In vitro fertilization for cancer patients and survivors

Objective: To determine in vitro fertilization (IVF) outcome in cancer pati ents. Design: Retrospective record review. Setting: Academic, hospital-based assisted reproductive technology (ART) pr ogram. Patient(s): Sixty-nine women undergoing 113 IVF/gamete intrafallopian trans fer (GIFT) cycles after cancer treatment in one partner, and 13 women under going 13 IVF cycles for embryo cryopreservation before chemotherapy/radiati on. Intervention(s): IVF, intracytoplasmic sperm injection (ICSI), assisted hat ching, and gamete intrafallopian transfer as indicated. Main Outcome Measure(s): Delivery rate, spontaneous abortion rate, number o f embryos cryopreserved, cancer diagnosis, systemic or local cancer treatme nt, female age, amount of gonadotropin used, treatment duration, peak estra diol level, and number of oocytes and embryos. Result(s): The women undergoing IVF after chemotherapy had poorer responses to gonadotropins than did the women with locally treated cancers even thou gh they were younger (33.5 +/- 1.3 vs. 36.5 +/- 0.5 years; P<.05). The deli very rates after the women had undergone chemotherapy tended to be lower am ong the systemic treatment group than it was for the local cancer treatment group: (13.3% [2 of 15] vs. 40% [14 of 56, P=NS]). The women who had cryop reserved all embryos before chemotherapy produced more oocytes (18.7 <plus/ minus> 3.2 vs. 14.5 +/- 1.2) and embryos (11.3 +/- 1.9 vs. 7.5 +/- 0.7) tha n did the women who had had a history of local cancer treatment. Male facto r infertility as a result of cancer treatment is well treated with IVF or i ntracytoplasmic sperm injection, where indicated (32% delivery rate/cycle), with no difference between the frozen sperm banked before cancer treatment and fresh sperm produced after treatment. Conclusion(s): Chemotherapy diminishes the response to ovulation induction in assisted reproductive technologies. IVF with cryopreservation of embryos allows embryo banking before chemotherapy for women who have been newly di agnosed with cancer. Factors related to the partner affect the success of I VF for male factor infertility as a result of cancer treatment. (C) 2001 by American Society for Reproductive Medicine.