ASPO Abstracts
Fertility treatment involving gestational carriers after cancer
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023
Abstract Body:
Purpose of the study: Fertility counseling for reproductive-age cancer patients is universally recommended by professional reproductive medicine and cancer societies. Some cancer treatment-related effects on future fertility may not be avoidable. For example, fertility-sparing surgery can be considered for some, but not all, gynecologic cancers. Gestational carriers are individuals who carry a genetically-unrelated pregnancy for others, typically using in vitro fertilization (IVF). Although allowable in most states, there is a wide range of cost and legal protections surrounding these practices. We evaluated characteristics related to fertility treatment involving gestational carriers after cancer. Methods: We linked data from seven statewide cancer registries with the national Society for Assisted Reproductive Technology Clinic Outcomes Reporting System during 2004-2018. Using the linked data, we identified women with ≥1 thaw-to-transfer IVF cycle following a cancer diagnosis. Multivariable modified Poisson models with robust variance error were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for transfer attempts involving a gestational carrier. Results: Overall, 17.8% of 760 women who used IVF to attempt pregnancy after cancer involved a gestational carrier. Gestational carrier involvement was most common among women with breast (19.0%) or gynecologic (35.6%) cancer, who were living in Massachusetts (26.2%), and those ages 31-35 and 36-40 at cancer diagnosis (16.2% and 16.8%, respectively). PRs for involving a gestational carrier were higher for those who initiated IVF for fertility preservation rather than after cancer treatment (PR=2.01; 1.45, 2.79), and among those who had any recorded chemotherapy (PR=2.16; 1.54, 3.03) compared to none. Gestational carrier involvement appeared less common in minoritized racial and ethnic groups (9.4%) compared to non-Hispanic White survivors (14.9%)(PR=0.65; 0.40, 1.04), and did not vary according to use of autologous versus donor oocytes or embryos. Conclusions: Gestational carriers contributed to IVF-related pregnancy attempts in approximately 1 in 6 cancer survivors. The potential role of gestational carriers is a critical component of fertility counseling for cancer survivors.
Keywords: Adolescent and young adult, fertility treatment, gestational carriers