Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options
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FERTILITY PRESERVATION
Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors Nicole Noyes & Katherine Melzer & Sarah Druckenmiller & M. Elizabeth Fino & Meghan Smith & Jaime M. Knopman Received: 17 February 2013 / Accepted: 16 July 2013 / Published online: 13 August 2013 # Springer Science+Business Media New York 2013
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-oflife marker for survivors.
Capsule While undergoing cancer treatment, females considering fertility preservation can often complete these processes concomitantly. Oocyte cryopreservation was most popular, highlighting patient desire for reproductive autonomy. N. Noyes (*) : K. Melzer : M. E. Fino : J. M. Knopman Fertility Center at NYU Langone Medical Center, NYU School of Medicine, 660 First Avenue, Fifth Floor, New York, NY 10016, USA e-mail: [email protected] S. Druckenmiller : M. Smith NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
Keywords Cancer survivor . Fertility preservation . Oocyte cryopreservation . Embryo cryopreservation . Quality-of-life
Introduction Malignancy in the reproductive-age female is a major health concern. In 2012, an estimated 790,740 women were diagnosed with cancer; approximately 9 % before age 45 [36]. Fortunately, due to improvements in early detection and treatment, female cancer death rates decreased by approximately 14 % between 1990 and 2008 [14]. Improved survival has resulted in a focus on survivorship issues, specifically those thought to improve quality of life [31], with the opportunity for family after cure at the forefront [33, 35]. Currently available data for most tumors suggest that post-treatment pregnancy does not necessarily impose an increased risk with regard to cancer progression or obstetrical/neonatal outcomes [3, 16, 17], making fertility preservation (FP) an attractive option to
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