Endometrial Receptivity Post-Oocyte Donation in Women With Anticancer Tx Hx
Endometrial Receptivity Post-Oocyte Donation in Women With Anticancer Tx Hx
Introduction: Information is scarce regarding the outcome of oocyte donation (OD) in patients with a history of cancer treatment. Therefore, we conducted a matched controlled analysis on the outcome of OD in these recipients.
Methods: Between January 2000 and November 2005, 33 patients with a history of chemotherapy and/or radiotherapy had an OD cycle. Matching was performed to the chronologically closest patient without a history of cancer therapy by number of days of hormonal stimulation before embryo replacement, number of replaced embryos, day of embryo transfer and origin of sperm.
Results: The primary diseases of the patients were Hodgkin's lymphoma (n = 12), non-Hodgkin's lymphoma (n = 3), leukaemia (n = 7), ovarian cancer (n = 6), Ewing's sarcoma (n = 2), breast cancer (n = 1), sympathoblastoma (n = 1) and histiocytosis X (n = 1). Twenty-three patients had undergone chemotherapy and radiotherapy, nine patients chemotherapy only and one radiotherapy only. The mean age of the recipients was 33.1 years [95% confidence interval (CI) 30.9-35.3] and 39.6 (95% CI 37.1-42.1) in the study and control groups, respectively. The average number of received oocytes and transferred embryos, was similar in both groups. Nineteen (57.6%) versus 13 (39.4%) pregnancies resulting in an ongoing pregnancy (i.e. viable at 12 weeks) in 15 (45.4%) versus 9 cycles (27.3%) (NS) were obtained in study and control groups, respectively. Implantation rate in study and control groups was 35.8 versus 17.9%, respectively (P = 0.02).
Conclusions: The results suggest that patients with a history of cancer treatment have a pregnancy rate after OD similar to that in the general population of oocyte recipients.
Improvements in cancer therapy have contributed to the enhancement of survival of children and adolescents with a malignant neoplasm. It has been estimated that one per thousand young adults, aged between 17 and 35 years, have been treated for cancer during childhood (Critchley et al., 2002). However, anticancer treatments can permanently impair reproductive functions as a result of chemotherapy and/or radiotherapy (Madsen et al., 1995).
Preserving fertility in female patients is important because it has been shown that a high percentage of the women treated with chemotherapy will develop premature ovarian failure (POF) due to primordial follicle damage (Familiari et al., 1993). About 50% of women over 25 years of age and 20% of women under 25 years treated with MOPP (Mustin, Oncovin, Procarbazine, Prednisone) will develop a premature menopause (Schilsky et al., 1981). The results of pilot studies on the effects of a GnRH agonist depot in women receiving chemotherapy for the prevention of POF are promising but need to be further elucidated in randomized controlled trials (Blumenfeld et al., 2005; Franke et al., 2005). Another preventive measure in the female is the transposition of the ovaries prior to pelvic irradiation (Williams et al., 1999) and a third possibility is the cryopreservation of embryos if the patient has a male partner (Nugent et al., 1997; Falcone et al., 2004). However, this option presents several issues: the possible carcinogenic risk of ovarian stimulation on the disease, the risk of postponing the start of the anticancer therapy, and when the cancer is ovarian, the risk of tumour cell dissemination by follicle puncture. Oocyte freezing and ovarian tissue cryopreservation are also often proposed before anticancer treatment although remain experimental (Demeester et al., 2006; Donnez et al., 2006).
Because none of the above mentioned preventive options give consistently satisfactory results, the only possibility for the majority of patients with a history of cancer treatment who wish to have children is adoption or to receive oocytes by oocyte donation (OD). However, only very few data based on case reports are available in the literature on the outcome of OD cycles in this particular subgroup of oocyte recipients. Most published reports show that OD is feasible but is associated with a lower pregnancy rate than that expected in the general population of oocyte recipients (Pados et al., 1992; Sauer et al., 1994; Remohi et al., 1997; Anselmo et al., 2001; Kavic et al., 2001). However, two other reports, also based on a limited number of patients, showed no difference in pregnancy rate in cancer survivors (Paulson et al., 1997; Moomjy et al., 1999).
More information regarding the success rate of OD and the pregnancy outcome in patients with a history of cancer treatment by chemotherapy and/or radiotherapy is needed in order to counsel the patients adequately. We therefore conducted a retrospective, matched controlled analysis on the outcome of OD and pregnancy outcome in this particular subgroup of oocyte recipients.
