In vitro fertilization outcomes after cancer

癌症后体外受精的结果

• 批准号: 10222590
• 负责人: BARBARA Joan LUKE
• 金额: $ 12.46万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222590
• 关键词: Address; Affect; Age; Assisted Reproductive Technology; Birth; Birth Certificates; Birth Rate; Blood Vessels; Child; Clinic; Conceptions; Congenital Abnormality; Consensus; Counseling; Couples; Data; Databases; Decision Making; Diagnosis; Embryo; Embryo Transfer; Exposure to; Failure; Fees; Female of child bearing age; Fertility; Fertilization in Vitro; Fetal Growth Retardation; Financial cost; Freezing; Future; Grouping; Growth; Guidelines; Late Effects; Length; Life; Link; Live Birth; Malignant Neoplasms; Oocytes; Outcome; Pathologic; Patients; Persons; Pilot Projects; Pregnancy; Pregnancy Outcome; Procedures; Process; Protocols documentation; Provider; Radiation; Recording of previous events; Records; Reporting; Research; Sample Size; Seminal fluid; Societies; Survival Rate; System; Time; United States; Uterus; Woman; aged; cancer care; cancer diagnosis; cancer therapy; cohort; cost; egg; embryo cryopreservation; evidence base; fertility preservation; follow-up; high risk; neoplasm registry; oocyte cryopreservation; oocyte retrieval; pregnancy hypertension; pregnant; premature; preservation; reproductive; response; sound; study population; success

ABSTRACT The proposed research will enhance cancer care for the ~75,000 women diagnosed with cancer at reproductive ages each year by providing contemporary evidence on fertility preservation outcomes. Accepted, non-experimental preservation options are limited to embryo and oocyte cryopreservation, both of which ultimately require in vitro fertilization (IVF) to achieve pregnancy. Fertility preservation counseling has been recommended by national cancer care guidelines for over a decade; however, there is inadequate evidence to allow patients and their providers to make informed decisions. In non-oncologic settings, IVF success rates range from 45% to 11% from the youngest to the oldest women. Our preliminary analyses and other studies suggest that response to IVF treatment may be worse among women with a cancer history. To address this evidence gap, we propose using detailed IVF data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), a national IVF database that includes >90% of IVF procedures since 2004, linked to State cancer registries and vital records (birth certificates) in 14 States. This proposed project will expand our pilot study in 3 States to 14 States to form a cohort of >663,000 U.S. women who had IVF cycles during 2004-16 and contribute close to five million person-years of follow-up. The study population will include an estimated 13,000 women with a cancer history, followed for up to 13 years after diagnosis. Within this cohort, we will 1.) Compare IVF cycle outcomes (oocytes retrieved, % of embryos that survive freeze/thaw, conception rates, and # of cycles required for conception) between three groups: those who initiate IVF before cancer treatment; after cancer treatment; and without a cancer history. We will also 2.) Compare IVF live birth rates and outcomes (length of gestation, birthweight, fetal growth restriction, gestational hypertension, and congenital malformations) in the three groups. Finally, we will 3.) Investigate the association between storage time of cryopreserved oocytes or embryos and IVF conception and live birth rates for women who return for thawing oocytes or embryos; and evaluate rates of spontaneous conception (i.e., live births without embryo transfer) for those who do not return. The proposed research is ideally timed to evaluate newly-accepted oocyte cryopreservation and dissemination of random-start IVF protocols to reduce the potential for cancer treatment delays. The research will provide a critical evidence base to women who must make time sensitive decisions about fertility preservation while faced with a potentially life threatening and financially devastating cancer diagnosis.

抽象的 拟议的研究将加强对约 75,000 名被诊断患有癌症的女性的癌症护理 每年的生育年龄，提供有关生育力保存结果的当代证据。公认， 非实验保存选项仅限于胚胎和卵母细胞冷冻保存，这两者 最终需要体外受精（IVF）来实现怀孕。生育力保存咨询已 十多年来一直受到国家癌症护理指南的推荐；然而，没有足够的证据表明 让患者及其提供者做出明智的决定。在非肿瘤环境中，IVF 的成功率 从最年轻的女性到最年长的女性，这一比例从 45% 到 11% 不等。我们的初步分析和其他研究 表明有癌症病史的女性对 IVF 治疗的反应可能更差。 为了解决这一证据差距，我们建议使用辅助生殖协会的详细 IVF 数据 技术临床结果报告系统 (SART CORS)，一个国家 IVF 数据库，包含超过 90% 自 2004 年起，IVF 程序与 14 个州的国家癌症登记处和生命记录（出生证明）相关联。 该拟议项目将把我们在 3 个州的试点研究扩大到 14 个州，以形成超过 663,000 名美国人的队列。 2004-16 年期间接受过 IVF 周期的女性，并贡献了近 500 万人年的随访。这 研究人群将包括估计 13,000 名有癌症病史的女性，随访时间长达 13 年 诊断后。在这个队列中，我们将 1.) 比较 IVF 周期结果（取出的卵母细胞、胚胎百分比 三组之间的冷冻/解冻存活率、受孕率和受孕所需的周期数）： 在癌症治疗前开始体外受精的人；癌症治疗后；并且没有癌症病史。我们将 还 2.) 比较 IVF 活产率和结果（妊娠时长、出生体重、胎儿生长受限、 三组的妊娠高血压和先天性畸形）。最后，我们将 3.) 调查 冷冻卵母细胞或胚胎的储存时间与 IVF 受孕和活产率之间的关系 对于返回解冻卵母细胞或胚胎的女性；并评估自然受孕率（即活体受孕率） 对于那些没有返回的人来说，没有胚胎移植的分娩）。 拟议的研究非常适合评估新接受的卵母细胞冷冻保存和传播 随机启动 IVF 方案以减少癌症治疗延迟的可能性。该研究将提供 对于必须在保留生育能力方面做出时间敏感决定的妇女来说，这是至关重要的证据基础 面临着可能危及生命和经济上毁灭性的癌症诊断。