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Fertility preservation for people with cancer

Assisted reproduction and risk of cancer recurrence

Clinical Question

In women with a history of cancer does the use of assisted reproduction technologies increase the likelihood of cancer recurrence?

There are now several studies evaluating the risk of breast cancer recurrence after fertility treatment. Goldrat et al evaluated the impact of subsequent pregnancy on recurrence risk in 198 women in a multicentre study with an average follow up of 8-9 years from cancer diagnosis and 4.5-5 years from pregnancy and found no difference in recurrence rate between women who conceived spontaneously and those who conceived with assisted reproductive technology (ART), regardless of hormone receptor status.[1] Larger studies are needed to confirm this observation.

Three retrospective cohort studies have looked at the impact of ART on women treated for borderline ovarian tumours. A systematic review and meta-analysis by Denschlag et al concluded that it was unclear if ART use was associated with an increased risk of recurrence.[2] In a small study of 43 patients, seven patients received IVF; two of whom developed a recurrence after IVF and two before IVF.[3] In another study of 17 women who received fertility-sparing surgery for borderline ovarian tumors, four experienced recurrences of BOTs after IVF and birth.[4]

Similarly, a small number of studies have looked at the impact of IVF following treatment for endometrial cancer. In one study 6 out of 22 women experienced a relapse following IVF treatment,[5] while in another study of 10 patients there was no evidence of recurrence.[6] The largest study of 36 patients found that there was no significant increase in recurrence for the 26 women who received infertility treatment in order to conceive.[7]

Recommendation

Consensus-based recommendation
Discussion with the treating oncologist to clarify an individual patient’s risk profile is required when considering pregnancy. Women with low-risk disease can be reassured that it is generally safe to attempt pregnancy, either spontaneously or with ART. Consideration must be given to minimise the duration of time off adjuvant endocrine treatment in women being treated for receptor positive breast cancer.

References

  1. Goldrat O, Kroman N, Peccatori FA, Cordoba O, Pistilli B, Lidegaard O, et al. Pregnancy following breast cancer using assisted reproduction and its effect on long-term outcome. Eur J Cancer 2015 Aug;51(12):1490-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26070684.
  2. Denschlag D, von Wolff M, Amant F, Kesic V, Reed N, Schneider A, et al. Clinical recommendation on fertility preservation in borderline ovarian neoplasm: ovarian stimulation and oocyte retrieval after conservative surgery. Gynecol Obstet Invest 2010;70(3):160-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20558989.
  3. Beiner ME, Gotlieb WH, Davidson B, Kopolovic J, Ben-Baruch G. Infertility treatment after conservative management of borderline ovarian tumors. Cancer 2001 Jul 15;92(2):320-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11466685.
  4. Li S, Lin H, Xie Y, Jiao X, Qiu Q, Zhang Q. Live Births after in vitro Fertilization with Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Case Series and Literature Review. Gynecol Obstet Invest 2019;84(5):445-454 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30799426.
  5. Kim MJ, Choe SA, Kim MK, Yun BS, Seong SJ, Kim YS. Outcomes of in vitro fertilization cycles following fertility-sparing treatment in stage IA endometrial cancer. Arch Gynecol Obstet 2019 Oct;300(4):975-980 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31440822.
  6. Han AR, Kwon YS, Kim DY, Kim JH, Kim YM, Kim YT, et al. Pregnancy outcomes using assisted reproductive technology after fertility-preserving therapy in patients with endometrial adenocarcinoma or atypical complex hyperplasia. Int J Gynecol Cancer 2009 Jan;19(1):147-51 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19258957.
  7. Ichinose M, Fujimoto A, Osuga Y, Minaguchi T, Kawana K, Yano T, et al. The influence of infertility treatment on the prognosis of endometrial cancer and atypical complex endometrial hyperplasia. Int J Gynecol Cancer 2013 Feb;23(2):288-93 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23314282.

Body of evidence

In cancer survivors does the use of assisted reproduction technologies increase the likelihood of cancer recurrence?

CitationLevel of EvidenceQuality of EvidenceSize of EffectNumber of PatientsRelevance of Evidence
Beiner ME, Gotlieb WH, Davidson B, Kopolovic J, Ben-Baruch G. Infertility treatment after conservative management of borderline ovarian tumors. Cancer 2001 Jul 15;92(2):320-5 Available from:http://www.ncbi.nlm.nih.gov/pubmed/11466685 IVLowN/A43N/A
Denschlag D, von Wolff M, Amant F, Kesic V, Reed N, Schneider A, et al. Clinical recommendation on fertility preservation in borderline ovarian neoplasm: ovarian stimulation and oocyte retrieval after conservative surgery. Gynecol Obstet Invest 2010;70(3):160-5 Available from:http://www.ncbi.nlm.nih.gov/pubmed/20558989 IVLowN/A62N/A
Goldrat O, Kroman N, Peccatori FA, Cordoba O, Pistilli B, Lidegaard O, et al. Pregnancy following breast cancer using assisted reproduction and its effect on long-term outcome. Eur J Cancer 2015 Aug;51(12):1490-6 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26070684 III-3LowN/A198N/A
Han AR, Kwon YS, Kim DY, Kim JH, Kim YM, Kim YT, et al. Pregnancy outcomes using assisted reproductive technology after fertility-preserving therapy in patients with endometrial adenocarcinoma or atypical complex hyperplasia. Int J Gynecol Cancer 2009 Jan;19(1):147-51 Available from:http://www.ncbi.nlm.nih.gov/pubmed/19258957 IVLowN/A11N/A
Ichinose M, Fujimoto A, Osuga Y, Minaguchi T, Kawana K, Yano T, et al. The influence of infertility treatment on the prognosis of endometrial cancer and atypical complex endometrial hyperplasia. Int J Gynecol Cancer 2013 Feb;23(2):288-93 Available from:http://www.ncbi.nlm.nih.gov/pubmed/23314282 III-2LowN/A36N/A
Kim MJ, Choe SA, Kim MK, Yun BS, Seong SJ, Kim YS. Outcomes of in vitro fertilization cycles following fertility-sparing treatment in stage IA endometrial cancer. Arch Gynecol Obstet 2019 Oct;300(4):975-980 Available from:http://www.ncbi.nlm.nih.gov/pubmed/31440822 IVLowN/AN/AN/A
Li S, Lin H, Xie Y, Jiao X, Qiu Q, Zhang Q. Live Births after in vitro Fertilization with Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Case Series and Literature Review. Gynecol Obstet Invest 2019;84(5):445-454 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30799426 IVLowN/AN/AN/A
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