Embryo cryopreservation

Does the use of cryopreserved embryos and assisted reproduction result in pregnancy and live birth for women with a history of cancer?

Embryo cryopreservation is a routine practice around the world. The latest data from the Australia and New Zealand Assisted Reproduction Database (ANZARD) shows that 54.1% of assisted reproduction cycles used cryopreserved embryos, and of the 14 515 live births resulting from assisted reproductive technology (ART) treatment across Australia and New Zealand, 58.1% involved the use of cryopreserved embryos.^[1] The routine use of a standard in vitro fertilisation (IVF) cycle to generate embryos that can be successfully cryopreserved and used several years later is established practice and is available across most IVF units in Australia. This treatment is also readily available for patients diagnosed with cancer.^[2]

Despite the small number of low powered studies it is clear that embryo cryopreservation before cancer treatment and the use of ART after cancer treatment can result in pregnancy and live birth for women living with a history of cancer.^{[3][4][5][6][7][8][9]} One retrospective cohort study found that the cumulative pregnancy and live birth rate rates per embryo transfer was similar for cancer patients compared to age-matched controls with tubal factor infertility.^[10]

There are particular issues for women diagnosed with cancer to consider when freezing embryos (as opposed to freezing oocytes) for the purpose of fertility preservation. A woman may consider the stability of her relationship prior to the fertilisation of the oocytes. This is often challenging in younger patients or those in new relationships. The speed needed to start cancer treatment puts additional stress on decision making, as often the time available to reflect on fertility decisions is limited. The improvements in oocyte freezing techniques means that patients can maintain their autonomy by cryopreserving oocytes.