Female cancer survivors are low responders and have reduced success compared with other patients undergoing assisted reproductive technologies

Abstract

Objective: To investigate the effect of prior chemotherapy and radiation on assisted reproductive technology (ART) outcomes.

Design: Retrospective cohort study.

Setting: University-based infertility clinic.

Patient(s): Female cancer survivors who had received chemotherapy or radiation and all other women undergoing first-fresh IVF/intracytoplasmic sperm injection (ICSI) cycles.

Intervention(s): Survivors' ART outcomes were compared with all women undergoing first-fresh IVF/ICSI cycles and those with male-factor infertility only. Multivariate logistic and Poisson regression analyses were used to estimate the effect of cancer therapy on ART outcomes.

Main outcomes measure(s): Number of oocytes retrieved and embryos obtained; odds of cycle cancelation, clinical pregnancy, and live birth.

Result(s): Compared with others undergoing IVF/ICSI, survivors had significantly fewer oocytes retrieved and embryos available for transfer. In addition, survivors were significantly more likely to be canceled (odds ratio [OR] 5.60, 95% CI 2.94-10.66) and had lower pregnancy and live birth rates (OR 0.30, 95% CI 0.13-0.68; and OR 0.27, 95% CI 0.10-0.69; respectively). Odds ratios were stronger when the comparison group was restricted to those with male-factor infertility only.

Conclusion(s): Women who have received systemic therapy for malignancy should be considered to be low responders and counseled that their per-cycle live birth rate is lower than that of their peers. These data strongly support offering fertility preservation before cancer therapy when possible.