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Fertility preservation treatments and outcomes in patients with hematologic disorders
When chemotherapy was planned to start later than 10 days after the initial presentation, women received either immediate GnRH-a followed 10–14 days later by chemotherapy (Arm III) or chemotherapy plus GnRH-a placebo (Arm IV). Resumption of menstruation after chemotherapy was the primary outcome. Post-chemotherapy hormonal changes (FSH, LH, E2, AMH) were secondary outcomes. RESULTS: Arm I/II: 64% and 80% of cases resumed menses at 6 and 12 months following termination of the GnRH-ant/GnRH-a/chemotherapy protocol versus 72% and 80% of cases in the control group (P>0.05), and no statistically significant differences in hormonal levels, whether at 6 and 12 months (P>0.05). Arm III/IV: 68% and 84% resumed menses at 6 and 12 months following termination of the GnRH-a/chemotherapy protocol versus 76% and 80% in the control group (P>0.05), and no statistically significant differences in hormonal levels at any time points (P>0.05). CONCLUSION: GnRH analogue administration before and during cyclophosphamide-based chemotherapy for young women with breast cancer does not appear to preserve post-treatment ovarian function. The Alexandria Regional Center for Women Health and Development (Alexandria, Egypt) Supported by: Zagazig University School of Medicine (Zagazig, Egypt) O-159 Tuesday, October 18, 2011 04:45 PM FERTILITY PRESERVATION TREATMENTS AND OUTCOMES IN PATIENTS WITH HEMATOLOGIC DISORDERS. S. Senapati, C. B. Morse, J. Kim, J. Mersereau, B. Efymow, C. Gracia. Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, NC. OBJECTIVE: Hematologic diseases present unique challenges for fertility preservation (FP), as patients often present after gonadotoxic therapies. There is little data to guide recommendations for treatment. This study seeks to identify differences in FP treatments and outcomes in patients with hematologic diseases who present before and after chemotherapy. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients with hematologic diseases seen for FP consultation at two university centers from 2006-2011 were included. Baseline FSH, estradiol (E2), antral follicle count (AFC), total gonadotropins, peak E2, follicles >14mm, and oocyte yield were compared between patients who had been exposed to chemotherapy vs. unexposed patients. Groups were compared using Chi2, t-tests, nonparametric tests and multivariable regression models. RESULTS: Of the 52 patients 16/52 (31%) had leukemia, 26 (50%) lymphoma, 5 (10%) myelodysplastic syndrome, and 3 (6%) aplastic anemia. 30/ 52 (58%) had prior chemotherapy and 18/52 (35%) were planning bone marrow transplant (BMT). Baseline characteristics were similar between groups. 21/52 (40%) pursued ovarian stimulation, and 5/52 (10%) ovarian tissue banking. 18/21 had an oocyte retrieval (12 banked embryos, 5 oocytes, 1 split). Patients with prior chemotherapy and those planning BMT were more likely to try stimulation (P¼0.019 and P¼0.005). Patients with prior chemotherapy had lower baseline AFCs (P¼0.04), received more total gonadotropins (P¼0.01), and had shorter stimulations (P¼0.05). There was no difference in baseline FSH, total follicles, peak E2, or oocyte yield (mean ¼ 10.9). CONCLUSION: Over half of patients with hematologic diseases who present for FP services have been exposed to chemotherapy. While ovarian reserve is likely impaired in this group, overall oocyte yield may be acceptable. The optimal timing of ovarian stimulation after chemotherapy and the outcomes of banking need further investigation. Supported by: Oncofertility Consortium Roadmap Grant NIH 1 UL1 RR024926-01
O-160 Tuesday, October 18, 2011 05:00 PM 42 OOCYTE CRYOPRESERVATION (OC)/THAW CYCLES WITH LIVEBIRTH OUTCOME IN HEALTHY WOMEN AFTER SLOW COOLING (SC) AND VITRIFICATION (VIT) USING OOCYTES RETRIEVED AT LESS THAN AGE 40. DOES METHOD MATTER? N. Noyes, R. S. Weinerman, P. A. LaBella. NYU Fertility Center, New York University School of Medicine, New York, NY. OBJECTIVE: As technology has improved, OC is now offered worldwide as a means to preserve reproductive potential. Our program currently uses both SC and VIT OC methods with most patients having ½ of their oocytes cryopreserved by SC and ½ by VIT.
