Oocyte Cryopreservation Outcomes in Women With Hematological Malignancies Undergoing Chemotherapy-A Systematic Review...

Hematological cancers are among the leading malignancies affecting women of reproductive age. Oocyte cryopreservation (OC) is routinely recommended before initiating gonadotoxic treatments. We aim to evaluate OC outcomes in women with hematological cancers undergoing chemotherapy.

A comprehensive literature search was conducted in Medline, Embase, and Cochrane Library until January 2024.

Studies examining fertility outcomes of women undergoing OC before chemotherapy for hematological cancers were included. Comparison groups included healthy controls or patients with other cancers. The primary outcome was the number of mature oocytes frozen per stimulation cycle; secondary outcomes included total cumulus-oocyte complexes, stimulation duration, total gonadotropin dose and fertility outcomes following the utilization of cryopreserved oocytes.

A total of 14 cohort studies, 2 case-control studies, and 6 case reports involving 858 hematological cancer patients undergoing OC and 2676 comparators were included. The mean mature oocyte yield ranged from 7 to 19 in the hematological cancer group, and 6 to 14 in the comparator groups (mean difference [MD] 0.11; 95% CI -0.10 to 0.33). A comparable number of total cumulus-oocyte complexes (MD 0.09; 95% CI -0.07 to 0.25) and total dose of gonadotropins were found (MD 0.33; 95% CI -0.32 to 0.98). The analysis found a marginally longer duration of stimulation in the hematological cancer group (MD 0.21; 95% CI 0.11-0.31). Also, the hematological cancer group was found to be statistically younger, (MD -1.32; 95% CI -1.85 to -0.79), the difference is not clinically meaningful. Results for subgroup analyses concurred with the main analysis. Fertility and utilization of cryopreserved oocyte data were lacking.

These findings suggest that women with hematological cancers undergoing OC may expect similar oocyte yield compared to women with other cancers or healthy controls. Oocyte quality and pregnancy outcomes following the utilization of cryopreserved oocytes in hematological cancer patients remain unclear and should be the subject of further study.