O-027 Beyond the cancer: twenty-year analysis of fertility preservation (FP) outcomes in young women with cancer (YWC)

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Abstract Study question To analyze the percentage of YWC who pursued 'active' (IVF ±PGTA/M, ovarian tissue cryopreservation) versus 'passive' (GnRHa) FP and their 20-year conception outcomes. Summary answer After FP consultation, most YWC pursued active FP. 23.1% returned to try to conceive. 76.6% of YWC were able to conceive post cancer treatment. What is known already Fertility preservation through oocyte, embryo, or ovarian tissue cryopreservation is an established option for young women with newly diagnosed cancer undergoing gonadotoxic treatments. GnRHa during chemotherapy or ovarian transposition are also viable options when ovarian stimulation is not possible. Over the past decade, embryo genetic testing via PGT-A and PGT-M has become readily available. However, little is known about the outcomes, including the live birth rate, of the use of oocytes and embryos retrieved from YWC at the time of their diagnosis who are followed long-term after their initial diagnosis until they are in remission and ready to conceive. Study design, size, duration This retrospective cohort study analyzed the charts of 998 oncology patients referred for FP consultation at an academic IVF centre in Canada from 2004 to 2024. YWC have been referred to our centre to discuss FP options, including IVF for oocyte or embryo freezing, PGT-A/PGT-M, GnRHa during chemotherapy, ovarian transposition, and ovarian tissue cryopreservation. The study covers a 20-year period, YWC are seen every 1-2 years post-diagnosis until they are trying to conceive (TTC). Participants/materials, setting, methods The following clinical data were extracted from charts and electronic databases: patient demographics, cancer and genetic history, FP decisions, IVF cycle parameters of YWC who proceeded with active FP, and pregnancy outcomes of those who returned trying to conceive. Data were analyzed using descriptive statistics, Chi-square tests, and ANOVA with post-hoc comparisons in SPSS. Statistical significance was defined as p < 0.05. Main results and the role of chance The mean age at consultation was 33.1±6.1 years, and the mean AMH was 21.4 pmol/L. 64% had no prior pregnancy. Cancer diagnoses included breast (43.6%), endometrial/atypical hyperplasia (15.5%), lymphoma (12.2%), ovarian (10.6%), cervical (6.2%), and other (11.8%). Following the initial FP consultation, 641/998 (64.2%) patients completed 781 active FP cycles to preserve oocytes (342, 43.8%), embryos (385, 49.3%), oocytes/embryos (46, 5.9%), or ovarian tissue (8, 1.0%). Of these, 162 also received passive FP (GnRHa) during chemotherapy. 109/998 (10.9%) patients did passive FP, and 248/998 (24.8%) declined all FP options. 128/641 active FP patients returned for 217 frozen embryo transfers (FET) using their cryopreserved oocytes/embryos. The mean time from OPU to FET was 28.9 months. The majority did one (54.9%) or two (30.5%) FET cycles. 98/128 (76.6%) had at least one successful pregnancy. Overall, 231/998 (23.1%) patients returned TTC (mean time from initial consultation to TTC was 27.4 months). The return rate was highest among those who did both active and passive FP (35.8%) and lowest among those who declined FP (11.7%, p < 0.001). The most common method of TTC was FET (n = 138). 172/231 (74.5%) had a successful pregnancy. 29/248 patients who declined FP returned to TTC; 19/29 (65.5%) had a livebirth. Limitations, reasons for caution The main limitation of this study was its retrospective design, which may introduce bias. Additionally, all patients were from a single academic centre, which may affect the generalizability of the findings. Further multi-centre, prospective studies would help to confirm these results. Wider implications of the findings After FP consultation, most YWC pursued active FP. Despite long term follow-up, only 23.1% returned to TTC. For those who did return, FP proved to be a valuable option, resulting in live births for the majority of patients after cancer treatment. Trial registration number No

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