The effect of different cancer therapies on clinical outcomes of assisted reproductive technology in breast cancer patients

Objective To evaluate the clinical outcomes of assisted reproductive technology (ART) on fertility preservation and infertility treatment in breast cancer patients who had undergone different cancer therapies. Methods 20 infertile females who had undergone breast cancer treatments during 2011–2018 were studied retrospectively. The patients were divided into two groups based on their cancer treatment methods and their needs of fertility preservation: the combined treatment group, who had both breast cancer surgery combining with any of the three treatments (adjuvant endocrine therapy, radiotherapy or chemotherapy), and the surgery only group. A group of infertile females without breast cancer history were used as a control group. An aromatase inhibitor Letrozole - based ovarian micro-stimulation protocol was used in females from the three groups for in vitro fertilization and embryo transfer. The ART clinical outcomes were evaluated by using the parameters of antral follicle count (AFC), the ratio of FSH/LH, oocyte retrieval number, 2 pronucleus(2 PN) fertilization rate, high-quality embryo rate, clinical pregnancy rate, and delivery outcome. Results The surgery only group had significantly lower ratio of FSH/LH than the combined treatment group and the control group. No significant difference on the ART clinical outcomes, evaluated by the aforementioned criteria, were found between the three groups. Conclusions Breast cancer surgery with adjuvant therapies, but not surgery alone, may damage ovarian function. The best time-limited window to preserve fertility for breast cancer patients is after surgery but before the initiation of adjuvant therapies. Importantly, the clinical outcomes of aromatase inhibitor-based ovary micro-stimulation in breast cancer patients are similar to that in non-breast cancer controls.