Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

10 years of medical fertility preservation at a tertiary centre in Australia (2009-2019): What have we learnt to inform future program provision? (#35)

Violet Kieu 1 , Genia Rozen 1 2 3 , Franca Agresta 1 2 , Debra Gook 1 3 , Catharyn Stern 1 2 3
  1. Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Parkville, VIC, Australia
  2. Melbourne IVF, Melbourne, VIC, Australia
  3. Obstetrics & Gynaecology, The University of Melbourne, Melbourne, VIC, Australia

Aims

To demonstrate how factors including survival confidence, acknowledging fertility as a key survivorship concern and improvements in fertility preservation (FP) techniques, (1) have resulted in a dramatic increase in referrals and utilization at a large FP service.

To review:

1)        FP referrals for women at risk of gonadotoxicity from cancer treatment;

2)        The range of cancer types referred;

3)        The uptake of oncofertility oocytes, embryos and ovarian tissue cryopreservation (OTC);

4)        Return to use and live birth rates.

 

Methods

A retrospective observational cohort study of patients undertaking biological FP.

 

Results

From 2009-2019, total n=1603 referrals, 91% increase of n=189 in 2019 (n= 99 in 2009). Cancer percentage (average years): 34% breast (34.6y), 16% gynaecological (32.5y), 15% Hodgkin’s lymphoma (25.2y), 6% non-Hodgkin’s lymphoma (28.8y), 6% leukaemia (24.6y), 5% bone (19.6y), 5% bowel (32.2y), 4% brain (22.4y), 9% other (25.2y). Consistent with breast most commonly diagnosed cancer in 2020. (2)

 

817% increase in oocytes n=55 in 2019 (n=6 in 2010), 338% increase in OTC n=35 in 2019 (n=8 in 2009). Embryos n=20 in 2019 (n=16 in 2010). This may relate to improvements in oocyte cryopreservation technology, no longer considered experimental since 2012. (3) Sub-group analysis for tertiary only, uptake FP n=360 (37.5%). To date 4%, 29% and 5% of patients returned to use cryopreserved oocytes, embryos and ovarian tissue, respectively. This yielded live birth per woman treated: 38%, 35% and 20%.

 

Conclusions

We report increased referrals and FP utilization year upon year, with a broad range of cancer types. This may reflect specialist oncologists’ increased comfort and knowledge of FP referral. With vitrification improving pregnancy outcomes and greater autonomy, oocyte cryopreservation has become most popular in recent years, with good comparative live birth rates between gametes, embryos and ovarian tissue. Our findings assist with patient counselling and informing service provision. 

 

 

  1. Anazodo, A. et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2019 Mar 1;25(2):159-179.
  2. Australian Institute of Health and Welfare (AIHW). Cancer Data in Australia. Web Report. 02 June 2020. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/summary
  3. American Society of Reproductive Medicine (ASRM) Practice Committee. Mature Oocyte Cryopreservation: A Guideline. Epub 2012 Oct 22. Fertil Steril. 2013 Jan;99(1):37-43.