Fertility Preservation by Ovarian Tissue Cryopreservation among Cancer Patients in Italy: a multicentric study in Assisted Reproductive technology (ART) centers.
Giulia Scaravelli (IT), Ettore Cittadini (IT), Alberto Revelli (IT), Raffaella Fabbri (IT), Raffaella De Palo (IT), Vincenzo Vigiliano (IT), Roberta Spoletini (IT), Roberto De Luca (IT), Lucia Speziale (IT)
[Scaravelli] ART Italian National Register, CNaPPS,National Health Institute , [Cittadini] University of Palermo, [Revelli] Physiopathology of Reproduction and In Vitro Fertilization Unit, S. Anna Hospital, University of Turin, [Fabbri ] Gynecology & Pathophysiology of Human Reproduction Unit, S. Orsola-Malpighi Hospital, University of Bologna, [De Palo] Unit of Physiopathology of Human Reproduction and Gametes Cryopreservation, University Hospital of Bari- Consorziale Policlinico, [Vigiliano] ART Italian National Register, CNaPP,National Health Institute , [Spoletini] ART Italian National Register, CNaPP,National Health Institute , [De Luca] ART Italian National Register, CNaPP,National Health Institute , [Speziale] ART Italian National Register, CNaPP,National Health Institute
Context In Italy, about 3% of cancer patients (CP) are <40 years and after cancer treatment may suffer a reduction in their reproductive capacity. Ovarian tissue cryopreservation (OTC), along with that of oocytes, is one of the therapeutic options for fertility preservation (FP). Today OTC gained ground as an effective procedure for FP. 60 children worldwide have been born after this procedure. Objective To assess the indication to treatment, access to the procedures, medical profile and outcomes of CP which undergo OTC. Methods Retrospective study on FP activity from 1998-2015 of 4 public Italian ART centers representative for expertise in OTC. Data collected by a survey. Patient(s) CP which underwent OTC. Intervention(s) Analysis of data on FP procedures on CP collected by a questionnaire sent to all ART centers (199). Among the 20 which reported to have performed OTC only the major 4 were selected for this study. Main Outcome Measure(s) Identification of ART centers with a large amount of data in OTC, clinical outcomes of CP undergoing ovarian tissue transplantation (OTT). Result(s) 20 ART centers made OTC on 938 CP. In the 4 ART centers, 777 (82.8%) women undergo FP by OTC. The indication for treatment were hematological cancers (42,2%), breast cancers (27,8%) and solid tumors (16,3%). 10 cases (1,28%) underwent OTT. In these, 7 OTT restored ovarian function, 1 determined a spontaneous pregnancy, 1 a negative outcome and 2 are still under observation. The period before OTT ranged between 6 to 13 years. Conclusions The number of OTT are small because these patients need to recover from cancer and reach the disease-free period. OTC was made mainly in nulliparous women < 35 years suggesting that the desire to have a child is a priority over the recovery of ovarian function. To monitor this phenomenon in the future we will need a systematic national data collection.