S48
Abstracts
DESIGN: Retrospective, university-based. MATERIALS AND METHODS: All OC cycles with pregnancy outcome data were reviewed. Patients with PGD, delayed freeze, cancer indications or multiple IVF failures as well as cycles where fresh and cryopreserved oocytes were used together were excluded. RESULTS: The mean age of women freezing was 32y (range 21-39). D2 FSH/E2 were normal. 536 oocytes were thawed (mean 12/cycle) after a mean of 42 weeks in LN2 storage. Peak E2 was 2590 pg/ml with 2.2 embryos replaced. Clinical outcomes included implantation-35/93(37.6%) and pregnancy (sac)-25/42(59.5%): 4 miscarriages, 1 ongoing and 20 deliveries of 26 liveborn infants (6 twins; 13 male/13 female; mean gestational age 38.1 wk single/34.3 wk twin; birth weight 3141g single/2180g twin). The Table compares SC and VIT data. 18 transfers had both SC and VIT-derived embryos. Of 25 pregnancy cycles, 32 SC + 24 VIT embryos were transferred; 35 (62.5%) implanted. Of 17 negative cycles, 24 SC + 13 VIT embryos had been replaced. Comparative data for 40 OC thaw cycles using SC and VIT.
Cryo Method
SC
No. MII oocytes thawed (no. not recovered) Survival of recovered 2PN fertilization Suitable for day 3 transfer (R5c,<20% frag): n(%2PN) Blastocyst formation rate (d5+d6/2PN) Usable embryos (all transferred+refrozen blasts): n(%thawed) Implantations known to be from one cryo method
274 (1)
VIT
p
261 (21)
228 (84%) 201 (84%) 0.9 194 (85%) 154 (77%) 0.03 124 (64%) 86 (56%) 0.2 85 (44%) 71 (26%) 11
50 (32%) 0.04 35 (13%) 0.0004 11
CONCLUSION: OC appears to be an effective means of fertility preservation with both SC and VIT resulting in acceptable laboratory and clinical outcomes. A current RCT to compare the 2 cryopreservation methods is ongoing at our center, while vitrification is gaining popularity worldwide. Supported by: Some FSH provided by Merck
O-161 Tuesday, October 18, 2011 05:15 PM THE EFFICACY AND SAFETY OF FERTILITY PRESERVATION USING OVARIAN STIMULATION AND OOCYTE OR EMBRYO CRYOPRESERVATION IN FEMALE CANCER PATIENTS. J. Y. Kim, B. E. Friedman, L. M. Westphal. Division of Reproductive Endocrinoloogy & Infertility, Dept. of Ob/Gyn, Stanford University School of Medicine, Stanford, CA. OBJECTIVE: To evaluate the efficacy and safety of oocyte or embryo cryopreservation with ovarian stimulation (OS) for fertility preservation (FP) in female cancer patients. DESIGN: Retrospective review and follow up of the patients. MATERIALS AND METHODS: From Jan.1999 to Apr.2009, eighty nine female cancer patients who underwent OS and oocyte or embryo cryopreservation for FP were analyzed. The cases were breast (n ¼ 44), hematologic (n ¼ 29, leukemia or lymphoma), and other cancer (n ¼ 16, uterine, brain, colon cancer, melanoma, osteosarcoma, or neuroblastoma). OS consisted primarily of a GnRH antagonist/recFSH. Breast cancer patients were administered tamoxifen continuously. With the analysis of outcomes of OS, patients were followed for cancer recurrence or progression. RESULTS: There were no significant differences in the number of retrieved oocytes (10.6 9.1 vs. 9.8 7.4 vs. 12.2 10.3), the OS duration (10.2 2.5 vs. 10.2 1.8 vs. 9.6 1.9 days), and the gonadotropin dose (3,834 1,287 vs. 4,151 1,109 vs. 4,120 1,261 IU) for each group, although the mean age was higher in breast cancer than in the other cancer types (34.5 3.5 vs. 28.4 7.1 vs. 29.5 6.6, P<0.00). The cycle cancellation rate was 2.3% in breast cancer and higher as 6.9% in hematologic cancer in which patients with chemotherapy before OS were included. One distant metastasis (2.3%, 1/44) was noted in breast cancer, 3 recurrences (10.3%, 3/29) and 4 mortalities (13.8%, 4/29) in hematologic cancer, and 1 recurrence (6.3%, 1/16) and 3 progression (18.8%, 3/16) in other cancers, during the mean follow up period of 38.3 15.6, 46.7 35.1 and 29.0 14.1 months, respectively.
Vol. 96., No. 3, Supplement, September 2011
O-160 Tuesday, October 18, 2011 05:00 PM 42 OOCYTE CRYOPRESERVATION (OC)/THAW CYCLES WITH LIVEBIRTH OUTCOME IN HEALTHY WOMEN AFTER SLOW COOLING (SC) AND VITRIFICATION (VIT) USING OOCYTES RETRIEVED AT LESS THAN AGE 40. DOES METHOD MATTER? N. Noyes, R. S. Weinerman, P. A. LaBella. NYU Fertility Center, New York University School of Medicine, New York, NY. OBJECTIVE: As technology has improved, OC is now offered worldwide as a means to preserve reproductive potential. Our program currently uses both SC and VIT OC methods with most patients having ½ of their oocytes cryopreserved by SC and ½ by VIT.
