JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):116
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263750

P-104. Fertility preservation in oncologic patients: a 12-year retrospective analysis from a single assisted reproduction center

Luísa Duarte Weissheimer¹, Nilo Frantz¹, Marcos Iuri Roos Kulmann¹

¹ Nilo Frantz Medicina Reprodutiva - Porto Alegre - RS - Brasil

Objective: Cancer impacts many women during their reproductive years, and antineoplastic treatments pose a significant risk to fertility. The extent of gonadotoxicity depends on cancer type, stage, treatment modality, and patient age. Chemotherapy, particularly in women over 35 or with breast cancer, increases the risk of premature ovarian insufficiency, while pelvic irradiation may impair endometrial receptivity. Oocyte cryopreservation is the most established strategy for preserving reproductive potential before cancer treatment. However, data remain limited on the characteristics of patients undergoing this procedure and their outcomes upon returning for in vitro fertilization (IVF). This study presents a 12-year clinical experience from a single assisted reproduction center, focusing on oocyte cryopreservation in female oncology patients.
Methods: We conducted a retrospective cohort study based on the clinical records of patients who underwent oocyte cryopreservation between 2012 and 2024 at a specialized fertility center. Inclusion criteria were: confirmed cancer diagnosis and oocyte cryopreservation performed prior to the initiation of oncologic therapy. Data extracted included cancer type, patient age at stimulation, controlled ovarian stimulation outcomes and oocyte yield. For patients who returned for the fertility treatment, a more detailed review of their IVF cycle and clinical outcomes was conducted.
Results: A total of 41 oncologic patients met the inclusion criteria. The mean age at the time of stimulation was 31.2 years (SD ±4.8; range 16–40). Breast cancer was the most prevalent diagnosis (42.9%), followed by gastrointestinal cancers (12.2%), cervical cancer (9.8%), Hodgkin lymphoma (7.3%), osteosarcoma (4.9%), glioma (4.9%), and others (17.1%). The average number of oocytes retrieved per cycle was 14.5 (SD ±7.9), with a mean of 11.6 metaphase II (MII) oocytes vitrified (SD ±6.6). Of the 41 patients, 4 passed away, 5 opted to discard their oocytes, and 3 returned for oocyte warming and IVF after completion of antineoplastic treatment. The remaining patients still have their oocytes in cryostorage. The observed return rate was 7.3%. All returning patients underwent ICSI and preimplantation genetic testing for aneuploidies (PGT-A). Patient 1, with a history of breast cancer, returned after 7 years, having previously vitrified 24 MII oocytes. Six blastocysts were generated, half of which were euploid. Despite three single euploid embryo transfers, pregnancy was not achieved. Endometrial polyps, often associated with pelvic irradiation, were observed. Patient 2, also treated for breast cancer, returned after 2 years. She vitrified 27 MII oocytes and generated five blastocysts, one of which was diagnosed as euploid. However, the patient became pregnant naturally and no transfer was carried out. Patient 3, previously diagnosed with cervical cancer, returned after 9 years. She vitrified 23 MII oocytes, yielding five blastocysts, two of which were euploid. Due to endometrial atrophy, she opted for gestational surrogacy, however pregnancy was not achieved.
Conclusion: Our findings reveal a notably low return rate among patients who underwent oocyte cryopreservation for oncologic reasons, potentially influenced by spontaneous conception, ongoing treatment, cancer recurrence, or unreported mortality. Remarkably, none of the patients who returned achieved a clinical pregnancy. Two out of those three patients exhibited endometrial factors impacting embryo transfer, emphasizing the lasting impact of oncologic therapy on reproductive tissues. These results underscore the importance of early fertility counseling and call for broader awareness and long-term follow-up strategies in oncofertility care. Further research is essential to refine outcomes and improve the reproductive potential of cancer survivors.