadal damage. In our hospital we introduced a five step standard oncofertility care plan for all newly diagnosed female patients aiming to identify, inform and triage 100% of patients and counsel 100% of patients at high risk (HR) of gonadal damage. This observational retrospective study (PEARL study) evaluated the use of this standard oncofertility care plan in the first full year in a national cohort. Methods The steps consist of 1)timely (preferably before start of gonadotoxic treatment) identification of all new patients, 2)triage of gonadal damage risk using a standardized gonadal damage risk stratification tool, 3)informing all patients and families, 4)counseling of a selected subset of girls, and 5) fertility preservation including ovarian tissue cryopreservation (OTC) in HR patients using amended Edinburgh criteria. A survey of the medical records of all girls newly diagnosed with cancer the first year (1-1-2019 until 31-12-2019) was conducted. Results Of 261 girls, 228 (87.4%) were timely identified and triaged. Triage resulted in 151 (66%) low(LR), 32 (14%) intermediate(IR) and 45 (20%) high risk(HR) patients. Ninety-nine families were documented to be timely informed regarding gonadal damage risk. In total, 35 girls (5 LR, 5 IR, 25 HR) were counseled by an oncofertility expert. 16/25 HR patients underwent fertility preservation (1 ovariopexy + OTC, oocyte cryopreservation (1 with and 1 without OTC) and 13 OTC). Fertility preservation did not lead to complications or delay of cancer treatment in any patient. Conclusion We timely identified and triaged most girls (88%) with cancer with a high risk of gonadal damage to be counseled for fertility preservation. We aim to optimize the oncofertility care plan and the standardized gonadal damage risk stratification tool based on this experience and these may be of value to other pediatric oncology centers.
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Affiliation(s)
| | | | | | - Irene M. IJgosse
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Simone L. Broer
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Aart J. Klijn
- Pediatric Urology, University Medical Center Utrecht—Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | - Brigitte Arends
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ralph J. A. Oude Ophuis
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hanneke M. van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Endocrinology, University Medical Center Utrecht—Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | | | | | - Annelies M. E. Bos
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
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Cho HW, Lee S, Min KJ, Hong JH, Song JY, Lee JK, Lee NW, Kim T. Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity. Int J Mol Sci 2020; 21:E7792. [PMID: 33096794 PMCID: PMC7589665 DOI: 10.3390/ijms21207792] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility preservation options including established and experimental techniques that take into consideration the patient's age, marital status, chemotherapy regimen, and the possibility of treatment delay should be provided. In addition, effective multidisciplinary oncofertility strategies that involve a highly skilled and experienced oncofertility team consisting of medical oncologists, gynecologists, reproductive biologists, surgical oncologists, patient care coordinators, and research scientists are necessary to provide cancer patients with high-quality care.
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Affiliation(s)
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea; (H.-W.C.); (K.-J.M.); (J.H.H.); (J.Y.S.); (J.K.L.); (N.W.L.); (T.K.)
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6
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Standen P, Cohen PA, Leung Y, Mohan GR, Salfinger S, Tan J, Bulsara C. Exploring Attitudes to Conception in Partners and Young Women with Gynecologic Cancers Treated by Fertility Sparing Surgery. Asian Pac J Cancer Prev 2020; 21:2609-2614. [PMID: 32986359 PMCID: PMC7779464 DOI: 10.31557/apjcp.2020.21.9.2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Approximately 20% of women with gynecologic cancers are under age 40 and with delayed childbearing, women may be diagnosed before their first pregnancy. Although fertility preservation is a priority for many women, attitudes to conception have not previously been investigated in these patients or their partners. We explored attitudes to conception in partners and young women, following fertility preserving treatment for gynecologic cancers. METHODS A total of 16 telephone interviews were conducted with a purposive sample of patients who had had an early stage gynecologic cancer or borderline ovarian tumor treated by fertility sparing surgery in Western Australia between January 1st, 2005 to December 31st, 2016. The interviews were audio recorded, transcribed and thematic analysis was conducted. RESULTS Four main themes were identified: (i) Emotions at diagnosis and perception of information given; (ii) Discussions of fertility and factors affecting childbearing; (iii) Role of partners in decision making and relationship pressures; (iv) Decision for treatment and postoperative regrets. CONCLUSIONS Regret and relationship breakdown were commonly reported. Women need appropriate support including inviting their partners to attend clinic appointments and may need several appointments before treatment. Regret was commonly reported by women who opted for completion surgery.<br />.
