Effect of Cancer Treatment on Female Reproductive Outcomes

The number of young female cancer survivors has increased in recent years as a result of modern anticancer treatments. Accordingly, attention has shifted from only cure of cancer to the quality of life including fertility preservation (FP) of cancer patients because chemotherapy and radiation therapy adversely affect their fertility. In this study, we compared the reproductive outcomes of assisted reproductive technology (ART) between patients who underwent oocyte retrieval (OR) for FP before cancer treatment and patients who underwent OR after cancer treatment. Retrospective cohort study. This study was conducted at Kyono ART clinic in Japan from January 2003 to March 2016. Also, the study was approved by the Ladies Clinic Kyono Ethics Committee. This study involved 46 patients who underwent OR for FP before cancer treatment (Group A) and 70 patients who underwent OR after cancer treatment (Group B). The average age at diagnosis in Group A and Group B was 32.6 ± 6.8 and 30.3 ± 7.7 year-old, respectively (not significant, N.S), while the average age at first visit in Group A and Group B was 32.6 ± 7.0 and 36.3 ± 5.1 year-old, respectively (p<0.01). The rate of unmarried women in Group A and Group B was 63% and 4%, respectively (p<0.01). The most common cancer types were breast (62%) and hematologic (13%) in Group A, and breast (37%), thyroid (23%) and hematologic (11%) in Group B. The average number of retrieved oocytes in Group A and Group B was 8.2 ± 8.1 vs. 5.7 ± 6.2 respectively (p<0.01). The rates of canceled cycles including no OR cycles in Group A and Group B were 8.8% and 7.8%, respectively (N.S). The cases that oocyte or embryo could be vitrified were 43/46 cases (93%; 26 cases were oocytes vitrified, 17 cases were embryos vitrified) in Group A and 57/70 (81%; 2 cases were oocytes vitrified, 55 cases were embryos vitrified) cases in Group B (N.S). Finally, 4/5 (80%) cases in Group A and 39/62 (63%) cases in Group B resulted in pregnancy (N. S). Although influence of aging could not be excluded, cancer treatment decreased the number of retrieved oocytes. Our results suggested cancer treatment affected ovarian reserve. From this perspective, we must strongly recommend FP with OR before cancer treatment. OR before cancer treatment may increase chances of pregnancy in female cancer survivors.