In vitro fertilization outcomes after cancer

摘要 这项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， 通过提供关于生育力保持结果的当代证据，每年确定生育年龄。接受， 非实验性的保存选择仅限于胚胎和卵母细胞的冷冻保存， 最终需要体外受精（IVF）来实现怀孕。生育力保护咨询一直是 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， 让患者和他们的医疗服务提供者做出明智的决定。在非肿瘤环境中，IVF成功率 从最年轻到最年长的妇女，从45%到11%不等。我们的初步分析和其他研究 这表明有癌症史女性对IVF治疗的反应可能更差。 为了解决这一证据缺口，我们建议使用辅助生殖协会的详细IVF数据。 技术诊所结果报告系统（SART CORS），一个国家IVF数据库，包括超过90%的 自2004年以来的体外受精程序，与14个州的国家癌症登记和生命记录（出生证明）相关联。 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，形成一个超过663，000名美国人的队列。 在2004- 2016年期间接受IVF周期的妇女，并提供了近500万人年的随访。的 研究人群将包括约13，000名有癌症病史的女性，随访时间长达13年 诊断后。在这个群体中，我们将1。比较IVF周期结果（取卵率，胚胎百分比 冷冻/解冻后存活的胚胎数、受孕率和受孕所需的周期数）： 那些在癌症治疗前开始IVF的人;癌症治疗后;没有癌症史。我们将 （2）比较IVF活产率和结局（妊娠时间、出生体重、胎儿生长受限， 妊娠期高血压和先天性畸形）。最后，我们将（3）。探讨 冻存卵母细胞或胚胎的储存时间与IVF受孕率和活产率之间的关系 对于返回解冻卵母细胞或胚胎的妇女;并评估自发受孕率（即，生活 没有胚胎移植的生育）。 这项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 随机开始IVF方案，以减少癌症治疗延迟的可能性。该研究将提供一个 关键的证据基础，妇女谁必须作出时间敏感的决定生育保存， 面临着潜在的生命威胁和经济破坏性的癌症诊断。

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.