Findings of a new study demonstrate the benefit of early referral of young women with breast cancer to reproductive specialists for fertility preservation.
The study, reported online September 27 in the Journal of Clinical Oncology, showed that referral to reproductive specialists before breast surgery increases the likelihood of obtaining a sufficient number of oocytes for fertility preservation without delaying breast cancer treatment.
The American Society of Clinical Oncology (ASCO) recommends that young patients be referred to reproductive specialists for fertility preservation as soon as possible after a cancer diagnosis. This study, however, was the first to quantify the benefits of early referral for fertility preservation. The findings “support a need for shift in practice for oncologists treating young women with breast cancer who wish to try to preserve their fertility,” according to the authors.
Kutluk Oktay, MD, of New York Medical College, Valhalla, and associates performed a secondary analysis of a prospective database of women with breast cancer undergoing ovarian stimulation for fertility preservation by oocyte or embryo cryopreservation. Of the 93 women (mean age, 35 years) who met study inclusion criteria, 35 were referred before breast cancer surgery (PreS group)and 58 were referred after surgery (PostS group).
The researchers found that the time periods from initial diagnosis to initiation of ovarian stimulation and from initial diagnosis to initiation of chemotherapy were significantly shorter in the PreS group compared with the PostS group. Also, significantly more of those in the PreS group than in the PostS group were able to undergo two fertility preservation cycles (25.7% vs 1.7%, respectively). This resulted in a increased yield of oocytes in the PreS group compared with the PostS group (18.2% vs 0.6%, respectively) and of embryos (17.2% vs 0.6%, respectively). Women who underwent oocyte retrieval within 5 weeks of surgery were able to complete a second cycle within 9 weeks of the surgery.
Because of the demonstrated benefit of early referral to a reproductive specialist, the researchers conclude that the study findings “may shift the responsibility for these referrals from the medical oncologist to the breast surgeon” and they recommend that practitioners adhere to the ASCO guidelines on fertility preservation.