Application of assisted reproductive technology in fertility pre-servation and promotion for women with malignant tumors.
10.3724/zdxbyxb-2025-0620
- Author:
Chunmei MA
1
;
Xiaoling HU
2
;
Shanshan ZHANG
3
;
Lanfeng XING
3
;
Yingwei ZHANG
3
;
Yimin ZHU
4
Author Information
1. Reproductive Medicine Center, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China. yyw97@zju.edu.cn.
2. Reproductive Medicine Center, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China. huxiaolinghxl@zju.edu.cn.
3. Reproductive Medicine Center, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
4. Reproductive Medicine Center, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China. zhuyim@zju.edu.cn.
- Publication Type:Journal Article
- Keywords:
Assisted reproductive technology;
Fertility enhancement;
Fertility preservation;
Malignant tumors;
Pregnancy outcome
- From:
Journal of Zhejiang University. Medical sciences
2025;():1-10
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVES:To evaluate the strategies and outcomes of assisted reproductive technology (ART) for fertility preservation and promotion in women with malignant tumors, and to analyze ART outcomes across different tumor types.
METHODS:We conducted a retrospective analysis of female patients who underwent ART for fertility preservation or treatment at the Reproductive Center of the Women's Hospital, Zhejiang University School of Medicine, between January 1, 2018, and December 31, 2023. A total of 163 ART-aided pregnancy patients with malignant tumors were included in the case group, among which 6 patients underwent embryo cryopreservation for fertility preservation before radiotherapy or chemotherapy. Additionally, 11 unmarried women underwent oocyte cryopreservation due to borderline ovarian tumors, ovarian cancer, breast cancer, or hematological malignancies. The control group was selected from women without a history of malignant tumors who received ART treatment during the same period, using propensity score matching at a ratio of 1∶2, resulting in 326 cases. Data were collected through the reproductive medical record system and telephone follow-up (as of October 31, 2024). Baseline characteristics, controlled ovarian hyperstimulation parameters, laboratory indicators, and pregnancy outcomes were compared between case and control groups and among patients with different tumor types, and the tumor recurrence of the patients was followed up.
RESULTS:Patients in the case group had significantly lower ovarian reserve (AMH, AFC) and a higher proportion of diminished ovarian reserve compared to the control group (all P<0.01). Regarding the ovulation induction protocol, the proportion of patients using the minimal stimulation protocol in the case group was significantly higher than that in the control group (29.45% vs. 12.88%, P<0.01), and the total dosage of gonadotropins used was lower (P<0.01). In terms of assisted reproductive outcomes, there were no statistically significant differences between the two groups in the number of retrieved oocytes, number of high-quality embryos, fertilization rate, cumulative pregnancy rate, cumulative live birth rate, or miscarriage rate (all P>0.05). However, the number of oocyte retrieval cycles and embryo transfer cycles required to achieve a live birth outcome in the case group were significantly higher than those in the control group (both P<0.05). Subgroup analysis showed that there were no significant differences in cumulative pregnancy rate and live birth rate among patients with different tumor types (thyroid cancer, reproductive system tumors, breast cancer, lung cancer). Nevertheless, lung cancer patients had the lowest ovarian reserve and required the most oocyte retrieval cycles due to their older age; breast cancer patients had a relatively lower fertilization rate partially because some of them were complicated with male factors. A follow-up of 154 tumor patients (with a follow-up rate of 88.5%) revealed that 6 patients (4.20%) had tumor recurrence, and 1 breast cancer patient died due to tumor recurrence. None of the 11 unmarried patients who had undergone oocyte cryopreservation had used the cryopreserved oocytes for assisted pregnancy yet, and 1 patient who had undergone fertility preservation died due to tumor recurrence.
CONCLUSIONS:Women of reproductive age with malignant tumors are at risk of diminished fertility. ART can effectively preserve and promote fertility, enabling favorable pregnancy and live birth outcomes. It is recommended to initiate a multidisciplinary assessment promptly prior to radiotherapy/chemotherapy and formulate an individualized ART regimen for fertility preservation or promotion, so as to achieve reproductive goals or safeguard future fertility potential.
