Fertility preserving techniques in neuro-oncology patients: A systematic review

Abstract

Background: Advancements in cancer treatments have enhanced survival rates and quality of life for patients with central nervous system (CNS) tumors. There is growing recognition of the significance of fertility preservation methods. Currently, techniques, including oocyte cryopreservation and sperm cryopreservation are established. Nevertheless, oncologists may exhibit reluctance when referring patients to reproductive specialists. This review aimed to assess the best evidence for fertility preservation techniques used in patients with CNS cancers and evaluate outcomes relating to their success and complications.

Methods: Two reviewers performed a search of Pubmed, Embase, Medline, Cochrane, and Google Scholar. Papers were included if they reported at least 1 fertility preservation technique in a neuro-oncology patient. Non-English studies, editorials, animal studies, and guidelines were excluded. Meta-analysis was performed using the random effects model.

Results: Sixteen studies containing data from 237 participants (78.8% female) were included in the systematic review and meta-analysis, of whom 110 (46.4%) underwent fertility preservation techniques. All patients (100%) successfully underwent fertility preservation with 1 participant (2.9%) returning to rewarm their oocytes, embryos or sperm. On average, 17.8 oocytes were retrieved with 78%, ultimately being cryopreserved. Five (6.0%) patients successfully conceived 9 healthy-term children after utilizing their cryopreserved sperm, embryos, or oocytes. Moreover, 6 patients successfully conceived naturally or using intrauterine insemination, resulting in 7 healthy-term children.

Conclusions: Fertility preservation techniques could offer a safe and effective way for neuro-oncology patients to deliver healthy-term babies following treatment. However, further studies concerning risks, long-term pregnancy outcomes, and cost-effectiveness are needed.

Keywords: embryo cryopreservation; fertility preservation; neuro-oncology; oocyte cryopreservation; ovarian tissue transposition.

Figure 1.

PRISMA flow diagram of papers included and excluded in the systematic review.

Figure 2.

Forest plot of the proportion of participants who returned to rewarm.

Figure 3.

Forest plot of the proportion of participants who delivered healthy children using fertility preservation.

Figure 4.

Forest of the pooled mean of oocytes retrieved through oocyte cryopreservation Of the oocytes retrieved, on pooled calculation 78% (95% CI [67–86%); Figure 5) were successfully frozen. There was no significant heterogeneity in the pooling calculation (I² < 50% and Q P value = .97). There was publication bias identified in the calculation (Eggers: P = .11 and Begg: P = .04).

Figure 5.

Forest plot of the proportion of oocytes frozen from those retrieved by fertility preservation.