Single euploid embryo transfer outcomes following cancer and systemic chemotherapy

Systemic chemotherapy may impair future reproduction due to its gonadotoxic effects. There are limited data on pregnancy outcomes in patients with a history of chemotherapy who undergo single euploid embryo transfer (SEET).

This retrospective cohort study included patients with prior chemotherapy who underwent SEET from 2011 to 2023. Cycles were matched 1:3 with controls by oocyte age, age at SEET, BMI, and year. Wilcoxon rank, chi-square, and adjusted logistic regression were used for analysis. A sub-analysis was performed to compare patients who had SEET using oocytes retrieved pre- and post-chemotherapy.

Fifty-five cycles from 32 patients with prior chemotherapy were matched to 165 control cycles. In the chemotherapy group, 23 cycles (41.8%) used embryos derived from oocytes pre-chemotherapy, while 32 cycles (58.2%) used embryos derived from oocytes post-chemotherapy. Endometrial thickness was significantly lower with prior chemotherapy vs. controls (8 mm vs 9 mm, respectively; p = 0.02). Ongoing pregnancy/live birth rate was similar in patients with prior chemotherapy and controls (56.4% vs. 57.0%, p = 0.94). Adjusted analysis confirmed the findings (aOR 1.5, CI 0.79-2.8, p = 0.21). Pregnancy, clinical pregnancy, and loss rates were similar. The subgroup analysis showed no statistical difference in outcomes in patients who used pre-chemotherapy vs. post-chemotherapy oocytes. However, a trend towards poorer outcomes in patients who used post-chemotherapy oocytes was observed.

Outcomes after SEET in patients with prior chemotherapy are comparable to controls. A possible trend toward reduced success using post-chemotherapy oocytes warrants further investigation. Understanding the potential mechanisms by which chemotherapy may affect future fertility is important for survivorship care.