Abstract
OBJECTIVES: To evaluate the strategies and outcomes of assisted reproductive technology (ART) for fertility enhancement and preservation in women with malignant tumors, and to analyze ART outcomes across different tumor types. METHODS: We conducted a retrospective analysis of female patients who underwent ART for fertility enhancement and preservation at the Reproductive Medicine Center of the Women's Hospital, Zhejiang University School of Medicine, between January 1, 2018 and December 31, 2023. A total of 163 ART-aided pregnancy patients with malignant tumors were included in the case group, among which 6 patients underwent embryo cryopreservation for fertility preservation before radiotherapy or chemotherapy. Additionally, 11 unmarried women underwent oocyte cryopreservation due to borderline ovarian tumors, ovarian cancer, breast cancer, or hematological malignancies. The control group was selected from women without a history of malignant tumors who received ART treatment during the same period, using propensity score matching at a ratio of 1∶2, resulting in 326 cases. Data were collected through the reproductive medical record system and telephone follow-up (as of October 31, 2024). Baseline characteristics, controlled ovarian hyperstimulation parameters, laboratory indicators, and pregnancy outcomes were compared between case and control groups and among patients with different tumor types, and the tumor recurrence of the patients was followed up. RESULTS: Patients in the case group had significantly lower ovarian reserve (anti-Müllerian hormone, antral follicle count) and a higher proportion of diminished ovarian reserve compared to the control group (all P<0.01). Regarding the ovulation induction protocol, the proportion of patients using a minimal stimulation protocol in the case group was significantly higher than that in the control group (29.45% vs. 12.88%, P<0.01), and the total dosage of gonadotropins used was lower (P<0.01). In terms of ART outcomes, there were no statistically significant differences between the two groups in the number of retrieved oocytes, number of high-quality embryos, fertilization rate, cumulative pregnancy rate, cumulative live birth rate, or miscarriage rate (all P>0.05). However, the number of oocyte retrieval cycles and embryo transfer cycles required to achieve a live birth outcome in the case group were significantly higher than those in the control group (both P<0.05). Subgroup analysis showed that there were no significant differences in cumulative pregnancy rate and live birth rate among patients with different tumor types, such as thyroid cancer, reproductive system tumors, breast cancer and lung cancer (all P>0.05). Nevertheless, lung cancer patients had the lowest ovarian reserve and required the most oocyte retrieval cycles due to the older age; breast cancer patients had a relatively lower fertilization rate partially because some of them were complicated with male factors. 154 tumor patients were followed up. Among the 143 married patients undergoing embryo cryopreservation/embryo transfer, 6 patients (4.20%) had tumor recurrence, and one breast cancer patient died due to tumor recurrence. Among the 11 unmarried patients who had undergone oocyte cryopre-servation, none had yet used the cryopreserved oocytes for assisted pregnancy yet, and one patient died due to tumor recurrence. CONCLUSIONS: Women of reproductive age with malignant tumors are at risk of diminished fertility. ART can effectively enhance and preserve fertility, enabling favorable pregnancy and live birth outcomes.