がん生存者における体外受精後の出生結果

To determine if patients with cancer who retrieve oocytes for IVF before or after cancer treatment have an increased risk of adverse birth outcomes compared to other IVF patients without cancer in the United States.

Retrospective cohort study SUBJECTS: Singleton IVF births during 2004-2018 from women with and without a history of cancer in 9 States (California, Colorado, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, New York, and Virginia).

Women with a cancer history prior to IVF who had oocyte retrieval before cancer treatment (fertility preservation) or after cancer treatment.

Multivariable relative risks (RR) and 95% confidence intervals (CI) for gestational hypertension, low birthweight [LBW, <2,500g], preterm birth [PTB, <37 weeks], small for gestational age (SGA), large for gestational age (LGA), and cesarean delivery.

Among 135,274 IVF births, 648 were from patients with cancer who retrieved oocytes before (fertility preservation, n=112) or after (n=536) cancer treatment. The IVF births in patients with cancer were compared to non-cancer IVF births which had IVF indications of male factor infertility (n=33,284 births), tubal ligation (n=1,258 births), and all other IVF indications (n=100,084 births). Preterm birth (13%), LBW (10%), SGA (12%), and LGA (10%) in the fertility preservation group were similar to non-cancer IVF referent groups, but cesarean section (55% vs 44-49%) was more common. In models adjusted for race, education, infant sex, and fresh/frozen embryo state, IVF births with oocyte retrieval after cancer treatment did not consistently differ from non-cancer IVF births for gestational hypertension (6%), PTB (13%), LBW (9%), SGA (9%), and cesarean delivery (53%), but had lower risk of LGA (8%) compared to male factor infertility (10%, RR=0.69, 95% CI=0.51-0.93), tubal ligation (13%, RR=0.56, 95% CI=0.40-0.78), and all other non-cancer IVF indications (10%, RR=0.71, 95% CI=0.53-0.96).

With the exception of LGA, we found similar risks of several adverse birth outcomes among IVF births across cancer and non-cancer indications for IVF. These findings support the use of evidence from non-cancer IVF contexts for counseling of patients with cancer/survivors about birth outcomes after IVF.