Introduction: Information is scarce regarding the outcome of oocyte donation (OD) in patients with a history of cancer treatment. Therefore, we conducted a matched controlled analysis on the outcome of OD in these recipients.
Methods: Between January 2000 and November 2005, 33 patients with a history of chemotherapy and/or radiotherapy had an OD cycle. Matching was performed to the chronologically closest patient without a history of cancer therapy by number of days of hormonal stimulation before embryo replacement, number of replaced embryos, day of embryo transfer and origin of sperm.
Results: The primary diseases of the patients were Hodgkin's lymphoma (n = 12), non-Hodgkin's lymphoma (n = 3), leukaemia (n = 7), ovarian cancer (n = 6), Ewing's sarcoma (n = 2), breast cancer (n = 1), sympathoblastoma (n = 1) and histiocytosis X (n = 1). Twenty-three patients had undergone chemotherapy and radiotherapy, nine patients chemotherapy only and one radiotherapy only. The mean age of the recipients was 33.1 years [95% confidence interval (CI) 30.9-35.3] and 39.6 (95% CI 37.1-42.1) in the study and control groups, respectively. The average number of received oocytes and transferred embryos, was similar in both groups. Nineteen (57.6%) versus 13 (39.4%) pregnancies resulting in an ongoing pregnancy (i.e. viable at 12 weeks) in 15 (45.4%) versus 9 cycles (27.3%) (NS) were obtained in study and control groups, respectively. Implantation rate in study and control groups was 35.8 versus 17.9%, respectively (P = 0.02).
Conclusions: The results suggest that patients with a history of cancer treatment have a pregnancy rate after OD similar to that in the general population of oocyte recipients.
Improvements in cancer therapy have contributed to the enhancement of survival of children and adolescents with a malignant neoplasm. It has been estimated that one per thousand young adults, aged between 17 and 35 years, have been treated for cancer during childhood (Critchley et al., 2002). However, anticancer treatments can permanently impair reproductive functions as a result of chemotherapy and/or radiotherapy (Madsen et al., 1995).
Preserving fertility in female patients is important because it has been shown that a high percentage of the women treated with chemotherapy will develop premature ovarian failure (POF) due to primordial follicle damage (Familiari et al., 1993). About 50% of women over 25 years of age and 20% of women under 25 years treated with MOPP (Mustin, Oncovin, Procarbazine, Prednisone) will develop a premature menopause (Schilsky et al., 1981). The results of pilot studies on the effects of a GnRH agonist depot in women receiving chemotherapy for the prevention of POF are promising but need to be further elucidated in randomized controlled trials (Blumenfeld et al., 2005; Franke et al., 2005). Another preventive measure in the female is the transposition of the ovaries prior to pelvic irradiation (Williams et al., 1999) and a third possibility is the cryopreservation of embryos if the patient has a male partner (Nugent et al., 1997; Falcone et al., 2004). However, this option presents several issues: the possible carcinogenic risk of ovarian stimulation on the disease, the risk of postponing the start of the anticancer therapy, and when the cancer is ovarian, the risk of tumour cell dissemination by follicle puncture. Oocyte freezing and ovarian tissue cryopreservation are also often proposed before anticancer treatment although remain experimental (Demeester et al., 2006; Donnez et al., 2006).
Because none of the above mentioned preventive options give consistently satisfactory results, the only possibility for the majority of patients with a history of cancer treatment who wish to have children is adoption or to receive oocytes by oocyte donation (OD). However, only very few data based on case reports are available in the literature on the outcome of OD cycles in this particular subgroup of oocyte recipients. Most published reports show that OD is feasible but is associated with a lower pregnancy rate than that expected in the general population of oocyte recipients (Pados et al., 1992; Sauer et al., 1994; Remohi et al., 1997; Anselmo et al., 2001; Kavic et al., 2001). However, two other reports, also based on a limited number of patients, showed no difference in pregnancy rate in cancer survivors (Paulson et al., 1997; Moomjy et al., 1999).
More information regarding the success rate of OD and the pregnancy outcome in patients with a history of cancer treatment by chemotherapy and/or radiotherapy is needed in order to counsel the patients adequately. We therefore conducted a retrospective, matched controlled analysis on the outcome of OD and pregnancy outcome in this particular subgroup of oocyte recipients.