S48
Abstracts
DESIGN: Retrospective, university-based. MATERIALS AND METHODS: All OC cycles with pregnancy outcome data were reviewed. Patients with PGD, delayed freeze, cancer indications or multiple IVF failures as well as cycles where fresh and cryopreserved oocytes were used together were excluded. RESULTS: The mean age of women freezing was 32y (range 21-39). D2 FSH/E2 were normal. 536 oocytes were thawed (mean 12/cycle) after a mean of 42 weeks in LN2 storage. Peak E2 was 2590 pg/ml with 2.2 embryos replaced. Clinical outcomes included implantation-35/93(37.6%) and pregnancy (sac)-25/42(59.5%): 4 miscarriages, 1 ongoing and 20 deliveries of 26 liveborn infants (6 twins; 13 male/13 female; mean gestational age 38.1 wk single/34.3 wk twin; birth weight 3141g single/2180g twin). The Table compares SC and VIT data. 18 transfers had both SC and VIT-derived embryos. Of 25 pregnancy cycles, 32 SC + 24 VIT embryos were transferred; 35 (62.5%) implanted. Of 17 negative cycles, 24 SC + 13 VIT embryos had been replaced. Comparative data for 40 OC thaw cycles using SC and VIT.
Cryo Method
SC
No. MII oocytes thawed (no. not recovered) Survival of recovered 2PN fertilization Suitable for day 3 transfer (R5c,<20% frag): n(%2PN) Blastocyst formation rate (d5+d6/2PN) Usable embryos (all transferred+refrozen blasts): n(%thawed) Implantations known to be from one cryo method
274 (1)
VIT
p
261 (21)
228 (84%) 201 (84%) 0.9 194 (85%) 154 (77%) 0.03 124 (64%) 86 (56%) 0.2 85 (44%) 71 (26%) 11
50 (32%) 0.04 35 (13%) 0.0004 11
CONCLUSION: OC appears to be an effective means of fertility preservation with both SC and VIT resulting in acceptable laboratory and clinical outcomes. A current RCT to compare the 2 cryopreservation methods is ongoing at our center, while vitrification is gaining popularity worldwide. Supported by: Some FSH provided by Merck
O-161 Tuesday, October 18, 2011 05:15 PM THE EFFICACY AND SAFETY OF FERTILITY PRESERVATION USING OVARIAN STIMULATION AND OOCYTE OR EMBRYO CRYOPRESERVATION IN FEMALE CANCER PATIENTS. J. Y. Kim, B. E. Friedman, L. M. Westphal. Division of Reproductive Endocrinoloogy & Infertility, Dept. of Ob/Gyn, Stanford University School of Medicine, Stanford, CA. OBJECTIVE: To evaluate the efficacy and safety of oocyte or embryo cryopreservation with ovarian stimulation (OS) for fertility preservation (FP) in female cancer patients. DESIGN: Retrospective review and follow up of the patients. MATERIALS AND METHODS: From Jan.1999 to Apr.2009, eighty nine female cancer patients who underwent OS and oocyte or embryo cryopreservation for FP were analyzed. The cases were breast (n ¼ 44), hematologic (n ¼ 29, leukemia or lymphoma), and other cancer (n ¼ 16, uterine, brain, colon cancer, melanoma, osteosarcoma, or neuroblastoma). OS consisted primarily of a GnRH antagonist/recFSH. Breast cancer patients were administered tamoxifen continuously. With the analysis of outcomes of OS, patients were followed for cancer recurrence or progression. RESULTS: There were no significant differences in the number of retrieved oocytes (10.6 9.1 vs. 9.8 7.4 vs. 12.2 10.3), the OS duration (10.2 2.5 vs. 10.2 1.8 vs. 9.6 1.9 days), and the gonadotropin dose (3,834 1,287 vs. 4,151 1,109 vs. 4,120 1,261 IU) for each group, although the mean age was higher in breast cancer than in the other cancer types (34.5 3.5 vs. 28.4 7.1 vs. 29.5 6.6, P<0.00). The cycle cancellation rate was 2.3% in breast cancer and higher as 6.9% in hematologic cancer in which patients with chemotherapy before OS were included. One distant metastasis (2.3%, 1/44) was noted in breast cancer, 3 recurrences (10.3%, 3/29) and 4 mortalities (13.8%, 4/29) in hematologic cancer, and 1 recurrence (6.3%, 1/16) and 3 progression (18.8%, 3/16) in other cancers, during the mean follow up period of 38.3 15.6, 46.7 35.1 and 29.0 14.1 months, respectively.
Vol. 96., No. 3, Supplement, September 2011