Value of early referral to fertility preservation in young women with breast cancer

Abstract

Purpose: To determine whether early referral to reproductive specialists improves fertility preservation (FP) outcomes and reduces delay in adjuvant treatment in young women with breast cancer.

Patients and methods: A secondary analysis of a prospective database of patients with breast cancer undergoing ovarian stimulation (OS) for FP by oocyte or embryo cryopreservation was performed.

Results: Of the 154 patients, 93 met the inclusion criteria (mean age, 35.2 ± 4.4 years). Thirty-five of the 93 patients were referred before breast surgery (PreS), and 58 patients were referred after surgery (PostS). The time periods from initial diagnosis (ID) to initiation of OS (42.6 ± 27.7 days for PreS v 71.9 ± 30.7 days for PostS; P < .001) and from ID to initiation of chemotherapy (83.9 ± 24.3 days for PreS v 107.8 ± 42.9 days for PostS; P = .045) were significantly shorter for the PreS group versus the PostS group. Nine (25.7%) of 35 patients in the PreS group versus one (1.7%) of 58 patients in the PostS group were able to undergo two FP cycles (P < .001), resulting in an increased yield of oocytes in the PreS group (18.2% [93 of 511 oocytes] v 0.6% [five of 800 oocytes], respectively; P < .001) and embryos (17.2% [40 of 233 embryos] v 0.6% [two of 357 embryos], respectively; P < .001). Patients who had an oocyte retrieval within 5 weeks of the surgery were able to complete a second cycle within 9 weeks of the surgery.

Conclusion: FP referral before breast surgery enables earlier initiation of cryopreservation cycles and chemotherapy and, when appropriate, multiple FP cycles. Women who can undergo multiple cycles may be at advantage for FP because of a larger number of oocytes or embryos cryopreserved. This is the first study demonstrating the benefit of early FP referral in patients with cancer.

Fig 1.

Comparison of referral patterns to fertility preservation (FP) in patients with breast cancer. Referral before breast surgery results in the initiation of chemotherapy on average 3 weeks earlier in (A) single FP cycles, as well as when the data from (B) double cycles are included, compared with (C) patients referred after breast surgery. This additional time enables multiple cycles of FP, if desired, in a shorter time period before chemotherapy compared with referral after breast surgery. Number of days indicates time from initial diagnosis with breast cancer (ID) to initiation of chemotherapy. FPC, first fertility preservation consultation; BS, breast surgery; OS, initiation of ovarian stimulation; OR, oocyte retrieval.