P-421 Return rates and outcome of fertility preservation in women with cervical cancer.
Authors: Marklund A , Röjlar H , Riodriguez-Wallberg K 
Published: June 2023

Abstract

Study question
What are the return rates and reproductive outcome after fertility preservation (FP) in women with cervical cancer (CC)?

Summary answer
Return rates after FP in women with CC seem to be comparable with those after FP for other indications.

What is known already
Cervical cancer is the fourth most common cancer among women. Approximately 42% of the affected women are under the age of 45, and many of them wish to preserve fertility at the time of diagnosis. Fertility sparing treatment modalities and FP with cryopreservation of oocytes, embryos or/and ovarian tissue can be offered for this purpose to carefully selected patients. These treatments are offered at Swedish academic centers within the health insurance coverage available to all citizens. To date, data on return rates, reproductive outcome and survival in women with cervical cancer undergoing FP are scarce.

Study design, size, duration
Prospective, single center study aiming to report long-term outcomes in women with CC who have versus have not undergone FP at Karolinska University Hospital between January 1st 1999 and September 30th 2018.

Participants/materials, setting, methods
During the study period, 74 women with CC received FP counseling at Karolinska University Hospital, and 52 of them women proceeded to FP. Data on return rates, reproductive outcomes and overall survival were extracted using the clinical registries.

Main results and the role of chance
By January 15th, 2023, 22 of 52 women with FP returned for a new fertility counselling or treatment, mean time between FP and return was 4 years (1-7 years). Among women with cryopreserved ovarian tissue (n = 40), 17 have been in contact with the clinic with fertility wish, 3 of them had re-transplantation of the tissue, but none of them achieved oocyte retrieval yet. Additionally, one woman is planned for re-transplantation in February 2023, and one woman is awaiting the decision. In two cases the decision not to re-transplant ovarian tissue was based on absence of endometrial growth following attempts of hormonal substitutive therapy. Among women with cryopreserved oocytes (n = 5), 1 returned for thawing but no pregnancy has been achieved. Among women with cryopreserved embryos (n = 5), 3 returned during follow-up, 2 proceeded to thawing and transfer, 1 got pregnant and gave birth to a child. Of two women with combination of oocytes and ovarian tissue cryopreserved, one returned for fertility treatment, but no pregnancy has been achieved after thawing and re-transplantation. Eight women died during follow-up because of recurrence of their cancer, 4 of 22 in the group without FP and 4 of 52 in the group with FP.

Limitations, reasons for caution
This study provides much needed data on real-world outcome in women with FP indicated by diagnosis of CC, but it has the limitations related to its descriptive character. The use of gestational carriers is not permitted in Sweden and FP program may differ from those in other countries.

Wider implications of the findings
The study results provide much needed data on real-world reproductive and oncologic outcome following FP in women with CC.

Trial registration number
NTC04602962