- Email: [email protected]
Factors that influence decisions about fertility preservation (FP) among women with cancer
underwent emergency IVF and 8 oocytes were retreived and 4 embryos were frozen. Five years after the end of chemotherapy she returned seeking for embryo transfer of the frozen embryos. Prior to the procedure she underwent routine cervical smear which disclosed uterine cervix carcinoma. Following evaluation she underwent trachelectomy for preserving her fertility. RESULTS: Two years after the trachelecyomy the patient returned for embryo transfer. Estradiol valerate was given for preparing the uterine cavity, and two frozen tgawed embryos were transferred. The two embryos were ipmlanted and in this stage the patient refused early embryo reduction. The nuchal translucency and the ultrasound screening tests were normal. At this stage trial to perform abdomunal cervical cerclage failed because of technical reasons. At week 18 the patient agreed to perform fetal reduction from twins to singletone. Following the procedure she suffered from bleeding and at 25 weeks og gestation she delivered a baby 500gm.The baby was treated in the intensive care unit and 4 month later was discharged. CONCLUSION: This case presents hoe fertility preservation options might be applied in a single - single patient. The case raises the dillema of how many embryos to transfer? the need for performing circlage during trachelectomy? The need for fetal reduction early in the pregnancy and finaly deminstrates that the lightening may stike more than twice.
P-86 Tuesday, October 15, 2013 FERTILITY PRESERVATION TRENDS AMONG MALE CANCER SURVIVORS. K. Omurtag,a J. Rhee,a K. Reynolds,a P. Dua,b A. Kracen,b E. Jungheim.a aReproductive Endocrinology and Infertility, Washington University St Louis, St Louis, MO; bSiteman Cancer Center, Barnes Jewish Hospital, St Louis, MO. OBJECTIVE: Attention on female cancer survivors has dominated the fertility preservation landscape. There remains a lack of understanding about the reproductive health needs of male cancer survivors and their desires for future fertility. We describe male cancer survivors’ attitudes about their future fertility and sexual health. DESIGN: Cross Sectional Survey. MATERIALS AND METHODS: Male cancer survivors aged 18-65 treated between 1990-2012 at a university-based hospital/cancer center with affiliated REI practice, where sperm banking services are available, were surveyed. Men were sent a 27 item questionnaire regarding their concern of future fertility and sexual function after being diagnosed with cancer. An interim analysis of 1,343 responses were extracted. RESULTS: Of 11,319 eligible men, 1,344 responses have been received. The majority of respondents were Caucasian (91.2%), in a relationship (82.5%), had 2 or more children (67.3%) and had health insurance (94.1%) at the time of cancer diagnosis. 17.6% did not have a child. Eighty percent were not concerned about their future fertility at the time of cancer diagnosis, 45.8% of whom cited ‘‘no interest in childbearing’’ and 19.3% citied ‘‘more concern about cancer diagnosis.’’ Only 3.3% of respondents banked sperm, with 73.9% citing ‘‘being done with childbearing.’’ Another 13.7% cited ‘‘not being presented with the opportunity to bank.’’ In regard to sexual function, 63.9% noted a reduction in ability to have an erection, 39.7% noted a reduction in sexual desire and 41.2% were dissatisfied with their sexual health after cancer diagnosis. CONCLUSION: Male cancer survivors do not seem concerned about future fertility, nor are they routinely counseled about their options when faced with cancer treatment. Their sexual function after diagnosis is also reduced. As cancer survivorship improves assumptions about future reproductive health should be validated based on age, marital status and type of cancer. Supported by: Barnes Jewish Hospital Foundation.