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Affiliation(s)
- Prue Standen
- Joan Kirner Hospital, St Albans, Victoria, Australia
| | - Paul A Cohen
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,St John of God Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Yee Leung
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Ganendra Raj Mohan
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,St John of God Hospital, Subiaco, Western Australia, Australia
| | - Stuart Salfinger
- St John of God Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jason Tan
- WOMEN Centre, West Leederville, Western Australia, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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7
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La Rosa VL, Shah M, Kahramanoglu I, Cerentini TM, Ciebiera M, Lin LT, Dirnfeld M, Minona P, Tesarik J. Quality of life and fertility preservation counseling for women with gynecological cancer: an integrated psychological and clinical perspective. J Psychosom Obstet Gynaecol 2020; 41:86-92. [PMID: 31373525 DOI: 10.1080/0167482x.2019.1648424] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Relational and sexual problems are frequent in patients with a diagnosis of gynecological cancer, because this disease has a strong negative impact on female identity and sexuality. Psychological and sexual functioning is affected by inauspicious diagnosis. Furthermore, therapies may compromise reproductive function. The aim of this study is to propose a general overview on the impact of gynecological cancer on quality of life and psychological and sexual functioning, as well as on the importance of adequate counseling related to fertility preservation techniques.Materials and methods: We provide a narrative overview of the recent literature about quality of life and fertility preservation counselling in women with gynecological cancer.Results and conclusions: According to recent studies, 75% of women between 18 and 45 years with a diagnosis of cancer wish to have children. When cancer affects the reproductive system, the psychological distress is even stronger because there is a loss of menstrual function and fertility. Currently, fertility preservation techniques in women with gynecological cancer are beneficial and lead to an improvement in the quality of life.
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Affiliation(s)
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ilker Kahramanoglu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Martha Dirnfeld
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology-IVF, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Haifa, Israel
| | | | - Jan Tesarik
- Molecular Assisted Reproduction and Genetics, MARGen Clinic, Granada, Spain
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8
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Manuel SL, Moravek MB, Confino R, Smith KN, Lawson AK, Klock SC, Pavone ME. Ovarian stimulation is a safe and effective fertility preservation option in the adolescent and young adult population. J Assist Reprod Genet 2019; 37:699-708. [PMID: 31828481 DOI: 10.1007/s10815-019-01639-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/21/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The aim of this study is to describe the multidisciplinary approach and controlled ovarian hyperstimulation (COH) outcomes in adolescent and young adult (AYA) patients (ages 13-21) who underwent oocyte cryopreservation for fertility preservation (FP). METHODS Multi-site retrospective cohort was performed from 2007 to 2018 at Northwestern University and Michigan University. Data were analyzed by chi-square test, t-test, and logistic regression. RESULTS Forty-one patients began COH of which 38 patients successfully underwent oocyte retrieval, with mature oocytes obtained and cryopreserved without any adverse outcomes. To treat this group of patients, we use a multidisciplinary approach with a patient navigator. When dividing patients by ages 13-17 vs. 18-21, the median doses of FSH used were 2325 and 2038 IU, the median number of mature oocytes retrieved were 10 and 10, and median number frozen oocytes were 11 and 13, respectively. Median days of stimulation were 10 for both groups. There was no statistical difference in BMI, AMH, peak E2, FSH dosage, days stimulated, total oocytes retrieved, mature oocytes retrieved, and oocytes frozen between the two groups. Three patients were canceled for poor response. CONCLUSION COH with oocyte cryopreservation is a feasible FP option for AYAs who may not have other alternatives when appropriate precautions are taken, such as proper counseling and having a support team. These promising outcomes correspond to similar findings of recent small case series, providing hope for these patients to have genetically related offspring in the future.
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Affiliation(s)
- Sharrόn L Manuel
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Molly B Moravek
- Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Kristin N Smith
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Angela K Lawson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Susan C Klock
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA.
