Female cancer survivors are low responders and have reduced success compared with other patients undergoing assisted reproductive technologies

Capsule:
Female cancer survivors who have received systemic therapy have lower pregnancy and live birth rates and a relatively high risk for cycle cancellation in ART compared with other infertility patients.

Authors:
Sara E. Barton, M.D., Stacey A. Missmer, Sc.D., Katharine F. Berry, M.A., Elizabeth S. Ginsburg, M.D.
Volume 97, Issue 2 , Pages 381-386, February 2012

Objective:
To investigate the effect of prior chemotherapy and radiation on assisted reproductive technology (ART) outcomes.

Design:
Retrospective cohort study.

Setting:
University-based infertility clinic.

Patient(s):
Female cancer survivors who had received chemotherapy or radiation and all other women undergoing first-fresh IVF/intracytoplasmic sperm injection (ICSI) cycles.

Intervention(s):
Survivors’ ART outcomes were compared with all women undergoing first-fresh IVF/ICSI cycles and those with male-factor infertility only. Multivariate logistic and Poisson regression analyses were used to estimate the effect of cancer therapy on ART outcomes.

Main Outcomes Measure(s):
Number of oocytes retrieved and embryos obtained; odds of cycle cancelation, clinical pregnancy, and live birth.

Result(s):
Compared with others undergoing IVF/ICSI, survivors had significantly fewer oocytes retrieved and embryos available for transfer. In addition, survivors were significantly more likely to be canceled (odds ratio [OR] 5.60, 95% CI 2.94–10.66) and had lower pregnancy and live birth rates (OR 0.30, 95% CI 0.13–0.68; and OR 0.27, 95% CI 0.10–0.69; respectively). Odds ratios were stronger when the comparison group was restricted to those with male-factor infertility only.

Conclusion(s):
Women who have received systemic therapy for malignancy should be considered to be low responders and counseled that their per-cycle live birth rate is lower than that of their peers. These data strongly support offering fertility preservation before cancer therapy when possible.

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