P-87 Tuesday, October 15, 2013 FACTORS THAT INFLUENCE DECISIONS ABOUT FERTILITY PRESERVATION (FP) AMONG WOMEN WITH CANCER. E. E. Niemasik,b S.-W. Chan,a C.-N. Kao,a A. Katz,a J. Belkora,c M. P. Rosen.a aObstetrics, Gynecology, and Reproductive Sciences, University of California,
S172
ASRM Abstracts
San Francisco, San Francisco, CA; bObstetrics and Gynecology, Weill Cornell Medical College, New York, NY; cHealth Policy and Surgery, University of California, San Francisco, San Francisco, CA. OBJECTIVE: Patients seeking reproductive counseling after a diagnosis of cancer are faced with a narrow window of time to acquire key information and pursue FP before cancer treatment. During this critical time, we sought to determine which factors have the greatest influence on guiding decisionmaking (DM) regarding FP. DESIGN: Prospective survey. MATERIALS AND METHODS: From Jan 2011 to March 2013, reproductive aged women with a new diagnosis of cancer who presented for FP counseling were consented. Women completed surveys at 4 time points: before and after a consultation, after making a decision about FP but before treatment, and 8 months later. At time point 3 participants were asked to rate how personal relationships and informational sources influenced their FP decision. Mean influence was calculated for each factor; t-tests were performed where appropriate. RESULTS: 147 women were recruited (92% accrual rate). The mean age was 32.9 years. 65% of women at time point 3 pursued FP. The most influential people in a woman’s DM were her partner (2.47) and fertility doctor (2.37). Among the types of information women used, a conversation with the healthcare team (2.32), and information from the doctor’s office (2.08) were the most influential. Women who decided to undergo FP viewed their fertility doctor to be more influential than those who did not (p<0.05). Mean satisfaction with materials gathered was 4.40/10. However, the mean importance of gathering information was 8.05/10. CONCLUSION: These findings suggest that the healthcare team is not only the most important factor informing DM regarding FP; they may be as influential as a patient’s partner. Given the urgency and stressful nature of this critical time, additional resources should be made available to ease this difficult process. This may be important before initial consultation, when patient interest in obtaining information is high, but satisfaction with available materials is relatively low. Supported by: NIH/NCRR/OD UCSF-CTSI Grant Number TL RR024129.
P-88 Tuesday, October 15, 2013 GOSERELIN FOSTERS BONE ELONGATION, BUT DOES NOT PREVENT OVARIAN DAMAGE, IN CYCLOPHOSPHAMIDE (CTX)-TREATED PRE-PUBERTAL MICE. L. Detti, C. J. Carter, L. J. Williams, S. E. Osborne, D. C. Martin, R. A. Uhlmann. Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN. OBJECTIVE: CTX hampers ovarian and long bone development in prepubertal mice. We tested if goserelin, a GnRH-agonist, could prevent those effects. DESIGN: Animal study. MATERIALS AND METHODS: 35 C57BL/6J mice were randomized to six groups: day 13 of life, GOS1 and GOS2 received depot goserelin (3.6 mg); all others received placebo. On day 18, CTX1, CTX2, GOS1 and GOS2 received 200 mg/kg of CTX; Cont1 and Cont2 received placebo. Group 1 was euthanized on day 20 of life (prepubertal), group 2 on day 92 (adult). Primordial (PD), primary (PR), secondary (SE) and tertiary (TE) ovarian follicles, femur length and weight, and growth plate thickness were measured. Data were analyzed with Kruskal-Wallis tests (SPSS v21). RESULTS: In prepubertal mice, PD and PR follicle counts were lower in CTX1 than Cont1 and GOS1 (PD: 1.2/mm2, CI: 0.4-1.9 CTX1 vs. 14.7/mm2, CI: 2.1-27.3 Cont1 and 2.4/mm2, CI: 1.9-2.8 GOS1; p<0.02; and, PR: 1.5/ mm2, CI: 0.7-2.2 CTX1 vs. 4.8/mm2, CI: 3.7-6.0 Cont1 and 4.2/mm2, CI: 3.0-5.4 GOS1; p¼0.02). In adults, PD, PR, and TE follicle counts were lower in CTX2 and GOS2 than Cont2 (PD: 0.3/mm2, CI: 0.2-0.5 CTX2 and 0.4/ mm2, CI: 0.1-0.6 GOS2 vs. 1.3/mm2, CI: 0.9-1.6 Cont2; p<0.2; PR: 0.7/ mm2, CI: 0.4-0.9 CTX2 and 0.8/mm2, CI: 0.7-1.0 GOS2 vs. 1.2/mm2, CI: 1.0-1.4 Cont2; p¼0.05; and, TE: 0.6/mm2, CI: 0.4-0.7 CTX2 and 0.7/mm2, CI: 0.6-0.9 GOS2 vs. 1.2/mm2, CI: 0.8-1.6 Cont2; p¼0.05). Femurs did not differ in pre-pubertal groups, but were shorter in CTX2 than Cont2 and GOS2 (14.8 mm, CI: 14.5-15.1 CTX2 vs. 15.8 mm CI: 15.2-16.4 Cont2 and 15.3 mm, CI: 15.1-15.5 GOS2; p¼0.01). Femurs were non-significantly lighter in GOS2 than Cont2. There were no differences in growth plate thickness.