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9
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Alvarez RM, Ramanathan P. Fertility preservation in female oncology patients: the influence of the type of cancer on ovarian stimulation response. Hum Reprod 2019; 33:2051-2059. [PMID: 27370358 DOI: 10.1093/humrep/dew158] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Does the type of cancer influence on the ovarian response to stimulation for fertility preservation (FP) in female oncology patients? SUMMARY ANSWER Patients with gynaecological cancer have less number of retrieved mature oocytes compared with haematological and breast cancer patients. WHAT IS KNOWN ALREADY Concerns about the impact of cancer therapy on future fertility have been raised and FP has become an important component in cancer management. Previous studies analysing FP results in cancer patients have shown conflicting findings. STUDY DESIGN, SIZE, DURATION This was a retrospective analytical study performed in the Centre for Reproductive Medicine, at St Bartholomew's Hospital, between January 2000 and December 2014. The aim of this study was to analyse the response to ovarian stimulation in cancer patients before undergoing cancer treatment and to determine whether any difference can be attributed to underlying cancer diagnosis. We also report the pregnancy outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 531 female patients recently diagnosed with cancer were referred for counselling on FP. A total of 306 patients underwent ovarian stimulation for oocyte or embryo cryopreservation. We compared the baseline characteristics and ovarian response in five main subgroups: breast cancer, haematological cancer, gynaecological cancer, gastrointestinal cancer and others. The primary outcome was the total number of mature oocytes retrieved and pregnancy outcomes. MAIN RESULTS AND THE ROLE OF CHANCE The main cancer diagnosis was breast cancer with 145 patients (47.4%); 79 patients (25.8%) had haematological malignancies; 42 (13.7%) had gynaecological malignancies; 20 (6.5%) had gastrointestinal cancer and 20 (6.5%) had other types of cancer. Patients with breast cancer were older (P < 0.001). Patients with haematological malignancies had higher number of mature oocytes retrieved (P = 0.003). The number of mature oocytes retrieved was lower in patients with gynaecological malignancy compared with haematological and breast cancer patients (P = 0.005 and P = 0.045, respectively). The fertilization rate and the number of cycles cancelled were comparable between all the groups. Thirty-two embryo transfer cycles have been done in 22 patients who have returned to attempt pregnancy. Pregnancy rate per transfer cycle was 43.75%, and cumulative pregnancy rate per patient was 54.5%. Live birth rate per patient was 22.72%. LIMITATIONS, REASONS FOR CAUTION Apart from the retrospective nature of the study, patients were included over the period of 15 years, and over that time technology has changed and protocols have evolved. The results obtained from subcategory analyses should be interpreted with caution, as in each subgroup there are different types of malignancies with different number of patients in different age groups. Different ovarian stimulation protocols were applied. Only a few patients have come back to attempt pregnancy after being cured from their disease. We do not have follow-up data on these patients; as a result, we are not able to report the survival rate and the reason for non-return for embryo transfer. In addition, we cannot report information on spontaneous conceptions and births. Slow freezing used for embryo cryopreservation, high miscarriage rate and low live birth rate per transfer are other limitations of this study. WIDER IMPLICATIONS OF THE FINDINGS The current study is the largest series analysing each group of cancer separately and showing pregnancy outcomes in oncology patients undergoing FP. These results provide valuable information about the success of this technique in oncology patients. STUDY FUNDING/COMPETING INTEREST(S) The authors have not received any funding to support this study. There are no conflicts of interest to declare.
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Affiliation(s)
- R M Alvarez
- The Centre for Reproductive Medicine, St Bartholomew's Hospital, West Smithfield, London, UK.,Department of Gynaecological Oncology, The Royal Marsden Hospital, Fulham Road, London, UK
| | - P Ramanathan
- The Centre for Reproductive Medicine, St Bartholomew's Hospital, West Smithfield, London, UK
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10
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EUropean REcommendations for female FERtility preservation (EU-REFER): A joint collaboration between oncologists and fertility specialists. Crit Rev Oncol Hematol 2019; 138:233-240. [DOI: 10.1016/j.critrevonc.2019.03.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/25/2018] [Accepted: 03/20/2019] [Indexed: 11/17/2022] Open
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11
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Korkidakis A, Lajkosz K, Green M, Strobino D, Velez MP. Patterns of Referral for Fertility Preservation Among Female Adolescents and Young Adults with Breast Cancer: A Population-Based Study. J Adolesc Young Adult Oncol 2019; 8:197-204. [PMID: 30676852 PMCID: PMC6479234 DOI: 10.1089/jayao.2018.0102] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To assess the fertility preservation (FP) referral rates and patterns of newly diagnosed breast cancer in female adolescent and young adult (AYA) patients. Methods: Women aged 15–39 years with newly diagnosed breast cancer in Ontario from 2000 to 2017 were identified using the Ontario Cancer Registry. Exclusion criteria included prior sterilizing procedure, health insurance ineligibility, and prior infertility or cancer diagnosis. Women with a gynecology consult between cancer diagnosis and chemotherapy commencement with the billed infertility diagnostic code (ICD-9 628) were used as a surrogate for FP referral. The effect of age, parity, year of cancer diagnosis, staging, income, region, neighborhood marginalization, and rurality on referral status was investigated. Results: A total of 4452 patients aged 15–39 with newly diagnosed breast cancer met the inclusion criteria. Of these women, 178 (4.0%) were referred to a gynecologist with a billing code of infertility between cancer diagnosis and initiation of chemotherapy. Older patients, prior parity, and advanced disease were inversely correlated with referrals. Referral rates also varied regionally: patients treated in the south-east and south-west Local Health Integration Networks (LHINs) had the highest probability of referral, and patients covered by north LHINs had the lowest (central LHIN as reference). General surgeons accounted for 36.5% of all referrals, the highest percentage of all specialists. Referral rates significantly increased over time from 0.4% in 2000 to 10.7% in 2016. Conclusion: FP referral rates remain low and continue to be influenced by patient demographics and prognosis. These findings highlight the need for further interdisciplinary coordination in addressing the fertility concerns of AYA with newly diagnosed breast cancers.
