Dados do Trabalho

Title

Fertility preservation of oncological patients assisted in a public assisted reproduction center in Natal-RN, Brazil

Objective

Cancer is one of the diseases that most lead to death in the world, and the severity of the disease can directly affect the reproductive capacity of affected individuals. Although the use of fertility preservation techniques is not new, it is a possibility that is still little known by a large part of the population. It is also noteworthy that in Brazil this is a possibility available even in the Unified Health System (SUS), through the associated Clinics and Assisted Reproduction Centers; as is the case of the Assisted Reproduction Center (CRA) of the Januário Cicco Maternity School (MEJC), located in the city of Natal-RN, Brazil, and linked to the Federal University of Rio Grande do Norte (UFRN), and to the Brazilian Hospital Services (EBSERH). In this sense, this study aimed to characterize the profile of cancer patients submitted to fertility preservation techniques at CRA/MEJC.

Methods

After approval by the UFRN Research Ethics Committee (CEP) and the National Research Ethics Committee (CONEP), a descriptive and retrospective observational study was carried out, based on secondary data from patients who met the eligibility criteria for treatment at CRA/MEJC, between 2013 and 2018. Information was then collected about the socioeconomic profile and clinical data of patients who consented to access data from their medical records.

Results

From a sample of 326 patients, 280 authorized the access of its medical records. Approximately 78% of these patients were from brown race, followed by 19% white and 0.4% black. As for the level of education, 14% and 50%, respectively, had completed primary or secondary education, 26% had completed higher education and 6% had incomplete higher education, when they started their treatment at CRA. These patients had an average age of 35.5 years at the time of their treatment, and about 63% had primary infertility, while 36% had secondary infertility. Among the medical records analyzed, 06 patients were submitted to fertility preservation procedures due to cancer, which represented less than 3% of the sample. All had primary infertility and ages between 23 and 37 years (mean of 27 years). Of these, 03 patients had Hodgin's Lymphoma, 01 had Non-Hodgkin's Lymphoma, 01 had Breast Cancer associated with Squamous Cell Carcinoma and 01 had Fibromyxoid Ingnal Sarcoma. One patient, carrier of Hodking's Lymphoma, also had associated severe male factor (Teratospermia) on its partner, and in this case embryonic cryopreservation was performed. The other patients underwent oocyte cryopreservation. Until the moment this study was carried out, no information was available about the return of these patients to continue their Assisted Human Reproduction (AHR) treatments after cancer treatment.

Conclusion

The low percentage of patients who resorted to fertility preservation may be associated with the general population's lack of knowledge about this possibility, where it is worth mentioning the fact that cancer patients have priority in the waiting list for treatment at the aforementioned CRA, given the severity of the disease and the high demand that this public center receives. Also noteworthy is the difficulty in obtaining information about the return of these patients to continue the treatment, which may be a direct reflection of the high mortality associated with cancer. This study demonstrates the great contribution of a public AHR center to allow cancer patients of any socioeconomic status to maintain the dream of obtaining a pregnancy even after cancer treatment. It also raises reflections on ethical issues related to the posthumous use of cryopreserved gametes, tissues or embryos.

Keywords

cancer; pregnancy; gametes; embryo; cryopreservation.