Fertility preservation in childhood and adolescent female tumor survivors

Abstract

Objective: To assess the proportion of female childhood and adolescent tumor survivors who could benefit from oocyte cryopreservation.

Design: Case series of female childhood and adolescent tumor survivors referred for fertility counseling.

Setting: A referral cancer center and an infertility unit of an academic hospital.

Patient(s): Young female childhood and adolescent tumor survivors who received gonadotoxic treatments.

Intervention(s): Patients were prescribed tests of ovarian reserve and a personalized counseling was given. Oocyte cryopreservation was considered in subjects aged ≥18 years who were diagnosed with diminished ovarian reserve (DOR) (antimüllerian hormone level <2 ng/mL or total antral follicle count ≤10).

Main outcome measure(s): Rate of women with DOR who stored their oocytes.

Result(s): Ninety out of 126 evaluated women completed the assessments. We documented preserved ovarian reserve, DOR, and premature ovarian insufficiency in 36 (40%), 35 (39%), and 19 (21%) cases, respectively. Overall, 13 subjects with DOR were eligible for oocyte cryostorage, of whom 9 (69%) underwent the procedure. Considering the whole cohort of evaluated young women (n = 90), the rate of those who had egg freezing was 10%. Finally, nine women started seeking pregnancy after the counseling (six with DOR), and seven of them became pregnant. When the data were analyzed separately according to most gonadotoxic treatments, considerable differences emerged but the evidence did not support the idea that counseling should be restricted to particular subgroups of women.

Conclusion(s): Ovarian reserve impairment is common in female childhood and adolescent tumor survivors. Postcancer oocyte cryopreservation may be part of the armamentarium of fertility preservation options.

Keywords: Childhood tumor survivor; fertility preservation; oocyte cryopreservation; ovarian reserve.