P-358 Fertility preservation outcome in patients with onco-hematological malignancies versus solid tumor neoplasms
Authors: Comana S , Serra N , Reschini M , Ciaffaglione M , Mondini I , Somigliana E , Filippi F 
Published: July 2024

Abstract

Study question
Do women diagnosed with onco-hematological malignancies exhibit poorer response to ovarian stimulation in comparison to those with localized neoplasms?

Summary answer
There are no significant differences between women undergoing fertility preservation for onco-hematological malignancies compared to those with solid tumor malignancies.

What is known already
Oocyte cryopreservation is now considered the first choice for fertility preservation in post-pubertal women scheduled for gonadotoxic anticancer treatments. Patients with onco-hematological diseases, such as leukemia or lymphoma, encounter unique challenges due to their aggressiveness and multi-organ nature, potentially impacting ovarian function. Conversely, patients with solid malignancies may experience more favorable outcomes, as the impact on their reproductive function is likely less severe. However, comparative data on oocyte cryopreservation outcomes in both groups remain limited, hence further research is essential to guide personalized fertility preservation counselling.

Study design, size, duration
This is a single center case-control retrospective study that included data collected from 142 patients who underwent oocyte cryopreservation in our center between 2013 to 2023. Laboratory exams, ovarian stimulation and oocyte retrieval were all performed in our center.

Participants/materials, setting, methods
The main group of patients (or group 1) comprised 71 women with onco-hematological malignancies such as leukemia and lymphoma. Patients from group 1 were matched for age and study period in a 1:1 ratio with solid malignancies (group 2), such as breast cancer. Gynecological tumors were excluded. Significance was considered with a p &lt; 0.05. Data are reported as median [interquartile range - IQR] or number (percentage).

Main results and the role of chance
In both groups, the mean age at oocyte cryopreservation was 30 years [25-34]. Only a minority of patients were undergoing estroprogestin therapy (10% in group 1 vs. 19% in group 2) (p=ns). Menstrual cycles were found to be regular in 88% and 90% of patients respectively (p=ns). Stimulation protocols were also comparable: 48% and 55% underwent GnRH antagonist, and the remaining underwent progestin-primed ovarian stimulation (p=ns). Duration of stimulation and total dose of gonadotropins did not differ between the two groups. Ovarian stimulation was interrupted due to inadequate response in two patients in the onco-hematological group and one in the control group (p=ns). At oocyte retrieval, the number of oocytes retrieved was 12 [7 - 18] and 15 [7-20] respectively (p=ns), and the number of cryopreserved oocytes was 10 [6-15] and 13 [7-15], respectively (p=ns). This result aligns with the antral follicle counts (AFC) detected before ovarian stimulation: 18 [12 - 24] vs. 20 [12 - 26], respectively (p=ns). However, a notable difference was found in anti-Mullerian hormone (AMH) levels, being 1.96 ng/mL [1.14 - 3.10] in onco-hematological patients and 3.11 ng/ml [1.52 - 4.52] in control patients (p = 0.01).

Limitations, reasons for caution
This is a retrospective, monocentric study with patients selected from a 10-year period.

Wider implications of the findings
When planning fertility preservation in women with systemic diseases like cancer, relying solely on AMH levels to estimate ovarian response to stimulation may be limited. In this scenario, AFC proves more reliable. Further evidence is needed to understand the clinical meaning of the lower AMH in onco-hematological cancer patients.

Trial registration number
NA