Dados do Trabalho

Title

Epidemiologic characteristics of patients undergoing oncofertility preservation at a leading public hospital

Objective

Assess the number of women who underwent fertility preservation (FP) at the Pérola Byington Hospital (PBH), their ages and the underlying diseases in this group, in addition to the percentage of women who returned to the hospital for embryo transfer and the possible reasons of dropout.

Methods

Retrospective study based on review of medical records of patients treated at the PBH Assisted Reproduction Centre for FP prior to undergoing treatment for the underlying pathology from January 2010 to December 2018. The method of FP used was oocyte cryopreservation. Ovarian stimulation protocol was individualized according to age, ovarian reserve, comorbidities, and the menstrual cycle period at treatment beginning. Among the inclusion criteria were age ≤ 40 years, the presence of menarche, and absence of ovarian failure criteria. 228 patients underwent fertility preservation in this period, but 66 were excluded from the study due to lack of data in the medical records. In total, 162 patients were included in the study.

Results

Of the 162 patients evaluated, 4 underwent fertility preservation treatment in 2010, 6 in 2011, 9 in 2012, 21 in 2013, 15 in 2014, 26 in 2015, 28 in 2016, 30 in 2017 and 23 in 2018. Of this total, 21 returned to use gametes or frozen embryos. The indications for FP were: 124 patients with breast cancer, 10 with ovarian cancer, 14 with other cancers (colon, endometrium, lung, thyroid, lymphoma and sarcoma), 14 with other indications (endometriosis, ovarian mass under investigation, autoimmune diseases).

Conclusion

Discussion on FP is essential, especially in some groups of patients, such as oncology patients, who will undergo potentially gonadotoxic treatments or even the surgical removal of the gonads, but also in benign pathologies such as endometriosis, benign ovarian tumours, and autoimmune diseases, which treatments often lead to diminished ovarian function. In cancer patients, the start of stimulation can occur on any day of woman's menstrual cycle, allowing for FP without a delay in the initiation of cancer treatment.
A limitation in the study was the difficulty in obtaining the medical records of some patients due to the lack of data. Despite this, the results demonstrate an increase in demand for fertility preservation over the past decade and that 13% of patients who underwent FP returned for embryo transfer. Mean age of patients undergoing treatment was 31 years. Regarding FP indications, 76.6% were due to breast cancer, 6.2% ovarian cancer, 8.6% other cancers and 8,6% other causes.
It is important to emphasize that the study was carried out in a leading hospital for gynecological oncology, thus, a large part of the study sample is composed by oncologic patients. Due to patient characteristics, possible reasons of dropout are oncological progression, long period of observation to rule out recurrence and other personal factors.
Our results are encouraging and even higher than the reported in literature. According to Specchia et al. and Cobo et al., 4.5% and 7.4%. of FP returned to use their gametes, respectively. Porcu et al reported a patient return rate of 28%, so most women did not attempt pregnancy, and their oocytes are still crypreserved. Nevertheless, offering FP is no longer considered optional and must be included in every therapeutic program for women who receive an oncological or other diagnosis that can impair ovarian reserve in reproductive age.

Keywords

oncofertility preservation, oocyte cryopreservation, fertility preservation