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Affiliation(s)
- Ann Korkidakis
- 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada.,2 Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, Canada
| | - Katherine Lajkosz
- 3 Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Michael Green
- 4 Department of Family Medicine, Centre for Health Services and Policy Research, Queen's University, Institute for Clinical Evaluative Sciences, Kingston, Canada
| | - Donna Strobino
- 5 Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria P Velez
- 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
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12
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Ehrbar V, Urech C, Tschudin S. Fertility decision-making in cancer patients – current status and future directions. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1503539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Verena Ehrbar
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Corinne Urech
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Sibil Tschudin
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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13
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Skaczkowski G, White V, Thompson K, Bibby H, Coory M, Orme LM, Conyers R, Phillips MB, Osborn M, Harrup R, Anazodo A. Factors influencing the provision of fertility counseling and impact on quality of life in adolescents and young adults with cancer. J Psychosoc Oncol 2018; 36:484-502. [DOI: 10.1080/07347332.2018.1443986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Gemma Skaczkowski
- center for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Victoria White
- center for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kate Thompson
- Peter MacCallum Cancer center, Melbourne, Victoria, Australia
| | - Helen Bibby
- center for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Michael Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Lisa M. Orme
- Peter MacCallum Cancer center, Melbourne, Victoria, Australia
| | - Rachel Conyers
- Peter MacCallum Cancer center, Melbourne, Victoria, Australia
- Children's Cancer center, The Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Michael Osborn
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Antoinette Anazodo
- Sydney Children's Hospital, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
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14
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Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS. Fertility preservation in women with gynaecologic cancer: the impact on quality of life and psychological well-being. HUM FERTIL 2017. [DOI: 10.1080/14647273.2017.1339365] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | | | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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15
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Flink DM, Kondapalli LA, Kellar-Guenther Y. Priorities in Fertility Decisions for Reproductive-Aged Cancer Patients: Fertility Attitudes and Cancer Treatment Study. J Adolesc Young Adult Oncol 2017; 6:435-443. [PMID: 28221816 DOI: 10.1089/jayao.2016.0072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The Fertility Attitudes and Cancer Treatment Study (FACTS) aims at better understanding the reasons and priorities of young adult cancer patients making decisions for fertility preservation (FP). Identifying the factors that center around a patient's fertility decisions will support the development of educational tools for providers and improve clinical care to meet patients' reproductive needs. METHODS An exploratory qualitative study was conducted of 27 newly diagnosed male and female cancer patients who had presented for an oncofertility consultation. Interviews lasted ∼30 minutes and were transcribed verbatim. A thematic analysis was conducted to explore the factors driving decisions for future fertility. Themes were grouped to address the following topics: reasons for/against FP, patient priorities, informational needs, support, wellness, and satisfaction with information. Strength of the theme was determined by examining the frequency of a response. RESULTS Patients who chose FP versus those who did not choose FP and men versus women proved to be more similar than different in their reasoning, priorities, and informational needs for FP decisions. Patients who chose FP identified a "concern for future fertility" as a top reason to do so and "parenthood" as a top priority. For those who did not choose FP, "cancer treatment" was identified as their top priority. For patients identifying financial barriers, 50% of them were able to overcome this to pursue FP. CONCLUSIONS Reproductive-aged patients diagnosed with a new cancer should be referred to a reproductive specialist and provided the opportunity to come to a fertility decision on their own before initiating cancer treatment.
