A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden - Trends in patients' choices and benefit of the chosen methods after long-term follow-up.

INTRODUCTION: In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary-care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients' choices after counseling and fertility preservation outcomes during follow-up in relation to benign vs malignant indications.

MATERIAL AND METHODS: Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (N=852) or benign indications (N=402) at Karolinska University Hospital, Stockholm, between 1 Oct 1998 and 1 Dec 2018 were analyzed. T-tests and chi-square tests were used to compare groups, as appropriate. Logistic regression was used to compare outcomes among groups depending on indications.

RESULTS: Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (N=538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (N=221, 27%). More than half of the women with partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All prepubertal (N=48) and 73% of postpubertal girls (N=66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (N=24, 17%) or after completion of cancer treatment (N= 15, 10%).During follow-up, 27% of women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47 vs 21%, p=0.002).

CONCLUSIONS: Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications. This article is protected by copyright. All rights reserved.