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

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.

METHODS: 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.