Vol. 100, No. 3, Supplement, September 2013
P-86 Tuesday, October 15, 2013 FERTILITY PRESERVATION TRENDS AMONG MALE CANCER SURVIVORS. K. Omurtag,a J. Rhee,a K. Reynolds,a P. Dua,b A. Kracen,b E. Jungheim.a aReproductive Endocrinology and Infertility, Washington University St Louis, St Louis, MO; bSiteman Cancer Center, Barnes Jewish Hospital, St Louis, MO. OBJECTIVE: Attention on female cancer survivors has dominated the fertility preservation landscape. There remains a lack of understanding about the reproductive health needs of male cancer survivors and their desires for future fertility. We describe male cancer survivors’ attitudes about their future fertility and sexual health. DESIGN: Cross Sectional Survey. MATERIALS AND METHODS: Male cancer survivors aged 18-65 treated between 1990-2012 at a university-based hospital/cancer center with affiliated REI practice, where sperm banking services are available, were surveyed. Men were sent a 27 item questionnaire regarding their concern of future fertility and sexual function after being diagnosed with cancer. An interim analysis of 1,343 responses were extracted. RESULTS: Of 11,319 eligible men, 1,344 responses have been received. The majority of respondents were Caucasian (91.2%), in a relationship (82.5%), had 2 or more children (67.3%) and had health insurance (94.1%) at the time of cancer diagnosis. 17.6% did not have a child. Eighty percent were not concerned about their future fertility at the time of cancer diagnosis, 45.8% of whom cited ‘‘no interest in childbearing’’ and 19.3% citied ‘‘more concern about cancer diagnosis.’’ Only 3.3% of respondents banked sperm, with 73.9% citing ‘‘being done with childbearing.’’ Another 13.7% cited ‘‘not being presented with the opportunity to bank.’’ In regard to sexual function, 63.9% noted a reduction in ability to have an erection, 39.7% noted a reduction in sexual desire and 41.2% were dissatisfied with their sexual health after cancer diagnosis. CONCLUSION: Male cancer survivors do not seem concerned about future fertility, nor are they routinely counseled about their options when faced with cancer treatment. Their sexual function after diagnosis is also reduced. As cancer survivorship improves assumptions about future reproductive health should be validated based on age, marital status and type of cancer. Supported by: Barnes Jewish Hospital Foundation.
P-87 Tuesday, October 15, 2013 FACTORS THAT INFLUENCE DECISIONS ABOUT FERTILITY PRESERVATION (FP) AMONG WOMEN WITH CANCER. E. E. Niemasik,b S.-W. Chan,a C.-N. Kao,a A. Katz,a J. Belkora,c M. P. Rosen.a aObstetrics, Gynecology, and Reproductive Sciences, University of California,
S172
ASRM Abstracts
San Francisco, San Francisco, CA; bObstetrics and Gynecology, Weill Cornell Medical College, New York, NY; cHealth Policy and Surgery, University of California, San Francisco, San Francisco, CA. OBJECTIVE: Patients seeking reproductive counseling after a diagnosis of cancer are faced with a narrow window of time to acquire key information and pursue FP before cancer treatment. During this critical time, we sought to determine which factors have the greatest influence on guiding decisionmaking (DM) regarding FP. DESIGN: Prospective survey. MATERIALS AND METHODS: From Jan 2011 to March 2013, reproductive aged women with a new diagnosis of cancer who presented for FP counseling were consented. Women completed surveys at 4 time points: before and after a consultation, after making a decision about FP but before treatment, and 8 months later. At time point 3 participants were asked to rate how personal relationships and informational sources influenced their FP decision. Mean influence was calculated for each factor; t-tests were performed where appropriate. RESULTS: 147 women were recruited (92% accrual rate). The mean age was 32.9 years. 65% of women at time point 3 pursued FP. The most influential people in a woman’s DM were her partner (2.47) and fertility doctor (2.37). Among the types of information women used, a conversation with the healthcare team (2.32), and information from the doctor’s office (2.08) were the most influential. Women who decided to undergo FP viewed their fertility doctor to be more influential than those who did not (p<0.05). Mean satisfaction with materials gathered was 4.40/10. However, the mean importance of gathering information was 8.05/10. CONCLUSION: These findings suggest that the healthcare team is not only the most important factor informing DM regarding FP; they may be as influential as a patient’s partner. Given the urgency and stressful nature of this critical time, additional resources should be made available to ease this difficult process. This may be important before initial consultation, when patient interest in obtaining information is high, but satisfaction with available materials is relatively low. Supported by: NIH/NCRR/OD UCSF-CTSI Grant Number TL RR024129.
