Post-Treatment Fertility Preservation
Some survivors may maintain
ovarian function for a number of years following cancer therapy, and
thus may have the possibility to undergo oocyte or embryo
cryopreservation in survivorship if deemed to be at increased risk for
future primary ovarian insufficiency (POI). Unfortunately, there are
limited to no data in humans on the ideal amount of time to wait between
completion of chemotherapy or radiation and ovarian stimulation for
oocyte retrieval, with many centers recommending waiting at least 6
months post completion of therapy based on risk of malformation and
fetal loss reported in animal studies.(43,44) There is also a delicate
balance between intervening with fertility preservation before oocyte
yield becomes extremely limited or POI occurs, and avoiding unnecessary
procedures in patients who may maintain adequate ovarian function during
their reproductive years. Age and maturity of the patient, as well as
family building goals should also be taken into account when considering
timing of post-treatment fertility preservation. Data from the 2017
Society for Assisted Reproductive Technology (sart.org) show a 46.8%
live birth rate per in-vitro fertilization (IVF) cycle for women under
35 in the United States, but it is unknown how having a history of
cancer impacts these results. Unfortunately, the out-of-pocket costs of
IVF can be prohibitive for many, and insurance coverage is quite
variable, which further complicates the decision.