1. Women with a history of cancer were less likely to have a successful live birth using autologous oocytes compared to healthy infertile women.
2. In donor oocyte cycles, live birth rates were similar between groups.
Evidence Rating Level: 2 (Good)
Study Rundown: Assisted reproductive technology (ART) is increasingly used to help infertile couples achieve pregnancy. As cancer treatment has improved over the years, more women and men survive to their reproductive years and many turn to ART to achieve a child. Men and women with a history of cancer treatment, including chemotherapy and radiation, may experience impairment or complete loss of reproductive function. Women who received high doses of pelvic radiation are at an increased risk of premature ovarian insufficiency and/or endometrial injury; others are exposed to harmful chemotherapeutic agents. These women may choose to have their own eggs harvested and cryopreserved before undergoing treatment or they may opt to use donor oocytes. Previous work has shown that women who have undergone systemic treatment for cancer have poorer outcomes in regards to oocyte retrieval, embryo transfer, and live birth rates. In the present study, authors found that women with a history of cancer within the last 5 years were less likely to achieve successful live birth using autologous oocytes but equally likely to experience live birth when using donor oocytes.
The strengths of the study were the large quality-controlled population database and adjustment for potential confounders. The study was limited primarily by retrospective design and inclusion of only cancer diagnoses within the last 5 years. Prospective studies are needed to further characterize the success rates of ART among women with a history of cancer.
In-Depth [retrospective cohort]: This study compared outcomes between 441 women with a history of cancer within the last 5 years and 52,985 women with no history of cancer who utilized assisted reproductive technology. The primary outcomes of interest were conception and live birth rates.
Women with a history of cancer were less likely to conceive and to experience a live birth using autologous oocytes compared to healthy women (p < 0.0001). In donor oocyte cycles, there was no difference in live birth rate between healthy women and those with a cancer diagnosis. Likelihood of live birth varied by type of cancer. Compared to their peers, women with a history of breast cancer were least likely to have a live birth following ART (OR 0.19, CI 0.11-0.30).
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