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Fertility preservation for people with cancer

Oocyte cryopreservation

Clinical Question

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

Cryopreservation of mature oocytes is now acknowledged as a successful form of fertility preservation for post pubertal girls and women at risk of premature ovarian insufficiency.[1] Given the delay between collection and eventual use of the oocytes in patients with cancer, there are few reports detailing success rates.[2][3][4] A large body of evidence regarding pregnancy and live birth rates for women who have cryopreserved oocytes for a variety of reasons (including cancer), demonstrates comparable pregnancy and live birth rates to infertile patients who have standard IVF treatment.[5][6]

Ten to fourteen days is required for the stimulation phase and retrieval, and back-to-back and luteal start cycles are possible to ensure maximal opportunity without undue delay of commencement of cancer treatment.[7] Early referral of cancer patients facilitates the opportunity for a stimulation cycle and should be a high priority. One or two cycles of ovarian stimulation will yield a finite number of oocytes. Even with a large cohort of oocytes retrieved, this will provide only a small number of embryos to conceive with in the future, given the expected attrition rate for any IVF treatment from cryopreserved oocyte to usable embryo.[5]

Pregnancy rates from oocyte cryopreservation are similar to those from embryo cryopreservation and fresh embryo transfer, hence consideration must be given to the degree of relationship security.


Evidence Summary

Evidence summaryLevelReferences
Mature oocyte cryopreservation provides a realistic opportunity for future pregnancy for cancer patients. The age of the patient and the number of oocytes retrieved will influence the number of opportunities for pregnancy. Pregnancy rates after oocyte cryopreservation are similar to those after embryo cryopreservation.II, III-3, IV[2], [3], [4]

Recommendation

Evidence-based recommendationGrade
The opportunity to freeze oocytes should be offered to post-pubertal girls and women at risk of gonadotoxicity from cancer treatment.C

References

  1. Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2018 Jul 1;36(19):1994-2001 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29620997.
  2. Druckenmiller S, Goldman KN, Labella PA, Fino ME, Bazzocchi A, Noyes N. Successful Oocyte Cryopreservation in Reproductive-Aged Cancer Survivors. Obstet Gynecol 2016 Mar;127(3):474-80 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26855092.
  3. Cobo A, García-Velasco J, Domingo J, Pellicer A, Remohí J. Elective and Onco-fertility preservation: factors related to IVF outcomes. Hum Reprod 2018 Dec 1;33(12):2222-2231 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30383235.
  4. Rodriguez-Wallberg KA, Marklund A, Lundberg F, Wikander I, Milenkovic M, Anastacio A, et al. A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. Acta Obstet Gynecol Scand 2019 May;98(5):604-615 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30723910.
  5. Cobo A, García-Velasco JA, Coello A, Domingo J, Pellicer A, Remohí J. Oocyte vitrification as an efficient option for elective fertility preservation. Fertil Steril 2016 Mar;105(3):755-764.e8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26688429.
  6. Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No. 356-Egg Freezing for Age-Related Fertility Decline. J Obstet Gynaecol Can 2018 Mar;40(3):356-368 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29223749.
  7. Chien AJ, Chambers J, Mcauley F, Kaplan T, Letourneau J, Hwang J, et al. Fertility preservation with ovarian stimulation and time to treatment in women with stage II-III breast cancer receiving neoadjuvant therapy. Breast Cancer Res Treat 2017 Aug;165(1):151-159 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28503722.

Body of evidence

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

CitationLevel of EvidenceQuality of EvidenceSize of EffectNumber of PatientsRelevance of Evidence
Cobo A, García-Velasco J, Domingo J, Pellicer A, Remohí J. Elective and Onco-fertility preservation: factors related to IVF outcomes. Hum Reprod 2018 Dec 1;33(12):2222-2231 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30383235III-3LowN/A1,073N/A
Druckenmiller S, Goldman KN, Labella PA, Fino ME, Bazzocchi A, Noyes N. Successful Oocyte Cryopreservation in Reproductive-Aged Cancer Survivors. Obstet Gynecol 2016 Mar;127(3):474-80 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26855092IVLowN/A176N/A
Rodriguez-Wallberg KA, Marklund A, Lundberg F, Wikander I, Milenkovic M, Anastacio A, et al. A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. Acta Obstet Gynecol Scand 2019 May;98(5):604-615 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30723910IIMediumN/AN/AN/A
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Cancer Council Australia