The following is the summary of “Outcomes after assisted reproductive technology in women with cancer: a systematic review and meta-analysis” published in the January 2023 issue of Human Reproduction by Meernik, et al.

Do those with a history of cancer have worse results from ART? In general, the success rates of embryo transfer and the chances of clinical pregnancy and live birth following Assisted Reproductive Technology (ART) were lower for women with cancer than those without illness. Cancer and its treatment may have a negative impact on ART outcomes, according to findings from a few small studies conducted at a single institution. Researchers did a systematic review, including a meta-analysis to further understand the differences in ART results between women with and without cancer. Original papers published in English up to June 2021 were sought by searching PubMed, Embase, and Scopus. Women with a cancer history who utilized ART for any reason were only eligible if their outcomes following controlled ovarian stimulation (COS) were reported. Duration of COS and live birth rate following embryo transfer were among the outcomes of interest. Mean differences and odds ratios (ORs) with 95% CIs and 95% prediction intervals (PIs) were determined using a random-effects meta-analysis (PIs). In addition, researchers looked at differences between women with breast cancer and those who started ART before cancer treatment, as well as differences in age adjustment, ART indication in the referent group, study site, and ART initiation time. The asymmetry of the funnel plot was evaluated visually, using Egger’s test and using the trim-and-fill technique.

From a total of 6,094 records, 42 studies were included; these studies included, on average, 58 women with cancer (interquartile range (IQR) = 159) and 114 women without cancer (IQR=348). Those with cancer had a reduced chance of a successful embryo transfer (OR: 0.22; 95% CI: 0.07, 0.74; 95% PI: 0.00, 64.98), clinical pregnancy (OR: 0.51), and live birth (OR: 0.56; 95% CI: 0.38, 0.83; 95% PI: 0.19, 1.35) compared to women without cancer. COS length, gonadotropin dose, cycle cancellation, total oocytes, and mature oocytes all showed substantial inter-study variation. There was less variation in the percentage of fertilized eggs, although these estimations still needed more precision from trial to research. There was also less variation in the total number of embryos, and most studies only found small variations when controlling for a patient’s cancer history. Estradiol peak and oocyte maturation percentge both showed asymmetrical funnel plots. There was substantial variation across studies for most outcomes, and 11 failed to account for age-related confounding adequately. We could not determine the impact of cancer clinical factors (such as cancer types other than breast, cancer stage, and cancer treatment) and ART cycle characteristics (such as fresh vs frozen embryo transfers and the use of gestational carriers) on outcomes due to a lack of data.

It’s possible that embryo transfer poses a higher risk of miscarriage and stillbirth for cancer patients. To strengthen evidence of the predicted efficacy of ART after a cancer diagnosis, further investigation of reproductive outcomes and causes of variation among studies is necessary. Funding for this study came from grants R01 CA211093 and P30 ES010126. C.M. benefited from funding from the National Cancer Institute and the University of North Carolina Lineberger Cancer Control Education Program (T32 CA057726) (F31 CA260787). The National Cancer Institute funded J.A.R.-H. ‘s research (K08 CA234333, P30 CA016672). J.A.R.-H. states that Schlesinger Group and Guidepoint have paid him for consultancy services. There are no conflicts of interest that have been disclosed by the remaining writers.

Source: academic.oup.com/humrep/article-abstract/38/1/30/6808914?redirectedFrom=fulltext