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Current status of fertility preservation in a Spanish tertiary public hospital: multidisciplinary approach and experience in over 1500 patients

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Abstract

Purpose

Currently, 15% of gynaecological and 9% of haematological malignancies are diagnosed before the age of 40. The increased survival rates of cancer patients who are candidates for gonadotoxic treatments, the delay in childbearing to older ages, and the optimization of in vitro fertilisation techniques have all contributed to an increased interest in fertility preservation (FP) treatments. This study reviews the experience of the Fertility Preservation Programme (FPP) of a tertiary public hospital with a multidisciplinary approach.

Methods

This retrospective study included all the available (FP) treatments, performed in patients of childbearing age between 2006 and 2022.

Results

1556 patients were referred to the FPP: 332 oocyte vitrification cycles, 115 ovarian cortex cryopreservation with 11 orthotopic autotransplantations, 175 gonadotropin-releasing hormone (GnRH) agonist treatments, 109 fertility-sparing treatments for gynaecological cancer, and 576 sperm cryopreservation were performed. Malignancy was the main indication for FP (the main indications being breast cancer in women and haematological malignancies in men), although non-oncological pathologies, such as endometriosis and autoimmune diseases, have increased in recent years. Currently, the most widely used FP technique is oocyte vitrification, the increase of which has been associated with a decrease in the use of cortex CP and GnRH agonists.

Conclusions

The increase in FP treatment reflects the implementation of reproductive counselling in oncology programmes. A multidisciplinary approach in a tertiary public hospital allows individualised FP treatment for each patient. In recent years, there has been a change in trend with the introduction of new indications for FP and a change in techniques due to their optimisation.

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Abbreviations

FP:

Fertility preservation

SLE:

Systemic lupus erythematosus

IVF:

In vitro fertilisation

FPP:

Fertility preservation programme

CP:

Cryopreservation

GnRH:

Gonadotrophin-releasing hormone

BOT:

Borderline ovarian tumours

SD:

Standard deviation

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Authors and Affiliations

  1. Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain

    Yasmina Barral, Aina Borrás, Pilar Carrillo, Inés Agustí, Sara Peralta, Gemma Casals, Francesc Fàbregues, Marta Guimerà, Juan Manuel Corral, Josep Maria Calafell, Miriam Redondo & Dolors Manau Trullàs

  2. Gynecologic Oncology Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Barcelona, Spain

    Ariel Glickman

  3. Department of Hematology, Clinical Institute of Hematological and Oncological Diseases, Hospital Clinic de Barcelona, Barcelona, Spain

    Montserrat Rovira

  4. Department of Medical Oncology, Hospital Clínic, Clinical Institute of Hematological and Oncological Diseases, Barcelona, Spain

    Bárbara Adamo

  5. Gastroenterology Department, Clinical Institute of Digestive and Metabolic Diseases, Hospital Clinic de Barcelona, Barcelona, Spain

    Elena Ricart

  6. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain

    Aina Borrás, Gemma Casals, Francesc Fàbregues, Montserrat Rovira, Bárbara Adamo, Elena Ricart & Dolors Manau Trullàs

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  1. Yasmina Barral
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Corresponding author

Correspondence to Dolors Manau Trullàs.

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All authors declare that they have no conflict of interest related to this project.

Ethical approval (research involving human participants and/or animals)

This study involving human participants was reviewed and approved by the Ethical Committee of the Hospital Clinic of Barcelona.

Informed consent

According to legislation, participant informed consent was not necessary because of the retrospective nature of the study, the use of anonymized recorded clinical data, and the impossibility of identifying participants directly or through identifiers in the study results.

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Appendices

Appendix A

See Fig. 4.

Fig. 4
figure 4

Algorithm for management of the female patient referred to a fertility preservation programme. a Antral follicular count. b Anti-Müllerian hormone

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Appendix B

See Fig. 5.

Fig. 5
figure 5

Medical indications for fertility preservation. a Colorectal cancer, lung cancer, central nervous system tumours, bladder cancer, melanoma, and osteosarcoma; b ulcerative colitis, Crohn’s disease, multiple sclerosis, and systemic lupus erythematosus

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Barral, Y., Borrás, A., Carrillo, P. et al. Current status of fertility preservation in a Spanish tertiary public hospital: multidisciplinary approach and experience in over 1500 patients. Clin Transl Oncol 26, 1129–1138 (2024). https://doi.org/10.1007/s12094-023-03330-2

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