Trends and Regional Differences for Fertility Preservation Procedures in Women With Breast Cancer

Volkan Turan; Giuliano Bedoschi; Dong-Yun Lee; Caio Parente Barbosa; Renato de Oliveira; Koray Gorkem Sacinti; Murat Sonmezer; Matteo Lambertini; Claudia Massarotti; Amelia Schaub; Erica Wang; Sonia Gayete-Lafuente; Cheryl Dunlop; Richard A Anderson; Heejung Bang; Kutluk H Oktay

doi:10.1016/j.clbc.2024.09.011

Trends and Regional Differences for Fertility Preservation Procedures in Women With Breast Cancer

Clin Breast Cancer. 2024 Sep 23:S1526-8209(24)00270-2. doi: 10.1016/j.clbc.2024.09.011. Online ahead of print.

Authors

Volkan Turan¹, Giuliano Bedoschi², Dong-Yun Lee³, Caio Parente Barbosa⁴, Renato de Oliveira⁴, Koray Gorkem Sacinti⁵, Murat Sonmezer⁵, Matteo Lambertini⁶, Claudia Massarotti⁷, Amelia Schaub⁸, Erica Wang⁹, Sonia Gayete-Lafuente¹⁰, Cheryl Dunlop¹¹, Richard A Anderson¹¹, Heejung Bang¹², Kutluk H Oktay¹³

Affiliations

¹ Department of Obstetrics and Gynecology, Istanbul Health and Technology University School of Medicine, Istanbul, Turkey; Innovation Institute for Fertility Preservation, Yorkvillle, NY and New Heaven, CT.
² Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
³ Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁴ Faculdade de Medicina do ABC, Santo Andre, Brazil.
⁵ Department of Obstetrics and Gynecology, Center of Human Reproduction and Infertility Ankara University, Ankara, Turkey.
⁶ Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁷ Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genoa, Genoa, Italy; Academic Unit of Obstetrics and Gynecology, Maternal-Child Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁸ Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL.
⁹ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁰ Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
¹¹ Centre for Reproductive Health, Institute for Repair and Regeneration, The University of Edinburgh, Edinburgh, United Kingdom.
¹² Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA.
¹³ Innovation Institute for Fertility Preservation, Yorkvillle, NY and New Heaven, CT; Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT. Electronic address: [email protected].

PMID: 39428290
DOI: 10.1016/j.clbc.2024.09.011

Abstract

Introduction: Breast cancer is the most common malignancy in women of reproductive age and chemotherapy protocols impair fertility, frequently necessitating fertility preservation (FP) referral. Embryo, oocyte, or ovarian tissue cryopreservation are established FP modalities in women with breast cancer but there are few data on their uptake over time. In this study our aim was to determine the regional time trends and utility differences for fertility preservation methods of reproductive tissue cryopreservation.

Methods: This multicenter study included 1623 women diagnosed with breast cancer from 7 tertiary centers in 6 countries (Brazil, Italy, Scotland, South Korea, Turkey, USA). Participant centers provided the details of FP cryopreservation approaches broken down annually from 2012 to 2021. Women with newly diagnosed breast cancer, aged 18-45 years who were referred for FP at participating centers and had normal ovarian function at the time were included.

Results: We found a mean increase of 7% per year (P = .002, adjusting for centers) in the number of women referred for FP. Of those who were referred (n = 1623), a mean 38.7% underwent FP (n = 629), with a range of 12% in South Korea) to 95% in Brazil. The number of women undergoing ovarian stimulation for FP continually increased until 2021, with oocyte cryopreservation being the most common procedure throughout the study period (P = .014 for time trend). The proportion of random start ovarian stimulation cycles increased each year from 58.3% in 2012 to 86.8% in 2021, (P = .005 for time trend, and P = .04 for 2012 vs. 2021).

Conclusions: The utility of FP has steadily increased for young women with breast cancer over the last decade, although regional differences significantly influence FP practices. The findings of our study could have value for policy making in FP care for young women with breast cancer at the local, regional, or global level.

Keywords: Cryopreservation; Embryo; Letrozole; Oocyte; Ovarian stimulation.