Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom.
UCL Institute for Women's Health, University College London, London, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2023 Feb;281:41-48. doi: 10.1016/j.ejogrb.2022.12.016. Epub 2022 Dec 10.
As cancer survivorship increases, there is higher uptake of fertility preservation treatments among affected women. However, there is limited evidence on the subsequent use of preserved material and pregnancy outcomes in women who underwent fertility preservation (FP) before cancer treatments. We aimed to systematically review the long-term reproductive and pregnancy outcomes in this cohort of women.
Women who underwent any type of the following FP treatments: embryo cryopreservation (EC), oocyte cryopreservation (OC) and ovarian tissue cryopreservation (OTC)) before any planned cancer treatment.
We searched electronic databases (MEDLINE, Embase, Cochrane CENTRAL, and HTA) from inception until May 2021 for all observational studies that met our inclusion criteria. We extracted data on reproductive and pregnancy outcomes in duplicate and assessed the risk of bias in included studies using the ROBINS-I tool. We pooled data using a random-effects model and reported using odds ratios (OR) with 95% confidence intervals (CI).
Our primary outcome was live birth rate and other important reproductive and pregnancy outcomes.
Of 5405 citations, we screened 103 and included 26 observational studies (n = 7061 women). Hematologic malignancy was the commonest cause for seeking FP treatments, followed by breast and gynecology cancers. Twelve studies reported on OTC (12/26, 46 %), eight included EC (8/26, 30 %), and twelve reported on OC (12/26, 46 %). The cumulative live birth rate following any FP treatment was 0.046 (95 %CI 0.029-0.066). Only 8 % of women returned to use their frozen reproductive material (558/7037, 8.0 %), resulting in 210 live births in total, including assisted conceptions following EC/OC/OTC and natural conceptions following OTC. The odds for live birth was OR 0.38 (95 %CI 0.29-0.48 I 83.7 %). The odds for live birth was the highest among women who had EC (OR 0.45, 95 %CI 0.14-0.76, I 95.1 %), followed by the OTC group (OR 0.37, 95 %CI 0.22-0.53, I 88.7 %) and OC group (OR 0.31, 95 %CI 0.15-0.47, I 78.2 %).
Fertility preservation treatments offered good long-term reproductive outcomes for women with cancer with a high chance to achieve a live birth. Further research is needed to evaluate the long-term pregnancy and offspring outcomes in this cohort.
随着癌症存活率的提高，受影响女性对生育保存治疗的接受率更高。然而，在癌症治疗前接受生育保存（FP）治疗的女性中，关于随后使用保存材料和妊娠结局的证据有限。我们旨在系统地综述该队列女性的长期生殖和妊娠结局。
在计划癌症治疗前接受以下任何一种 FP 治疗的女性：胚胎冷冻保存（EC）、卵母细胞冷冻保存（OC）和卵巢组织冷冻保存（OTC）。
我们从创建到 2021 年 5 月在电子数据库（MEDLINE、Embase、Cochrane 中心和 HTA）中搜索符合我们纳入标准的所有观察性研究。我们对生殖和妊娠结局的数据进行了重复提取，并使用 ROBINS-I 工具评估了纳入研究的偏倚风险。我们使用随机效应模型对数据进行了汇总，并使用优势比（OR）和 95%置信区间（CI）报告结果。
我们的主要结局是活产率和其他重要的生殖和妊娠结局。
在 5405 条引用中，我们筛选了 103 条，并纳入了 26 项观察性研究（n=7061 名女性）。寻求 FP 治疗的最常见原因是血液系统恶性肿瘤，其次是乳腺癌和妇科癌症。12 项研究报告了 OTC（12/26，46%），8 项包括 EC（8/26，30%），12 项报告了 OC（12/26，46%）。任何 FP 治疗后的累积活产率为 0.046（95%CI 0.029-0.066）。只有 8%的女性返回使用其冷冻生殖材料（558/7037，8.0%），总共导致 210 例活产，包括 EC/OC/OTC 后的辅助受孕和 OTC 后的自然受孕。活产的优势比为 0.38（95%CI 0.29-0.48，I 83.7%）。EC 组的活产优势比最高（OR 0.45，95%CI 0.14-0.76，I 95.1%），其次是 OTC 组（OR 0.37，95%CI 0.22-0.53，I 88.7%）和 OC 组（OR 0.31，95%CI 0.15-0.47，I 78.2%）。
生育保存治疗为癌症女性提供了良好的长期生殖结局，有很大的机会实现活产。需要进一步研究来评估该队列的长期妊娠和后代结局。
