P-582 Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study
Authors: Li H , Lin J , Sun X 
Published: July 2024

Abstract

Study question
Do women diagnosed with gynecologic cancer have worse pregnancy and neonatal outcomes of assisted reproductive technology (ART) ?

Summary answer
Decreased live birth rate was observed in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers.

What is known already
Gynecologic malignancies comprise approximately 13% of female cancer diagnoses, and oncological treatments such as surgery, chemotherapy, abdominal or pelvic radiotherapy, and hormonotherapy may induce infertility, premature ovarian failure, or early menopause, resulting in a loss of reproductive potential. ART has emerged as an important option for cancer patients undergoing treatment, but the reproductive outcomes of ART among cancer survivors remain poorly understood. Limited research exists regarding the impact of a history of gynecologic cancer on reproductive outcomes of ART.

Study design, size, duration
136 women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were retrospectively enrolled in this study. 241 infertile women without any history of cancer were matched to the cancer group.

Participants/materials, setting, methods
Women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were included. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type.

Main results and the role of chance
A total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significant shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P &lt; 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P &lt; 0.001). Maternal and neonatal complications did not significantly differ between the groups (P &gt; 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P &lt; 0.001, respectively).

Limitations, reasons for caution
Our study was limited by the retrospective design in nature and small sample size of its patient cohort. In addition, the effect of cancer treatments was not evaluated specifically in the current study due to the limited number of patients and possible inconsistency in surgical operations.

Wider implications of the findings
Our study provides data support for further exploration of the effects of endometrial cancer, cervical cancer, and other gynecologic cancers on fertility. Comprehensive ovarian function assessment, detailed counseling, individualized fertility guidance, and close follow-up after ART therapy are recommended for patients with gynecologic malignancy history.

Trial registration number
Not applicable