ESHRE 2023: Female Fertility Preservation: Lessons Learned So Far

An umbrella review of meta-analysis regarding the incidence of female specific malignancies following fertility treatment -Lorraine Kasaven

Infertility is a global issue estimated to affect 48.5 million couples worldwide. Various meta-analysis and systematic reviews have attempted to define the association between exposure of fertility treatment (FT) and female specific malignancies with conflicting results. This umbrella review interrogated the existing systematic reviews and meta-analysis on this topic. The primary aim was to investigate the validity of the association between the development of female specific malignancies including breast, ovarian, borderline ovarian tumors, endometrial and cervical cancer following fertility treatment. The review concluded that there is an observed association between ovarian cancers with exposure to fertility treatment. The association was consistent amongst the IVF population specifically and when sub-categorized according to fertility drug used for borderline ovarian tumors only. Understanding the potential long-term sequelae of fertility treatment is fundamental to guide counseling and enable individuals to make informed decisions about their reproductive future. Prospective studies with more wide-ranging, nuanced and standardized reporting over longer follow-up periods are required.

A 10-year follow-up of reproductive outcomes in women returning after elective oocyte cryopreservation -Ezgi Darici

Elective oocyte cryopreservation (EOC) is done to enhance reproductive options when motherhood is postponed. It is most cost-efficient in women of 35-37 years. A 10-year follow-up of reproductive outcomes in women who returned to the fertility clinic after elective oocyte cryopreservation was done. It was observed that although 27.4% of women returned to the clinic, the utilization rate of cryopreserved autologous oocytes was relatively low at 16.7% (141/843 women) but again very similar to that in other published series. A minority of women will use their oocytes, but long term follow up data are scarce. The cumulative ongoing pregnancy rate per woman after oocyte thawing at an average of 41 years was more than 50%. It is suggestible that past EOC users who failed to conceive naturally after the age of 40 may prefer to use their cryopreserved oocytes instead of fresh oocytes because of the favorable success rate and the low miscarriage rate with their younger cryopreserved oocytes.

15-year-experience in oncological fertility preservation: impact on disease survival and reproductive outcomes - Jessica Subira

Fertility preservation (FP) has become a crucial part of oncological evaluation of young women facing cancer given the high survival rates achieved. Oocyte vitrification (OV) and ovarian cortex cryopreservation (OCC) are the main techniques offered to these patients at the moment. Although there is some data about the safety of these techniques the impact of FP on disease survival is yet to be definitely assessed. This was a prospective cohort study which enrolled 695 patients with minimum follow-up of 5 years. The primary outcome was median survival time after FP in months. The secondary outcomes included relapse rate, POI and LOR incidence, usage FP rate, clinical pregnancy and LBR naturally and after FP use. It was concluded that almost half of the patients had ovarian damage as a result of the treatment. Even in patients with previous FP technique, there were a significant number of natural pregnancies. FP does not have a negative impact on survival even if ovarian stimulation is used. Among patients with fertility wish around one third achieved a LB naturally and this is higher than previously reported.

Ovarian reserve, reproductive function and pregnancy outcomes among female survivors of childhood hodgkin lymphoma: results from DCOG LATER-VEVO study - Katja Drechsel

Hodgkin lymphoma (HL) has high survival rates (>90%). Until recently, standard HL treatment often included procarbazine and high dose radiotherapy. The knowledge on risk of fertility impairment after treatment is crucial to improve HL protocols and fertility care. This study was done to assess the effect of treatment for childhood HL on markers of ovarian reserve, ovarian function and pregnancy rates and outcomes. The study included 84 HL survivors and 798 controls. All evaluated clinical markers of ovarian reserve and function were significantly worse in survivors compared to controls. Survivors had a lower age at first pregnancy and increased time to first pregnancy. But, when they did become pregnant, pregnancy rates and outcomes were similar. Treatment with CED-score >6gm/m² was associated with abnormal clinical reproductive markers. HL survivors are at a risk of a reduced fertility life span. The chance to conceive and pregnancy outcomes appear to be reassuring, when attempting pregnancy at a relatively young age. It is important to counsel the survivors for family planning and fertility preservation methods. 

Fertility outcomes several years after urgent fertility preservation for breast cancer -Maeliss Peigne

Breast cancer is the most common cancer in women of childbearing age with a very good survival rate. The pregnancy in breast cancer survivors is safe, however, a 40-60% decrease is seen in the pregnancy rate of women after breast cancer compared to the general population. This retrospective observational bicentric cohort study was done to assess the fertility outcomes who tried to conceive after breast cancer treatment and FP. It showed that three to ten years after FP for BC patients, 39% of 695 patients tried to conceive. Among them, 39% had a child mainly through spontaneous conception.  Multiparity at the time of BC diagnosis and absence of chemotherapy were positive predictive factors of pregnancy. 27% of patients who tried to conceive used their frozen oocytes/embryos with a success rate of approximately 12%. These results allow us to better advice women at the time of FP. Other studies with longer follow-up for usefulness and efficacy of the FP techniques for the completion of family planning with one or more children are required.