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Affiliation(s)
- Dina M Flink
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
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16
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Laganà AS, La Rosa VL, Rapisarda AMC, Platania A, Vitale SG. Psychological impact of fertility preservation techniques in women with gynaecological cancer. Ecancermedicalscience 2017; 11:ed62. [PMID: 28275393 PMCID: PMC5336386 DOI: 10.3332/ecancer.2017.ed62] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Indexed: 02/01/2023] Open
Abstract
Gynaecological cancer is a very stressful experience for women and treatments can compromise fertility and reproductive capacity. Fertility preservation techniques in women with gynaecological cancer can play an important role in improving the quality of life of these patients but, in many cases, the information about this type of treatment is not adequate. It is important to further investigate this topic in order to reduce the impact of gynaecological cancer on the quality of life of survivors as much as possible.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G Barresi", University of Messina, Messina, 98125, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, 95124, Italy
| | | | - Alessio Platania
- Department of Health Services and Epidemiological Observatory, Palermo, 90121, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G Barresi", University of Messina, Messina, 98125, Italy
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17
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The Importance of Fertility Preservation Counseling in Patients with Gynecologic Cancer. J Reprod Infertil 2017; 18:261-263. [PMID: 28868252 PMCID: PMC5565906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Flink DM, Sheeder J, Kondapalli LA. Do Patient Characteristics Decide if Young Adult Cancer Patients Undergo Fertility Preservation? J Adolesc Young Adult Oncol 2016; 6:223-228. [PMID: 27893303 DOI: 10.1089/jayao.2016.0071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The Fertility Attitudes and Cancer Treatment Study (FACTS) is a two-phase research initiative aimed to understand factors involved with decision making for future fertility. The FACTS will improve services and utilization of fertility preservation (FP) before cancer treatment. Phase-I examined patient characteristics as associated with FP decision. METHODS A retrospective cohort study of 108 reproductive-aged (18-45 years) males and females who received a fertility consultation before cancer treatment from January 1, 2012 to April 30, 2014 was conducted. Chi-square, student's t-test, and logistic regression were conducted to examine associations with FP decision. RESULTS The utilization rate of FP following fertility consultation was 49%. Gender was the most significant factor contributing to FP decision; 74% of those who choose FP were male (odds ratio = 12.5; 95% confidence interval 5.1-31.4). Those who opted for FP were more likely to be Caucasian (p = 0.042), have a solid tumor (p = 0.03), and have a shorter time from diagnosis to fertility consultation (29.5 vs. 58.8 days; p = 0.017). Age, relationship, tumor location, treatment plan, and parity were not significant predictors of FP. CONCLUSIONS Current perceptions about patient demographics do not predict FP utilization by young adult cancer patients. Providing patients an informed fertility consultation has demonstrated an increase in FP utilization to nearly one-half of patients. Despite gender being a significant factor in choosing FP, the study did not provide reasons as to why. The phase-II study will explore patients' reasons for FP decision in a qualitative design to understand these differences.
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Affiliation(s)
- Dina M Flink
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jeanelle Sheeder
- 2 Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
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19
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Flink DM, Sheeder J, Kondapalli LA. A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services. J Adolesc Young Adult Oncol 2016; 6:31-44. [PMID: 27529573 DOI: 10.1089/jayao.2015.0065] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology issued practice guidelines in 2006 to provide critical information about fertility impact to adolescents and young adults (AYA) at the time of cancer diagnosis. Survivors continue to express concerns about their long-term reproductive health after cancer therapy even as treatment options for fertility preservation evolve. An underutilization of fertility preservation methods by cancer patients continues to persist. A review of the literature cites barriers and challenges that limit fertility information and preservation options for AYA cancer patients. METHODS A review of medical literature was conducted to examine current practice for patients receiving fertility information and the barriers to patients receiving fertility preservation services. RESULTS A total of 69 publications were included in this review. The review summarizes (1) patient experiences with receiving fertility information and (2) patient desires, barriers, and challenges to utilizing fertility preservation services. CONCLUSIONS Despite advances in fertility preservation, there are challenges for patients to utilizing fertility preservation services. Barriers include the following: urgency to initiate treatment, inadequate information, clinic time constraints, and perceptions around patients' gender, age, cost, parity, race, relationship, and sociodemographic status influence whether patients receive fertility preservation consultation. Patients report a lack of adequate information to make informed fertility decisions.
