P-404 Sexual function, psychological distress, and remaining fertility in female cancer survivors
Authors: Reiser E , Bettina B , Charlotte O , Julia S , Susanne T , Bettina T 
Published: June 2023

Abstract

Study question
How many women after fertility preservation and gonadotoxic treatment suffer from sexual dysfunction und psychological distress?

Summary answer
Sexual dysfunction was detected in 60.4% of 53 patients with no increased presence of psychological distress compared to the general population.

What is known already
Gonadotoxic treatment in female cancer patients can lead to reversible or permanent impaired fertility. The risk depends on the agent, number of cycles and age of the women. Different methods of fertility preservation are offered, including cryopreservation of (non-) fertilized oocytes, cryopreservation of ovarian tissue, and GnRH analogues. Improved survivorship leads to new challenging issues such as comorbidities resulting from the cancer treatment itself, secondary malignancy, and potential impairment of quality of life, sexual function, and fertility.

Study design, size, duration
This prospective single center study was conducted at the Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria between June 2021 and November 2021. The department holds the biggest cryobank of ovarian tissue in Austria, offering the procedure since 2007.

Participants/materials, setting, methods
In this prospective study, 202 female cancer survivors who underwent fertility preservation methods at time of cancer diagnosis between 2010 and 2020 were invited to a gynecological exam, laboratory assessment and two questionnaires (Female Sexual Function Index (FSFI) and Hospital anxiety and depression scale (HADS)) in 2022. FSFI and HADS scores were compared depending on Anti-Mullerian-hormone (AMH) levels, current desire to have a child, and age.

Main results and the role of chance
At time of cancer diagnosis, these patients underwent at least one of the following fertility preservation methods: cryopreservation of (non-) fertilized oocytes (n = 27 [48%]), cryopreservation of ovarian tissue (n = 38 [68%]), GnRH analogues (n = 53 [95%]). After a mean follow up time of 70 +/-50 months, sexual dysfunction was detected in 60.4% of the 53 patients. Normal results regarding HADS-D/Anxiety and HADS-D/Depression were found in 88.7% and 94.3% of patients, respectively. At time of follow up, 69.9% of patients regained regular menstrual cycles, 53% of patients &lt;40 years showed a diminished ovarian reserve with AMH levels &lt; 1.1ng/ml. and 15 patients (28.3 %) suffered from infertility. 14 (25%) women already fulfilled their desire to have children, whereas 16 (30%) women expressed the desire to have children at time of follow up. Out of 9 women, who conceived after gonadotoxic treatment, four used cryopreserved oocytes and one underwent ovarian tissue transplantation.

Limitations, reasons for caution
A possible limitation is the small sample size and varying follow up intervals.

Wider implications of the findings
Female cancer survivors are at highly increased risk for SD. Cancer patient should be informed about possible sexual dysfunction already at the start of cancer treatment and during follow up.

Trial registration number
1471/2020