P-88 Tuesday, October 15, 2013 GOSERELIN FOSTERS BONE ELONGATION, BUT DOES NOT PREVENT OVARIAN DAMAGE, IN CYCLOPHOSPHAMIDE (CTX)-TREATED PRE-PUBERTAL MICE. L. Detti, C. J. Carter, L. J. Williams, S. E. Osborne, D. C. Martin, R. A. Uhlmann. Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN. OBJECTIVE: CTX hampers ovarian and long bone development in prepubertal mice. We tested if goserelin, a GnRH-agonist, could prevent those effects. DESIGN: Animal study. MATERIALS AND METHODS: 35 C57BL/6J mice were randomized to six groups: day 13 of life, GOS1 and GOS2 received depot goserelin (3.6 mg); all others received placebo. On day 18, CTX1, CTX2, GOS1 and GOS2 received 200 mg/kg of CTX; Cont1 and Cont2 received placebo. Group 1 was euthanized on day 20 of life (prepubertal), group 2 on day 92 (adult). Primordial (PD), primary (PR), secondary (SE) and tertiary (TE) ovarian follicles, femur length and weight, and growth plate thickness were measured. Data were analyzed with Kruskal-Wallis tests (SPSS v21). RESULTS: In prepubertal mice, PD and PR follicle counts were lower in CTX1 than Cont1 and GOS1 (PD: 1.2/mm2, CI: 0.4-1.9 CTX1 vs. 14.7/mm2, CI: 2.1-27.3 Cont1 and 2.4/mm2, CI: 1.9-2.8 GOS1; p<0.02; and, PR: 1.5/ mm2, CI: 0.7-2.2 CTX1 vs. 4.8/mm2, CI: 3.7-6.0 Cont1 and 4.2/mm2, CI: 3.0-5.4 GOS1; p¼0.02). In adults, PD, PR, and TE follicle counts were lower in CTX2 and GOS2 than Cont2 (PD: 0.3/mm2, CI: 0.2-0.5 CTX2 and 0.4/ mm2, CI: 0.1-0.6 GOS2 vs. 1.3/mm2, CI: 0.9-1.6 Cont2; p<0.2; PR: 0.7/ mm2, CI: 0.4-0.9 CTX2 and 0.8/mm2, CI: 0.7-1.0 GOS2 vs. 1.2/mm2, CI: 1.0-1.4 Cont2; p¼0.05; and, TE: 0.6/mm2, CI: 0.4-0.7 CTX2 and 0.7/mm2, CI: 0.6-0.9 GOS2 vs. 1.2/mm2, CI: 0.8-1.6 Cont2; p¼0.05). Femurs did not differ in pre-pubertal groups, but were shorter in CTX2 than Cont2 and GOS2 (14.8 mm, CI: 14.5-15.1 CTX2 vs. 15.8 mm CI: 15.2-16.4 Cont2 and 15.3 mm, CI: 15.1-15.5 GOS2; p¼0.01). Femurs were non-significantly lighter in GOS2 than Cont2. There were no differences in growth plate thickness.
Vol. 100, No. 3, Supplement, September 2013