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Affiliation(s)
- Dina M Flink
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jeanelle Sheeder
- 2 Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
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20
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Abstract
OBJECTIVE To demonstrate that oocyte cryopreservation is a feasible reproductive option for patients with cancer of childbearing age who require gonadotoxic therapies. METHODS This study is a university-based retrospective review of reproductive-aged cancer patient treatment cycles that included ovarian stimulation, transvaginal oocyte retrieval, oocyte cryopreservation, and, in some cases, subsequent oocyte thaw, in vitro fertilization, and embryo transfer. Outcome measures included ovarian stimulation response, number of oocytes retrieved, cryopreserved, and thawed, and pregnancy data. RESULTS From 2005 to 2014, 176 reproductive-aged patients with cancer (median age 31 years, interquartile range 24-36) completed 182 oocyte cryopreservation cycles. Median time between consult request and oocyte retrieval was 12 days (interquartile range 10-14). Median peak stimulation estradiol was 1,446 pg/mL (interquartile range 730-2,687); 15 (interquartile range 9-23) oocytes were retrieved and 10 (interquartile range 5-18) metaphase II oocytes were cryopreserved per cycle. Ten patients (11 cycles) have returned to attempt pregnancy with their cryopreserved oocytes. Among thawed oocytes, the cryopreservation survival rate was 86% (confidence interval [CI] 78-94%). Nine of 11 thaw cycles resulted in embryos suitable for transfer. The embryo implantation rate was 27% (CI 8-46%) and the live birth rate was 44% (CI 12-77%) per embryo transfer. Chance for live birth with embryos created from cryopreserved oocytes was similar between the patients with cancer in this study and noncancer patients who underwent the same treatment at our center (44% [CI 12-77%] compared with 33% [CI 22-44%] per embryo transfer). CONCLUSION Oocyte cryopreservation is now a feasible fertility preservation option for reproductive-aged patients with cancer who require gonadotoxic therapies.
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21
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Shah MS, Letourneau JM, Niemasik EE, Bleil M, McCulloch CE, Rosen MP. The role of in-depth reproductive health counseling in addressing reproductive health concerns in female survivors of nongynecologic cancers. J Psychosoc Oncol 2016; 34:305-17. [PMID: 27144587 DOI: 10.1080/07347332.2016.1182958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population.
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Affiliation(s)
- M S Shah
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA
| | - J M Letourneau
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA.,b Department of Obstetrics and Gynecology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - E E Niemasik
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA.,c Department of Obstetrics and Gynecology , Cornell University , New York , NY , USA
| | - M Bleil
- d Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - Charles E McCulloch
- d Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - M P Rosen
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA
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Angarita AM, Johnson CA, Fader AN, Christianson MS. Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer. Front Oncol 2016; 6:102. [PMID: 27200291 PMCID: PMC4843761 DOI: 10.3389/fonc.2016.00102] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/11/2016] [Indexed: 12/14/2022] Open
Abstract
Fertility preservation in the young cancer survivor is recognized as a key survivorship issue by the American Society of Clinical Oncology and the American Society of Reproductive Medicine. Thus, health-care providers should inform women about the effects of cancer therapy on fertility and should discuss the different fertility preservation options available. It is also recommended to refer women expeditiously to a fertility specialist in order to improve counseling. Women’s age, diagnosis, presence of male partner, time available, and preferences regarding use of donor sperm influence the selection of the appropriate fertility preservation option. Embryo and oocyte cryopreservation are the standard techniques used while ovarian tissue cryopreservation is new, yet promising. Despite the importance of fertility preservation for cancer survivors’ quality of life, there are still communication and financial barriers faced by women who wish to pursue fertility preservation.
