Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy.

Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy.

Hum Reprod. 2012 May 22;


Abstract
BACKGROUND
Chemotherapy and radiotherapy can result in ovarian failure and premature menopause. However, there is still a paucity of information on the ovarian reserve and efficacy of assisted reproduction treatment (ART) procedures in patients with cancer previously exposed to chemotherapy or radiotherapy. The aim of our study was to evaluate the ovarian reserve and ovarian response to IVF or in vitro maturation (IVM) treatment in women who had previously been treated with chemotherapy.

METHODSI
In this retrospective cohort study, we compared 23 women with cancer who had undergone chemotherapy and subsequently underwent fertility treatment with IVF (n= 14) or IVM (n= 9). In the IVF group, patients mostly had hematologic, gynecologic, gastro-intestinal, bone and soft tissue cancers, whereas in the IVM group patients had estrogen-receptor positive breast cancer, hematologic and brain cancers. The control (unexposed) group consisted of 70 age-matched women with male factor infertility undergoing the same treatment protocol (IVF n= 42 and IVM n= 28). All women were aged <42 years and undergoing their first cycle of ART.

RESULTS
There were no differences in age and FSH levels between the cancer and the control groups. However, the antral follicle count (AFC) was lower in the cancer-IVF group (median: 5, range: 3-12) than in the control group (median: 15, range: 12-18; P = 0.0009). Women with cancer treated with IVF had lower peak estradiol levels on the day of hCG administration than controls (P = 0.006) and lower number of oocytes retrieved [median: 4.5, range: 2-7; versus 12 (8-16) in controls; P < 0.0001]. In patients with cancer treated with IVM, the AFC was lower than in the control group (median: 14, range: 9.5-17; versus median: 20.5 range: 16-23, respectively; P = 0.0007). Likewise, the number of oocytes retrieved was lower in the cancer-IVM group (median: 6, range: 4-10) than that in the control group (median 10.5, range: 7.5-17; P = 0.01). The percentage of mature metaphase II oocytes was comparable in the cancer and control groups.

CONCLUSIONS
The ovarian reserve, response to gonadotrophins and number of oocytes retrieved are adversely affected by previous chemotherapy. This study reports the first series of IVM outcomes in cancer patients with a prior history of chemotherapy. In women with estrogen-receptor positive breast cancer, IVM of oocytes with cryopreservation of oocytes or embryos is a viable option. Since the efficacy of ART is significantly reduced after chemotherapy, early referral for fertility preservation before gonadotoxic treatment will give these young women the best chance to conceive.

open access: Reproductive Technologies and the Risk of Birth Defects — NEJM

Blogger's Note: this is not cancer-specific/related but may be of interest to young cancer survivors

Reproductive Technologies and the Risk of Birth Defects — NEJM

abstract: Too Early To Determine Cancer Risk from Infertility Treatments

Too Early To Determine Cancer Risk from Infertility Treatments

As more and more women wait to have children, the use of fertility drugs is rapidly rising, along with concerns about the possible association with increased risk of certain cancers, primarily of the breast, ovary, and uterus.

Such interest was on display when Elizabeth Edwards, the wife of former Sen. John Edwards, died from a recurrence of breast cancer in 2010, years after she had used fertility treatments. Researchers agree that the issue is important, given the millions of women who have been treated with fertility drugs. By one estimate, that number will climb to 7 million by 2025. 

But the findings from the few studies that have tried to address the issue have been mixed. Most have been conducted outside the U.S., primarily in European countries with centralized health care systems that can track pharmacy and cancer registries. These studies can have methodological limitations, but researchers say the largest drawback is that, usually, it is too early to tell whether an association exists, especially for drugs used for in vitro fertilization (IVF). 

“We are just really now getting into an era where we have enough women who are in the right age range to be able to evaluate their cancer risk,” said Louise Brinton, Ph.D., M.P.H., chief of the hormonal and reproductive epidemiology branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute.

But it won’t ever be completely clear whether these drugs cause even a slight increase in cancer risk, says Jennifer Litton, M.D., an assistant professor in the department of breast medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston. “Infertility itself is a risk factor for increases in breast and ovarian cancers, so it is going to be difficult, if …(Blogger's Note: to read further subscription required $$$)