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A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up.
Acta Obstet Gynecol Scand. 2019 05; 98(5):604-615.AO

Abstract

INTRODUCTION

In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary-care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients' choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications.

MATERIAL AND METHODS

Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi-square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications.

RESULTS

Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre-pubertal (n = 48) and 73% of post-pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002).

CONCLUSIONS

Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications.

Authors+Show Affiliations

Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden. Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30723910

Citation

Rodriguez-Wallberg, Kenny A., et al. "A Prospective Study of Women and Girls Undergoing Fertility Preservation Due to Oncologic and Non-oncologic Indications in Sweden-Trends in Patients' Choices and Benefit of the Chosen Methods After Long-term Follow Up." Acta Obstetricia Et Gynecologica Scandinavica, vol. 98, no. 5, 2019, pp. 604-615.
Rodriguez-Wallberg KA, Marklund A, Lundberg F, et al. A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. Acta Obstet Gynecol Scand. 2019;98(5):604-615.
Rodriguez-Wallberg, K. A., Marklund, A., Lundberg, F., Wikander, I., Milenkovic, M., Anastacio, A., Sergouniotis, F., Wånggren, K., Ekengren, J., Lind, T., & Borgström, B. (2019). A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. Acta Obstetricia Et Gynecologica Scandinavica, 98(5), 604-615. https://doi.org/10.1111/aogs.13559
Rodriguez-Wallberg KA, et al. A Prospective Study of Women and Girls Undergoing Fertility Preservation Due to Oncologic and Non-oncologic Indications in Sweden-Trends in Patients' Choices and Benefit of the Chosen Methods After Long-term Follow Up. Acta Obstet Gynecol Scand. 2019;98(5):604-615. PubMed PMID: 30723910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden-Trends in patients' choices and benefit of the chosen methods after long-term follow up. AU - Rodriguez-Wallberg,Kenny A, AU - Marklund,Anna, AU - Lundberg,Frida, AU - Wikander,Ida, AU - Milenkovic,Milan, AU - Anastacio,Amandine, AU - Sergouniotis,Fotios, AU - Wånggren,Kjell, AU - Ekengren,Jeanette, AU - Lind,Tekla, AU - Borgström,Birgit, Y1 - 2019/03/18/ PY - 2019/01/10/received PY - 2019/01/29/accepted PY - 2019/2/7/pubmed PY - 2020/1/29/medline PY - 2019/2/7/entrez KW - adolescents KW - benign diseases KW - cancer KW - female KW - fertility preservation KW - long-term follow up KW - outcome KW - pre-pubertal girls SP - 604 EP - 615 JF - Acta obstetricia et gynecologica Scandinavica JO - Acta Obstet Gynecol Scand VL - 98 IS - 5 N2 - INTRODUCTION: In Scandinavian countries, programs for fertility preservation are offered free of charge at tertiary-care university hospitals to all patients facing treatments with risk of subsequent sterility. In this prospective study we aimed to investigate trends in female patients' choices after counseling and fertility preservation outcomes during follow up in relation to benign vs malignant indications. MATERIAL AND METHODS: Data on 1254 females including 1076 adults and 178 girls who received fertility preservation counseling for either oncologic (n = 852) or benign indications (n = 402) at Karolinska University Hospital, Stockholm, between 1 October 1998 and 1 December 2018 were analyzed. As appropriate, t tests and chi-square tests were used to compare groups. Logistic regression was used to compare outcomes among groups depending on indications. RESULTS: Adult women generally elected to undergo oocyte retrieval after controlled ovarian stimulation for cryopreservation of embryos or oocytes (n = 538, 73%), whereas a minor proportion opted for cryopreservation of ovarian tissue retrieved through laparoscopy (n = 221, 27%). More than half of the women with a partner chose either not to fertilize their oocytes aiming at cryopreservation of oocytes or to share obtained oocytes attempting both cryopreservation of oocytes and cryopreservation of embryos. All pre-pubertal (n = 48) and 73% of post-pubertal girls (n = 66) elected cryopreservation of ovarian tissue. In recent years, an increasing number of teenagers have opted for controlled ovarian stimulation aiming at cryopreservation of oocytes, either before (n = 24, 17%) or after completion of cancer treatment (n = 15, 10%). During follow up, 27% of the women returned for a new reproductive counseling, additional fertility preservation or to attempt pregnancy. Utilization rates among individuals who were alive and of childbearing age by December 2018 indicated 29%, 8% and 5% for embryos, oocytes and ovarian tissue with live birth rates of 54%, 46% and 7%, respectively. Women with benign indications were significantly younger than women with previous malignant indications at the time of attempting pregnancy. Although the pregnancy rates were similar among both groups, the live birth rate was significantly higher in women with benign vs previous malignant indications (47% vs 21%, P = .002). CONCLUSIONS: Trends in fertility preservation choices have changed over time. Women with previous malignancy had lower live birth rates than women with benign fertility preservation indications. SN - 1600-0412 UR - https://www.unboundmedicine.com/medline/citation/30723910/A_prospective_study_of_women_and_girls_undergoing_fertility_preservation_due_to_oncologic_and_non_oncologic_indications_in_Sweden_Trends_in_patients'_choices_and_benefit_of_the_chosen_methods_after_long_term_follow_up_ L2 - https://doi.org/10.1111/aogs.13559 DB - PRIME DP - Unbound Medicine ER -