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Affiliation(s)
- Ana Milena Angarita
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Cynae A Johnson
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Mindy S Christianson
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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23
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Bann CM, Treiman K, Squiers L, Tzeng J, Nutt S, Arvey S, McGoldrick D, Rechis R. Cancer Survivors' Use of Fertility Preservation. J Womens Health (Larchmt) 2015; 24:1030-7. [DOI: 10.1089/jwh.2014.5160] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carla M. Bann
- RTI International, Research Triangle Park, North Carolina
| | | | - Linda Squiers
- RTI International, Research Triangle Park, North Carolina
| | - Janice Tzeng
- RTI International, Research Triangle Park, North Carolina
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24
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Deshpande NA, Braun IM, Meyer FL. Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: A systematic review. Cancer 2015; 121:3938-47. [DOI: 10.1002/cncr.29637] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/20/2015] [Accepted: 07/21/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Neha A. Deshpande
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Department of Obstetrics and Gynecology; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Ilana M. Braun
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Department of Psychiatry; Harvard Medical School; Boston Massachusetts
- Department of Psychosocial Oncology and Palliative Care; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Fremonta L. Meyer
- Department of Psychiatry; Brigham and Women's Hospital; Boston Massachusetts
- Department of Psychiatry; Harvard Medical School; Boston Massachusetts
- Department of Psychosocial Oncology and Palliative Care; Dana-Farber Cancer Institute; Boston Massachusetts
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25
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Cardozo ER, Thomson AP, Karmon AE, Dickinson KA, Wright DL, Sabatini ME. Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience. J Assist Reprod Genet 2015; 32:587-96. [PMID: 25595540 DOI: 10.1007/s10815-015-0428-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare the in-vitro fertilization (IVF) outcomes of cancer patients who underwent oocyte retrieval and embryo/oocyte cryopreservation prior to gonadotoxic therapy to those of age and time-matched controls with tubal factor infertility. METHODS All cancer patients who underwent embryo/oocyte cryopreservation at our institution from 1997 to 2014 were reviewed. Primary outcomes were total dose of gonadotropins used, number of oocytes retrieved, and number of 2pn embryos obtained. Outcomes were compared to age-matched controls with tubal-factor infertility who underwent a fresh embryo transfer within the same relative time period as the IVF cycle of the cancer patient. RESULTS Sixty-three cancer patients underwent 65 IVF cycles, and 21 returned for frozen embryo transfer. One hundred twenty-two age-matched controls underwent IVF cycles with fresh transfer, and 23 returned for frozen embryo transfer. No difference was seen between cancer patients and controls with respect to total ampules of gonadotropin used (38.0 vs. 35.6 respectively; p = 0.28), number of oocytes retrieved (12.4 vs. 10.9 respectively; p = 0.36) and number of 2pn embryos obtained (6.6 vs. 7.1 respectively; p = 0.11). Cumulative pregnancy rate per transfer for cancer patients compared to controls was 37 vs. 43 % respectively (p = 0.49) and cumulative live birth rate per transfer was 30 vs. 32 % respectively (p = 0.85). Cancer patients had a higher likelihood of live birth resulting in twins (44 vs. 14 %; p = 0.035). CONCLUSIONS Most IVF outcomes appear comparable for cancer patients and age-matched controls. Higher twin pregnancy rates in cancer patients may reflect lack of underlying infertility or need for cancer-specific transfer guidelines.
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Affiliation(s)
- Eden R Cardozo
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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26
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A national study of the provision of oncofertility services to female patients in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:849-858. [PMID: 22971454 DOI: 10.1016/s1701-2163(16)35384-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to gain a better understanding of the fertility preservation services provided by Canadian fertility clinics to women with cancer. METHODS We invited a total of 76 fertility clinics across Canada to complete a mailed questionnaire related to the availability, accessibility, affordability, and utilization of fertility preservation services for oncology patients. RESULTS The total response rate was 59.2%: 72.4% for IVF clinics and 51.1% for fertility centres without on-site IVF. Not all the responding IVF centres accepted oncology referrals for women. Six clinics without on-site IVF accepted cancer patients for consultation. The medical consultation fees are covered by public health insurance in all provinces. The majority of respondents expedited the referrals to schedule an initial medical appointment within three days. Despite that, the referral volume reported by respondents was markedly low for all except two facilities. With over 4000 young women of reproductive age given a diagnosis of cancer each year in Canada, the findings suggest that cancer patients are severely under-served by fertility clinics. CONCLUSION There is a need to develop a stronger partnership between the fields of oncology and reproductive medicine to further improve access of patients with cancer to fertility preservation services. Development of evidence-based practice guidelines covering medical, clinical, psychosocial, ethical, and legal aspects geared to the Canadian health care system would help to avoid ambiguity relating to the roles and responsibilities in the provision of fertility preservation services. Such processes would ensure optimization of services so that all young cancer patients would receive the best care in protecting their fertility.
