Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study

Our plain-English summary of Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study, by B. Courbiere, C. Decanter, S. Bringer-Deutsch, et al (Human Reproduction, 2013).

The study

• Authors: B. Courbiere, C. Decanter, S. Bringer-Deutsch, N. Rives, S. Mirallié, J.C. Pech, D. De Ziegler, F. Carré-Pigeon, P. May-Panloup, C. Sifer, V. Amice, T. Schweitzer, G. Porcu-Buisson, C. Poirot, French Study Group for Ovarian and Testicular Cryopreservation (GRECOT)
• Journal: Human Reproduction
• Published: 2013;28(9):2381-8
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Study Question: What are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment?

Summary Answer: Pregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART.

Study Design, Size, Duration: A French retrospective multicentre cohort study initiated by the GRECOT network-the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97).

Participants/materials, Setting, Methods: Fourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients.

Main Results And The Role Of Chance: The patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8.2 ± 4.8 oocytes were retrieved, with 6.1 ± 4.2 mature oocytes and 4.4 ± 3.3 pronuclear-stage embryos per cycle. The mean number of embryos frozen per cycle was 4.2 ± 3.1. During follow-up, three patients died from the consequences of their disease. For the 49 surviving patients, 22.5% of the couples concerned (n = 11) requested embryo replacement. A total of 33 embryos were thawed with a post-thawing survival rate of 76%. Embryo replacement was finally performed for 10 couples with a total of 25 embryos transferred, leading to one biochemical pregnancy, one miscarriage and three live births. Clinical pregnancy rate and live birth per couple who wanted a pregnancy after cancer were, respectively, 36% (95% CI = 10.9-69.2%) and 27% (95% CI = 6.0-61%).

Limitations, Reasons For Caution: The overall response rate for clinics was 53.6%. Therefore, it is not only that patients may not have been included, but also that those that were included were biased towards the University sector with a response rate of 83% (25/30) for a small number of patients.

Wider Implications Of The Findings: According to literature, malignant disease is a risk factor for a poor response to COS. However, patients having emergency IVF before gonadotoxic treatment have a reasonable chance of pregnancy after embryo replacement. Embryo freezing is a valuable approach that should be included among the strategies used to preserve fertility.

Study Funding/competing Interest(s): No external funding was sought for this study. None of the authors has any conflict of interest to declare.

In plain English

This French study did not examine asbestos exposure. It concerned fertility preservation, and one of its 52 patients had mesothelioma; the article does not say what type. The authors ran a retrospective multicentre survey of all 97 French assisted reproduction centres, and 52 responded. Fourteen centres reported performing emergency IVF with embryo freezing before gonadotoxic treatment between 1999 and July 2011, in 52 women (56 cycles). Three cycles were cancelled. Per cycle, a mean of 8.2 eggs was retrieved and 4.2 embryos were frozen. Three patients died of their disease. Of the 49 survivors, 11 couples asked for embryo transfer and 10 received one. Transfers led to one biochemical pregnancy, four clinical pregnancies, one miscarriage and three live births. Among the 11 couples who wanted a pregnancy, the clinical pregnancy rate was 36% (95% CI 10.9 to 69.2%) and the live birth rate 27% (95% CI 6.0 to 61%). The authors concluded there is a real chance of pregnancy. They noted that responding centres were biased towards university hospitals, that there was no control group, and that a larger series is needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective multicentre cohort study based on an e-mail survey of French assisted reproduction (ART) centres, with data collected from medical files
• Who was studied: 52 women (mean age 28.9 years) who had emergency IVF (56 cycles) at 14 French centres between 1999 and July 2011. Of the 97 centres surveyed, 52 responded.
• Exposure: No asbestos exposure was studied. The study concerned emergency IVF with embryo freezing before gonadotoxic (fertility-damaging) treatment such as chemotherapy. 28% of the 52 patients had already had chemotherapy before ovarian stimulation.
• Main results:
  • One of the 52 patients had mesothelioma, listed under 'Other cancers'; the type of mesothelioma and any asbestos history are not given
  • 37 of the 52 responding centres did not perform emergency IVF and embryo freezing before gonadotoxic treatment
  • Three of the 56 cycles were cancelled
  • In the 53 completed cycles, a mean of 8.2 (plus or minus 4.8) oocytes was retrieved per cycle
  • Three patients died during follow-up from the consequences of their disease
  • Embryo replacement was requested by 22.5% (11) of the couples of the 49 surviving patients
  • Of 33 embryos thawed, 76% survived thawing
  • Transfers in 10 couples (25 embryos) led to one biochemical pregnancy and four clinical pregnancies, resulting in one miscarriage and three live births
  • Per couple who had an embryo transfer (10 couples), the clinical pregnancy rate was 40% (95% CI 12.2 to 73.8%) and the live birth rate 30% (95% CI 6.7 to 65.3%)
  • Per couple who wanted a pregnancy after cancer (11 couples), the clinical pregnancy rate was 36% (95% CI 10.9 to 69.2%) and the live birth rate 27% (95% CI 6.0 to 61%)
• The authors' conclusion: The authors concluded that their study shows a real chance of pregnancy after ovarian stimulation and embryo freezing for malignant disease, with live birth rates similar to those for patients without malignant conditions
• Limitations the authors state:
  • Only 53.6% of centres responded, and the responding centres were biased towards university hospitals (83%, 25 of 30, responded)
  • The retrospective design made it difficult to find suitable controls, so there was no control group
  • The authors could not compare data on cumulative chemotherapy dose received before ovarian stimulation
  • The study is only descriptive
  • A larger series of patients is needed before firm conclusions can be drawn

Topics

Medical terms in this study, explained in our Lexicon: Cohort Study, Sarcoma, Mesothelioma, Chemotherapy.

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