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Fertility preservation for people with cancer

Embryo cryopreservation

Clinical Question

Does the use of cryopreserved embryos and assisted reproduction result in pregnancy and live birth for women with a history of cancer?

Embryo cryopreservation is a routine practice around the world. The latest data from the Australia and New Zealand Assisted Reproduction Database (ANZARD) shows that 54.1% of assisted reproduction cycles used cryopreserved embryos, and of the 14 515 live births resulting from assisted reproductive technology (ART) treatment across Australia and New Zealand, 58.1% involved the use of cryopreserved embryos.[1] The routine use of a standard in vitro fertilisation (IVF) cycle to generate embryos that can be successfully cryopreserved and used several years later is established practice and is available across most IVF units in Australia. This treatment is also readily available for patients diagnosed with cancer.[2]

Despite the small number of low powered studies it is clear that embryo cryopreservation before cancer treatment and the use of ART after cancer treatment can result in pregnancy and live birth for women living with a history of cancer.[3][4][5][6][7][8][9] One retrospective cohort study found that the cumulative pregnancy and live birth rate rates per embryo transfer was similar for cancer patients compared to age-matched controls with tubal factor infertility.[10]

There are particular issues for women diagnosed with cancer to consider when freezing embryos (as opposed to freezing oocytes) for the purpose of fertility preservation. A woman may consider the stability of her relationship prior to the fertilisation of the oocytes. This is often challenging in younger patients or those in new relationships. The speed needed to start cancer treatment puts additional stress on decision making, as often the time available to reflect on fertility decisions is limited. The improvements in oocyte freezing techniques means that patients can maintain their autonomy by cryopreserving oocytes.

Evidence Summary

Evidence summaryLevelReferences
Embryo cryopreservation is an established fertility preservation treatment that results in live births for women with a history of cancer.III-3[10], [9]

Recommendation

Evidence-based recommendationGrade
Women of reproductive age at risk of gonadotoxicity from cancer treatment should be offered the opportunity to cryopreserve embryos before cancer treatment.C

References

  1. Fitzgerald O, Paul RC, Harris K, Chambers GM. Assisted reproductive technology in Australia and New Zealand 2016. Sydney: National Perinatal Epidemiology and Statistics Unit, the University of New South Wales; 2018 Available from: https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202016.pdf.
  2. Hart R. Preservation of fertility in adults and children diagnosed with cancer. BMJ 2008 Oct 27;337:a2045 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18955375.
  3. Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer. J Clin Oncol 2015 Aug 1;33(22):2424-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26101247.
  4. Sabatini ME, Wolkovich AM, Macklin EA, Wright DL, Souter I, Toth TL. Pronuclear embryo cryopreservation experience: outcomes for reducing the risk of ovarian hyperstimulation syndrome and for fertility preservation in cancer patients. J Assist Reprod Genet 2011 Mar;28(3):279-84 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21107899.
  5. Courbiere B, Decanter C, Bringer-Deutsch S, Rives N, Mirallié S, Pech JC, et al. Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study. Hum Reprod 2013 Sep;28(9):2381-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23832792.
  6. Creux H, Monnier P, Son WY, Buckett W. Thirteen years' experience in fertility preservation for cancer patients after in vitro fertilization and in vitro maturation treatments. J Assist Reprod Genet 2018 Apr;35(4):583-592 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29502188.
  7. Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet 2015 Aug;32(8):1233-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26174124.
  8. Hashimoto T, Nakamura Y, Obata R, Doshida M, Toya M, Takeuchi T, et al. Effects of fertility preservation in patients with breast cancer: A retrospective two-centers study. Reprod Med Biol 2017 Oct;16(4):374-379 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29259491.
  9. Michaan N, Ben-David G, Ben-Yosef D, Almog B, Many A, Pauzner D, et al. Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients. Eur J Obstet Gynecol Reprod Biol 2010 Apr;149(2):175-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20074845.
  10. 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 Apr;32(4):587-96 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25595540.

Body of evidence

In female cancer patients does the use of embryo cryopreservation result in pregnancy and live birth?

CitationLevel of EvidenceQuality of EvidenceSize of EffectNumber of PatientsRelevance of Evidence
Azim A, Oktay K. Letrozole for ovulation induction and fertility preservation by embryo cryopreservation in young women with endometrial carcinoma. Fertil Steril 2007 Sep;88(3):657-64 Available from:http://www.ncbi.nlm.nih.gov/pubmed/17428480IVLow242
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 Apr;32(4):587-96 Available from:http://www.ncbi.nlm.nih.gov/pubmed/25595540III-3Low1631
Courbiere B, Decanter C, Bringer-Deutsch S, Rives N, Mirallié S, Pech JC, et al. Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study. Hum Reprod 2013 Sep;28(9):2381-8 Available from:http://www.ncbi.nlm.nih.gov/pubmed/23832792IVMedium1521
Creux H, Monnier P, Son WY, Buckett W. Thirteen years' experience in fertility preservation for cancer patients after in vitro fertilization and in vitro maturation treatments. J Assist Reprod Genet 2018 Apr;35(4):583-592 Available from:http://www.ncbi.nlm.nih.gov/pubmed/29502188IVHigh5394N/A
Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet 2015 Aug;32(8):1233-7 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26174124IVMedium1541
Hashimoto T, Nakamura Y, Obata R, Doshida M, Toya M, Takeuchi T, et al. Effects of fertility preservation in patients with breast cancer: A retrospective two-centers study. Reprod Med Biol 2017 Oct;16(4):374-379 Available from:http://www.ncbi.nlm.nih.gov/pubmed/29259491IVMedium5622
Michaan N, Ben-David G, Ben-Yosef D, Almog B, Many A, Pauzner D, et al. Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients. Eur J Obstet Gynecol Reprod Biol 2010 Apr;149(2):175-7 Available from:http://www.ncbi.nlm.nih.gov/pubmed/20074845III-3Low1212
Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer. J Clin Oncol 2015 Aug 1;33(22):2424-9 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26101247IVHigh51311
Sabatini ME, Wolkovich AM, Macklin EA, Wright DL, Souter I, Toth TL. Pronuclear embryo cryopreservation experience: outcomes for reducing the risk of ovarian hyperstimulation syndrome and for fertility preservation in cancer patients. J Assist Reprod Genet 2011 Mar;28(3):279-84 Available from:http://www.ncbi.nlm.nih.gov/pubmed/21107899IVHigh1281
Cancer Council would like to acknowledge the traditional custodians of the land on which we live and work. We would also like to pay respect to the elders past and present and extend that respect to all other Aboriginal people.
Acknowledgement Image Title
Cancer Council Australia