In vitro fertilization outcomes after cancer

癌症后体外受精的结果

• 批准号: 10468027
• 负责人: BARBARA Joan LUKE
• 金额: $ 44.59万
• 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/10468027
• 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.

摘要 拟议的研究将加强对约75,000名被诊断患有癌症的妇女的癌症护理 通过提供有关保留生育力结果的当代证据，每年的生育年龄都在增加。接受， 非试验性保存选择仅限于胚胎和卵母细胞的冷冻保存，这两者 最终需要体外受精(IVF)才能实现怀孕。不孕不育咨询一直是 被国家癌症护理指南推荐了十多年；然而，没有足够的证据表明 允许患者和他们的提供者在知情的情况下做出决定。在非肿瘤环境中，试管受精成功率 从最年轻的女性到年龄最大的女性，从45%到11%不等。我们的初步分析和其他研究 这表明有癌症病史的女性对试管受精治疗的反应可能更差。 为了解决这一证据差距，我们建议使用来自辅助生殖学会的详细试管受精数据 技术临床结果报告系统(SART CORS)，这是一个全国性的试管受精数据库，包括&gt；90% 自2004年以来，试管受精程序与14个州的国家癌症登记和生命记录(出生证明)挂钩。 这个拟议的项目将把我们在3个州的试点研究扩大到14个州，以形成一个队列&gt；663,000美国。 在2004-16年间进行试管受精周期并进行了近500万人年随访的妇女。这个 研究人群将包括大约13,000名有癌症病史的女性，跟踪调查长达13年 在确诊后。在这个队列中，我们将1。)比较试管受精周期的结果(取卵、胚胎百分比 受孕率、受孕率和受孕所需周期数)在三组之间存活： 那些在癌症治疗前、癌症治疗后和没有癌症病史的情况下开始试管受精的人。我们会 也是2.)比较试管受精活产率和结局(孕期、出生体重、胎儿生长受限、 妊娠期高血压疾病、先天畸形)。最后，我们将3。)调查 卵母细胞或胚胎冷冻保存时间与体外受精受孕及活产率的关系 对于那些回来解冻卵母细胞或胚胎的妇女；并评估自然受孕率(即存活 没有胚胎移植的出生)对于那些没有回来的人。 建议的研究是评估新接受的卵母细胞冷冻保存和传播的理想时机。 随机启动试管受精方案，以减少癌症治疗延迟的可能性。这项研究将提供一种 对女性来说至关重要的证据基础，她们必须在保留生育能力的同时做出时间敏感的决定 面临着潜在的生命危险和经济上的毁灭性癌症诊断。