Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Victorian Assisted Reproductive Treatment Authority, Victoria, Australia.
Hum Reprod. 2017 Dec 1;32(12):2423-2430. doi: 10.1093/humrep/dex314.
What are the reproductive experiences and outcomes of people who store reproductive material before cancer treatment?
Of respondents who had tried to achieve pregnancy since completing cancer treatment almost all had succeeded, in most cases through natural conception.
People of reproductive age who are diagnosed with cancer can cryopreserve reproductive material to guard against the adverse effects on fertility of gonadotoxic treatment. Little is known about the reproductive outcomes of people who undergo fertility preservation before cancer treatment.
STUDY DESIGN, SIZE, DURATION: Cross-sectional survey.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Women and men who had stored reproductive material before cancer treatment at two private and one public fertility clinics up to June 2014 and were at least 18 years old at the time were identified from medical records and invited to complete an anonymous questionnaire about their reproductive experiences.
Of the 870 potential respondents 302 (171 female and 131 male) returned completed questionnaires yielding a response rate of 34.5% (39.5% and 29.7% for female and male respondents, respectively). Current age was similar for women and men (37.2 years) but men had been diagnosed with cancer significantly earlier in life than women (28.2 versus 30.3 years, P = 0.03). Almost two-thirds of respondents wished to have a child or another child in the future, some of whom knew that they were unable to. One in ten respondents was a parent before the cancer diagnosis and around one-third had had a child since diagnosis or was pregnant (or a partner in pregnancy) at the time of the survey. Of those who had tried to conceive since completing cancer treatment (N = 119) 84% (79% of women and 90% of men) had had a child or were pregnant (or a partner in pregnancy). Most of the pregnancies since the diagnosis of cancer occurred after natural conception (58/100, 58%). Of the 22 women (13% of all women) and 35 men (27% of all men) who had used their stored reproductive material four women (18%) and 28 men (80%) had had a child or were pregnant or a partner in pregnancy at the time of completing the survey. The most commonly stated reason for not using the stored material was not being ready to try for a baby.
LIMITATIONS, REASON FOR CAUTION: The relatively low response rate, particularly among men, means that participation bias may have influenced the findings. As type of cancer was self-reported and we did not ask questions about respondents' cancer treatments, it is not possible to link reproductive outcomes to type of cancer or cancer treatment. Also, there is no way of comparing the sample with the populations they were drawn from as data on reproductive outcomes of people who store reproductive material before cancer treatment are not collected routinely. This might have led to over- or underestimates of the reproductive experiences and outcomes reported in this paper.
The findings add to the limited evidence about the reproductive outcomes of this growing group of people and can be used to inform the advice given to those contemplating fertility preservation in the context of cancer.
STUDY FUNDING/COMPETING INTERESTS: The study was funded by the National Health and Medical Research Council (APP1042347). The authors have no conflicts of interest to declare.
Not applicable.
在接受癌症治疗之前储存生殖材料的人有哪些生殖经历和结果？
在完成癌症治疗后尝试怀孕的受访者中，几乎所有人都成功了，大多数情况下是通过自然受孕。
被诊断患有癌症的育龄人士可以冷冻保存生殖材料，以防止性腺毒性治疗对生育能力产生不利影响。对于在癌症治疗前进行生育保存的人的生殖结果知之甚少。
研究设计、大小、持续时间：横断面调查。
参与者/材料、地点、方法：从两家私人和一家公共生育诊所的病历中确定了截至 2014 年 6 月之前接受过癌症治疗前储存生殖材料且年龄至少 18 岁的女性和男性，并邀请他们填写一份关于其生殖经历的匿名问卷。
在 870 名潜在受访者中，有 302 名（女性 171 名，男性 131 名）人返回了完整的问卷，回复率为 34.5%（女性和男性的回复率分别为 39.5%和 29.7%）。女性和男性的当前年龄相似（37.2 岁），但男性被诊断出癌症的年龄明显小于女性（28.2 岁对 30.3 岁，P = 0.03）。近三分之二的受访者希望未来有一个孩子或另一个孩子，其中一些人知道自己无法生育。十分之一的受访者在癌症诊断前已经是父母，大约三分之一的人在诊断后已经有了孩子或怀孕（或怀孕的伴侣）。在完成癌症治疗后尝试怀孕的受访者中（N = 119），84%（女性 79%，男性 90%）已经有了孩子或怀孕（或怀孕的伴侣）。自癌症诊断以来的大多数怀孕都是自然受孕（58/100，58%）。在使用储存的生殖材料的 22 名女性（所有女性的 13%）和 35 名男性（所有男性的 27%）中，有 4 名女性（18%）和 28 名男性（80%）已经有了孩子或怀孕或怀孕的伴侣。未使用储存材料的最常见原因是还没准备好要孩子。
局限性、谨慎的原因：相对较低的回复率，尤其是在男性中，意味着参与偏见可能影响了研究结果。由于癌症类型是自我报告的，我们没有询问受访者的癌症治疗问题，因此无法将生殖结果与癌症类型或癌症治疗联系起来。此外，由于没有办法将样本与他们所来自的人群进行比较，因为没有收集到癌症治疗前储存生殖材料的人的生殖结果数据，因此报告的生殖经历和结果可能存在高估或低估的情况。
这些发现增加了关于这一不断增长的人群生殖结果的有限证据，可以为那些在癌症背景下考虑生育保存的人提供建议。
研究资金/利益冲突：该研究由澳大利亚国家健康与医学研究委员会（APP1042347）资助。作者没有利益冲突需要申报。
不适用。
