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Case History

image A 32-year-old nulliparous woman comes to your clinic having been diagnosed with breast cancer. She has recently had surgery but has been told that she requires chemotherapy. She has read that it is possible to freeze eggs so that once her chemotherapy is over she may still have the chance of having children who are genetically her own.

How would you advise her as to the success rates of oocyte cryopreservation?

What are the risks of ovulation induction in a woman with breast cancer?

What alternatives to oocyte cryopreservation are available to her?


image Approximately 15% of breast cancers occur before the age of 45 years. Treatment with adjuvant chemotherapy is well recognized as a cause of infertility.1 The younger the woman and the greater her ovarian reserve, the less likely she is to become menopausal as a consequence of chemotherapy. However, even young women are likely to become menopausal earlier than they otherwise would have done, as a consequence of chemotherapy. Given the increasing numbers of women who delay childbirth, there are significant numbers of women who develop breast cancer and have to face the prospect of infertility.2 It has been found that concerns regarding fertility influenced the treatment decisions of almost a third of young women with breast cancer.3

How would you advise her as to the success rates of oocyte cryopreservation?

It has been possible for many years to cryopreserve sperm in order to preserve fertility in men who need treatment with chemotherapy or radiotherapy which is likely to comprom ise their fertility. Frozen sperm does not fertilize oocytes as effectively as fresh sperm and intracytoplasmic sperm injection (ICSI) is usually required.

In recent years there has been increasing research attempting to successfully preserve human oocytes. This has been done either to preserve future fertility for women undergoing cancer treatment or to protect against the decreased fertility of the ageing ovary in women wishing to have children later in life. The first pregnancy resulting from oocyte cryopreservation was reported in 1986.4

As this is a relatively new technique, there is a lack of good data on oocyte cryopreservation and thus it remains difficult to counsel women. A meta-analysis of reported oocyte cryopreservation programmes showed a live birth rate per oocyte thawed of 1.9%–2.0%. If the oocyte survived the freeze–thaw and ICSI was performed, the live birth rate was 3.4%. If embryo transfer took place, the live birth rate was 21.6%.5

The technology surrounding oocyte cryopreservation continues to develop rapidly and survival rates of cryopreserved oocytes will no doubt continue to improve. For women with cancer who wish to preserve fertility but do not want to proceed to embryo cryopreservation, egg cryopreservation may be an acceptable option. Conversely, in women who wish oocyte preservation only to delay childbearing, ...

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