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27
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Noyes N, Melzer K, Druckenmiller S, Fino ME, Smith M, Knopman JM. Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors. J Assist Reprod Genet 2013; 30:1263-70. [PMID: 23942892 DOI: 10.1007/s10815-013-0066-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 07/16/2013] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes. METHODS Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome. RESULTS From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte + zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12 ± 2 days with 14 ± 11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded. CONCLUSIONS Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-of-life marker for survivors.
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Affiliation(s)
- Nicole Noyes
- Fertility Center at NYU Langone Medical Center, NYU School of Medicine, 660 First Avenue, Fifth Floor, New York, NY, 10016, USA,
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Lambertini M, Anserini P, Levaggi A, Poggio F, Del Mastro L. Fertility counseling of young breast cancer patients. J Thorac Dis 2013; 5 Suppl 1:S68-80. [PMID: 23819030 DOI: 10.3978/j.issn.2072-1439.2013.05.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 05/29/2013] [Indexed: 12/11/2022]
Abstract
Approximately 6% of women with breast cancer are diagnosed before the age of 40. Young age is an independent predictor of adverse outcome and most young breast cancer patients receive systemic treatment with chemotherapy, hormonal therapy or both. The loss or impairment of fertility is a potential side effect of antineoplastic treatments. Due to the rising trend to delaying pregnancy in life, an increasing proportion of young cancer patients who are yet to have a pregnancy will face the problem of iatrogenic menopause in the future. The incidence of anticancer-treatment-related ovarian failure depends on the type of chemotherapy regimen administered, the use of tamoxifen and the age of patients. It rises with increasing age, in the range of 22-61% and 61-97% in women aged <40 years and >40 years respectively. Although there is a clear trend to increasing incidence of ovarian failure with the rise in aging, there may be a small proportion of patients who became amenorrhoeic despite the very young age, thus indicating that also individual factors still unknown may affect the probability of treatment-related ovarian failure. A prompt referral of patients to reproductive counseling and a multidisciplinary team including Oncology and Reproductive Units are essential to face the management of fertility issues in cancer patients. Fertility counseling should include a detailed description of all the available techniques to preserve fertility. The main available fertility preservation techniques, standard and experimental, for young breast cancer patients include: temporary ovarian suppression during chemotherapy with gonadotropin-releasing hormone analogues, embryo cryopreservation, cryopreservation of oocytes and cryopreservation of ovarian tissue. Research efforts are still necessary to improve the efficacy and safety of the available fertility preservation strategies as well as an efficient collaboration between oncologists and gynecologists is necessary to improve patients' access to the strategies themselves.
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Rodriguez S, Campo-Engelstein L, Emanuel L. Fertile Future? Potential Social Implications of Oncofertility. J Clin Oncol 2013; 31:665-7. [DOI: 10.1200/jco.2012.44.0990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Niemasik EE, Letourneau J, Dohan D, Katz A, Melisko M, Rugo H, Rosen M. Patient perceptions of reproductive health counseling at the time of cancer diagnosis: a qualitative study of female California cancer survivors. J Cancer Surviv 2012; 6:324-32. [PMID: 22752834 DOI: 10.1007/s11764-012-0227-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/08/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE We sought to determine what women recall about reproductive health risks (RHR) from cancer therapy at the time of cancer diagnosis in order to identify barriers to reproductive health counseling (RHC) and fertility preservation (FP). METHODS Data were obtained by surveying 1,041 female cancer survivors from the California Cancer Registry. Inclusion criteria included women age 18-40 with a diagnosis of leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, breast or GI cancer diagnosed between 1993 and 2007. Women were asked to respond to an open-ended question: "what did your doctor tell you about how cancer treatment could affect your ability to get pregnant?" Framework analysis was used to identify themes surrounding patient perceptions of RHC. RESULTS Of the patients, 51.8 % (361 out of 697) recalled receiving reproductive health counseling and 12.2 % (85 out of 697) recalled receiving FP counseling. Of the patients, 45.3 % (277 out of 612) reported that uncertain prognosis, risk of recurrence or vertical transmission, age, parity, or uncertain desire may have prevented them from receiving timely and essential information on RHRs. Communication barriers included omission of information, failure to disclose RHRs, and presentation of incorrect information on FP. DISCUSSION In a sample of women diagnosed with cancer of reproductive age, almost half did not recall counseling on RHRs and few recalled FP counseling. Communication barriers between physicians and patients regarding fertility may lead to uninformed (reproductive health) RH decisions. IMPLICATIONS FOR CANCER SURVIVORS Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.
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Affiliation(s)
- Erin Ebbel Niemasik
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA 94115, USA.
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