A small study from France claims chemotherapy—even one round of the common cancer treatment—can have a negative impact on the outcome of in vitro fertilization (IVF).1
Other Options to Consider
Since sterilization is a common side effect of chemotherapy, cancer patients who intend to have children later are faced with making alternative decisions, writes Jacques Donnez, MD, and his colleagues in the department of Gynecology at Université Catholique de Louvain in Brussels, Belgium. While IVF followed by freezing of the resulting embryos may be a viable option for women undergoing chemotherapy, "ovarian stimulation is time consuming and chemotherapy cannot be delayed in most cancer patients," they wrote. "For this reason, some centers offer IVF and embryo [freezing] in the interval between two chemotherapy regimens."
Based on that, Donnez and his colleagues wanted to know how chemotherapy impacted IVF results.
The efficacy and safety of IVF in women previously treated for cancer has been sparse, Donnez's team wrote. Thus, "we decided to conduct a retrospective analysis of our patients undergoing stimulation before and after chemotherapy to determine the impact of one or two regimens of chemotherapy on IVF outcome with embryo cryopreservation."
Information Aggregation
The investigators gathered information on 11 patients between ages 22 and 33 who had previously undergone controlled ovarian stimulation followed by IVF before or during a course of chemotherapy. Four patients underwent IVF treatment after an initial round of chemotherapy, and the rest were given IVF before starting chemotherapy.
Following egg retrieval, each patient underwent IVF combined with intracytoplasmic sperm injection (ICSI) in which a single sperm is injected into the egg to ensure fertilization.2 The resulting embryos were then frozen for later use.
On studying the data of those who underwent IVF following chemotherapy, Donnez and his associates learned that only one embryo was successfully fertilized from six eggs collected in patient 1, no eggs were collected in the second patient, and "stimulation was discontinued because of a complete lack of response (no follicular development)" in the last two patients.
The patients who had IVF after chemotherapy also required more ovulation stimulation drugs, on average.
By contrast, patients who underwent IVF before chemotherapy had between 4 and 11 embryos fertilized and later frozen. Additionally, 88 eggs, on average, had been collected in the group. "This represents an almost 10-fold increase over the women who had already received chemotherapy, from whom only 6 oocytes [eggs] had been retrieved," Donnez's group wrote. This difference, they added, was significant. Embryos in this group were generally of higher quality, as well, the study team emphasized.
Advice for Cancer Patients
"In conclusion, IVF efficacy is dramatically reduced after chemotherapy, even after only one regimen," Donnez and his team wrote. "For women whose cancer therapy can be delayed, IVF with embryo [freezing] should be offered before chemotherapy and not after."
In patients who require immediate treatment because their cancer is more serious, ovarian tissue or egg freezing should be considered beforehand "as an alternative way of preserving fertility without delaying cancer treatment," they wrote.
Other Findings
One other study released four years ago also assessed the results of IVF in cancer patients treated with chemotherapy.3 This small study involved 15 women undergoing IVF after systemic or localized cancer therapy compared to women undergoing IVF before chemotherapy. Similar to the Donnez research, the investigators at Brigham and Women's Hospital in Boston found that those who had undergone chemotherapy before IVF had poorer responses to ovulation induction medications compared to those women who had received localized cancer therapy beforehand. Women undergoing chemotherapy before IVF also had poorer outcomes compared to those given IVF before chemotherapy.
Donnez and his colleagues noted the similar findings, but criticized the research's methodology. "The study does not analyze the number of regimens or type of chemotherapy that the patients received, or the interval between the chemotherapy and the IVF attempt," they wrote.
1. Dolmans MM, Demylle D, Martinez-Madrid B, Donnez J. Efficacy of in vitro fertilization after chemotherapy. Fertil Steril 2005 Apr;83(4):897-91.
2. Idaho Center for Reproductive Medicine. IVF Cycle. Available at: http://www.idahofertility.com/education/ivf_cycle.html. Accessed May 4, 2005.
3. Ginsburg ES, Yanushpolsky EH, Jackson KV. In vitro fertilization for cancer patients and survivors. Fertil Steril 2001 Apr;75(4):705-10.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
