High risk patients should be offered fertility preservation
This press release is in support of a presentation by Dr Ruth Howie presented online at the 37th Annual Meeting of ESHRE.
29 June 2021: Cancer treatments can cause premature ovarian failure (POI) including in girls who want to become mothers eventually. Ovarian tissue cryopreservation (OTC) provides a future fertility option but is invasive, has risks and evidence indicates that most girls don’t develop POI. So, doctors face the dilemma of how to offer OTC appropriately.
Now, an assessment tool has been found to help predict correctly which female cancer patients aged under 18 years will develop POI and should therefore be offered OTC. Results from a long-term follow-up study of 423 girls and young women show nearly a quarter (24%; n = 9) of the 37 assessed as high risk by this method – known as the Edinburgh selection criteria – were later diagnosed with POI. This compares with only 3% who developed POI out of the 386 identified to be at low-risk.
Principal investigator Dr Ruth Howie, from the University of Edinburgh and NHS Lothian, will present the findings today online at the 37th Annual Meeting of ESHRE. She said that although prevalence of POI after childhood cancer is low at around 10%, the Edinburgh selection criteria (see notes) “are a robust tool for selecting those at high risk at the time of diagnosis who should be offered OTC”.
She added: “Cancer treatments, especially aggressive chemotherapy and radiotherapy, can cause permanent damage to ovaries. Future fertility and reproductive health should be considered at time of diagnosis and treatment planning.
“Correct identification of patients at high risk allows appropriate discussion of fertility preservation with OTC and future transplantation.”
The Edinburgh selection criteria for OTC have been in use since 1996 and were developed by a multidisciplinary group of experts. The criteria are based on knowledge of relevant scientific literature and clinician experience of POI. This report represents the longest follow-up to date to validate the selection method.
Overall, a total of 26 patients of the 37 offered OTC chose to actually have the procedure.
Data are based on all females under 18 years old and diagnosed with cancer in South East Scotland between 1 January 1996 and 30 April 2020. Reproductive function was assessed by the presence of menstruation, pregnancy, hormonal measurements, evidence of puberty or POI diagnosis at most recent follow-up to October 2020. The average time in the study for developing POI was 5.8 years, although many patients will develop the condition immediately after cancer treatment.
Of the 639 diagnosed, a total of 216 were excluded including those on hormonal contraception, girls aged under 12 because they were likely to be prepubertal and unable to have accurate assessment of current reproduction function, and those who had died before age 12.
The 423 remaining included a significant number (n = 143) with unknown reproductive outcomes. Dr Howie said this is likely to reflect “a lack of recording of normal menstrual function” in oncology and haematology clinics.
To address this, a subgroup analysis of 280 patients was carried out in addition to the main analysis. A total of 29 of the 280 were assessed as high risk of POI and offered OTC, and 31% (n = 9) of these developed the condition. This compares with 4% (n = 11) of the 251 patients assessed as low-risk.
Howie says the findings demonstrate that the Edinburgh criteria are successful at identifying “those at risk of developing a life changing and long-term effect”. However, she added that the criteria should be continuously appraised via long-term follow up of the reproductive outcomes of those assessed. This is to ensure OTC is offered selectively.
Presentation 0-177, Tuesday 29 June 2021
Long-term follow up to assess criteria for ovarian tissue cryopreservation for fertility preservation in young women and girls with cancer
Notes on the Edinburgh selection criteria for OTC
- – Age younger than 35 years
– No previous chemotherapy or radiotherapy if aged 15 years or older at diagnosis, but mild, non-gonadotoxic chemotherapy acceptable if younger than 15 years
– A realistic chance of surviving for 5 years
– A high risk of premature ovarian insufficiency (>50%)
– Informed consent (from parents and, where possible, patient)
– Negative serology results for HIV, syphilis, and hepatitis B
– Not pregnant and no existing children
* When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.