Kappy Michelle, Lieman Harry J, Pollack Staci, Buyuk Erkan
Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Arch Gynecol Obstet. 2021 Jun;303(6):1617-1623. doi: 10.1007/s00404-021-05985-0. Epub 2021 Feb 5.
Women with cancer may desire fertility preservation (FP) prior to initiating cancer treatment, but undergoing FP may result in treatment delays. This study sought to determine whether such delays existed in our population and which factors were associated with patients' decision to proceed with FP.
This was a historical cohort study performed at Montefiore Medical Center's Institute for Reproductive Medicine and Health. Reproductive age women diagnosed with cancer and consulted for FP were included. The main outcome measure was the number of days between FP consultation and cancer treatment initiation. Factors associated with patients' decisions to proceed with FP were also analyzed.
Thirty out of 51 women in our study underwent FP including embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (OTC), both oocyte and embryo cryopreservation, or GnRH agonist treatment. The majority of women who underwent FP chose embryo cryopreservation (36.7%), followed by oocyte cryopreservation (33.3%). Of the 20 patients with partners who underwent FP, 13 (65%) froze embryos. Only 4 of the 30 women who underwent FP had all, or a portion of their services, covered by insurance. The mean treatment delay was 18 days (p = 0.007), with a mean consultation to oncologic treatment gap of 23 ± 16.8 and 41.4 ± 25.9 days in the non-FP and FP groups, respectively.
Women with cancer diagnosis who underwent FP prior to initiating cancer treatment experienced a statistically significant delay in initiating cancer treatment. However, the clinical significance of this finding is unknown since FP treatments have not been associated with increased recurrence or mortality.
癌症女性患者在开始癌症治疗前可能希望保留生育功能（FP），但进行FP可能会导致治疗延迟。本研究旨在确定我们的患者群体中是否存在此类延迟，以及哪些因素与患者进行FP的决定相关。
这是一项在蒙特菲奥里医疗中心生殖医学与健康研究所进行的历史性队列研究。纳入被诊断患有癌症并咨询FP的育龄女性。主要结局指标是FP咨询与癌症治疗开始之间的天数。还分析了与患者进行FP决定相关的因素。
我们研究中的51名女性中有30名进行了FP，包括胚胎冷冻保存、卵母细胞冷冻保存、卵巢组织冷冻保存（OTC）、卵母细胞和胚胎冷冻保存或GnRH激动剂治疗。进行FP的大多数女性选择胚胎冷冻保存（36.7%），其次是卵母细胞冷冻保存（33.3%）。在20名有伴侣且进行FP的患者中，13名（65%）冷冻了胚胎。进行FP的30名女性中只有4名全部或部分服务费用由保险支付。平均治疗延迟为18天（p = 0.007），非FP组和FP组从咨询到肿瘤治疗的平均间隔分别为23±16.8天和41.4±25.9天。
在开始癌症治疗前进行FP的癌症诊断女性患者在开始癌症治疗时经历了具有统计学意义的延迟。然而，由于FP治疗与复发或死亡率增加无关，这一发现的临床意义尚不清楚。
