Live birth rate after female fertility preservation for cancer or haematopoietic stem cell transplantation: a systematic review and meta-analysis of the three main techniques; embryo, oocyte and ovarian tissue cryopreservation
- PMID: 36421038
- PMCID: PMC9977128
- DOI: 10.1093/humrep/deac249
Live birth rate after female fertility preservation for cancer or haematopoietic stem cell transplantation: a systematic review and meta-analysis of the three main techniques; embryo, oocyte and ovarian tissue cryopreservation
Abstract
Study question: What are the chances of achieving a live birth after embryo, oocyte and ovarian tissue cryopreservation (OTC) in female cancer survivors?
Summary answer: The live birth rates (LBRs) following embryo and oocyte cryopreservation are 41% and 32%, respectively, while for IVF and spontaneous LBR after tissue cryopreservation and transplantation, these rates are 21% and 33%, respectively.
What is known already: Currently, fertility preservation (FP) has become a major public health issue as diagnostic and therapeutic progress has made it possible to achieve an 80% survival rate in children, adolescents and young adults with cancer. In the latest ESHRE guidelines, only oocyte and embryo cryopreservation are considered as established options for FP. OTC is still considered to be an innovative method, while it is an acceptable FP technique in the American Society for Reproductive Medicine guidelines. However, given the lack of studies on long-term outcomes after FP, it is still unclear which technique offers the best chance to achieve a live birth.
Study design, size, duration: We performed a systematic review and meta-analysis of published controlled studies. Searches were conducted from January 2004 to May 2021 in Medline, Embase and the Cochrane Library using the following search terms: cancer, stem cell transplantation, FP, embryo cryopreservation, oocyte vitrification, OTC and reproductive outcome.
Participants/materials, setting, methods: A total of 126 full-text articles were preselected from 1436 references based on the title and abstract and assessed via the Newcastle-Ottawa Quality Assessment Scale. The studies were selected, and their data were extracted by two independent reviewers according to the Cochrane methods. A fixed-effect meta-analysis was performed for outcomes with high heterogeneity.
Main results and the role of chance: Data from 34 studies were used for this meta-analysis. Regarding cryopreserved embryos, the LBR after IVF was 41% (95% CI: 34-48, I2: 0%, fixed effect). Concerning vitrified oocytes, the LBR was 32% (95% CI: 26-39, I2: 0%, fixed effect). Finally, the LBR after IVF and the spontaneous LBR after ovarian tissue transplantation were 21% (95% CI: 15-26, I2: 0%, fixed-effect) and 33% (95% CI: 25-42, I2: 46.1%, random-effect), respectively. For all outcomes, in the sensitivity analyses, the maximum variation in the estimated percentage was 1%.
Limitations, reasons for caution: The heterogeneity of the literature prevents us from comparing these three techniques. This meta-analysis provides limited data which may help clinicians when counselling patients.
Wider implications of the findings: This study highlights the need for long-term follow-up registries to assess return rates, as well as spontaneous pregnancy rates and birth rates after FP.
Study funding/competing interest(s): This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare.
Registration number: CRD42021264042.
Keywords: cancer; embryo cryopreservation; fertility preservation; haematopoietic stem cell transplantation; live birth rate; meta-analysis; oocyte vitrification; ovarian tissue cryopreservation.
© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.
Figures
![Figure 1.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9977128/bin/deac249f1.gif)
![Figure 2.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9977128/bin/deac249f2.gif)
![Figure 3.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9977128/bin/deac249f3.gif)
Similar articles
-
Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis.Hum Reprod Open. 2024 Jan 30;2024(1):hoae006. doi: 10.1093/hropen/hoae006. eCollection 2024. Hum Reprod Open. 2024. PMID: 38389980 Free PMC article. Review.
-
Live births following fertility preservation using in-vitro maturation of ovarian tissue oocytes.Hum Reprod. 2020 Sep 1;35(9):2026-2036. doi: 10.1093/humrep/deaa175. Hum Reprod. 2020. PMID: 32829388
-
Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes.Hum Reprod. 2019 Oct 2;34(10):1948-1964. doi: 10.1093/humrep/dez163. Hum Reprod. 2019. PMID: 31644803 Free PMC article.
-
Elective and Onco-fertility preservation: factors related to IVF outcomes.Hum Reprod. 2018 Dec 1;33(12):2222-2231. doi: 10.1093/humrep/dey321. Hum Reprod. 2018. PMID: 30383235
-
Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance.Hum Reprod Update. 2017 Mar 1;23(2):139-155. doi: 10.1093/humupd/dmw038. Hum Reprod Update. 2017. PMID: 27827818 Free PMC article. Review.
Cited by
-
Oncofertility as an Essential Part of Comprehensive Cancer Treatment in Patients of Reproductive Age, Adolescents and Children.Cancers (Basel). 2024 May 13;16(10):1858. doi: 10.3390/cancers16101858. Cancers (Basel). 2024. PMID: 38791937 Free PMC article. Review.
-
Enhancement of Vascularization and Ovarian Follicle Survival Using Stem Cells in Cryopreserved Ovarian Tissue Transplantation-A Systematic Review.Biology (Basel). 2024 May 14;13(5):342. doi: 10.3390/biology13050342. Biology (Basel). 2024. PMID: 38785824 Free PMC article. Review.
-
Ovarian tissue transplantation: 10 years of experience at the Bologna University.Front Endocrinol (Lausanne). 2024 Mar 7;15:1332673. doi: 10.3389/fendo.2024.1332673. eCollection 2024. Front Endocrinol (Lausanne). 2024. PMID: 38516411 Free PMC article.
-
Fertility Preservation in Cervical Cancer-Treatment Strategies and Indications.Curr Oncol. 2024 Jan 4;31(1):296-306. doi: 10.3390/curroncol31010019. Curr Oncol. 2024. PMID: 38248104 Free PMC article. Review.
-
BRCA Mutations and Fertility Preservation.Int J Mol Sci. 2023 Dec 22;25(1):204. doi: 10.3390/ijms25010204. Int J Mol Sci. 2023. PMID: 38203374 Free PMC article. Review.
References
-
- Alvarez RM, Ramanathan P.. Fertility preservation in female oncology patients: the influence of the type of cancer on ovarian stimulation response. Hum Reprod 2018;33:2051–2059. - PubMed
-
- Babb A, Farah N, Lyons C, Lindsay K, Reddy N, Goldman J, Apperley JF, Salooja N.. Uptake and outcome of assisted reproductive techniques in long-term survivors of SCT. Bone Marrow Transplant 2012;47:568–573. - PubMed
-
- Chien AJ, Chambers J, Mcauley F, Kaplan T, Letourneau J, Hwang J, Kim M-O, Melisko ME, Rugo HS, Esserman LJ. et al. Fertility preservation with ovarian stimulation and time to treatment in women with stage II–III breast cancer receiving neoadjuvant therapy. Breast Cancer Res Treat 2017;165:151–159. - PubMed
-
- Cobo A, García-Velasco J, Domingo J, Pellicer A, Remohí J.. Elective and onco-fertility preservation: factors related to IVF outcomes. Hum Reprod 2018;33:2222–2231. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials