A Real-Life Analysis of Reproductive Outcome after Fertility Preservation in Female Cancer Patients

Background: Fertility preservation before or during cancer treatment in young women has become an important health issue because of delayed motherhood and improved survival rates. This study evaluates the necessity and the efficacy of fertility preservation, with a focus on actual pregnancy wish and outcome after fertility preservation and cancer treatment.

Patients and methods: All consecutive patients who received fertility preservation in 2 university referral centers before or during cancer treatment were included. After a minimal follow-up of 3 years, pregnancy wish, pregnancy attempts and fertility outcome were assessed during a dedicated consultation or during a telephone interview.

Results: A total of 159 patients received fertility preservation including hormonal protection with gonadotropin-releasing hormone agonist (n = 93, 58.5%), ovarian tissue cryopreservation (n = 44, 27.7%), and combined hormonal protection and ovarian tissue cryopreservation (n = 22, 13.8%). Among the 91 (57.2%) patients in remission after a mean follow-up of 61.5 months, 29 (31.9%) women actively attempted pregnancy. Patients who had received ovarian cryopreservation were more likely to attempt pregnancy (18/66) than those who only received hormonal protection (11/93, p = 0.02). Out of the 29 women who attempted pregnancy, 16 (55.2%) became pregnant, and most of them conceived spontaneously (87.5%, 14/16). Out of the 13 women who did not become pregnant, 1 patient adopted a child and 12 patients still wanted to become pregnant, including 1 patient who underwent a transplantation of her cryopreserved ovarian tissue without success.

Conclusion: In one of the first studies reporting real-life experience in centers for fertility preservation, we found that, within 5 years following the end of cancer treatment, only one third of patients in remission attempted to become pregnant, with a pregnancy rate of 55%, mostly after spontaneous conception.