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.