title: Female cancer survivors are low responders and have reduced success compared with other patients undergoing assisted reproductive technologies.
abstract: OBJECTIVE
  To investigate the effect of prior chemotherapy and radiation on assisted reproductive technology (ART) outcomes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-based infertility clinic.
  
  
  METHODS
  Female cancer survivors who had received chemotherapy or radiation and all other women undergoing first-fresh IVF/intracytoplasmic sperm injection (ICSI) cycles.
  
  
  METHODS
  Survivors' ART outcomes were compared with all women undergoing first-fresh IVF/ICSI cycles and those with male-factor infertility only. Multivariate logistic and Poisson regression analyses were used to estimate the effect of cancer therapy on ART outcomes.
  
  
  METHODS
  Number of oocytes retrieved and embryos obtained; odds of cycle cancelation, clinical pregnancy, and live birth.
  
  
  RESULTS
  Compared with others undergoing IVF/ICSI, survivors had significantly fewer oocytes retrieved and embryos available for transfer. In addition, survivors were significantly more likely to be canceled (odds ratio [OR] 5.60, 95% CI 2.94-10.66) and had lower pregnancy and live birth rates (OR 0.30, 95% CI 0.13-0.68; and OR 0.27, 95% CI 0.10-0.69; respectively). Odds ratios were stronger when the comparison group was restricted to those with male-factor infertility only.
  
  
  CONCLUSIONS
  Women who have received systemic therapy for malignancy should be considered to be low responders and counseled that their per-cycle live birth rate is lower than that of their peers. These data strongly support offering fertility preservation before cancer therapy when possible.
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. sbarton@partners.org
authors.forename: Sara E
authors.initials: SE
authors.lastname: Barton
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.forename: Katharine F
authors.initials: KF
authors.lastname: Berry
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Ginsburg
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001900:Boston; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D016017:Odds Ratio; D054315:Oocyte Retrieval; D011247:Pregnancy; D018873:Pregnancy Rate; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic; D017741:Survivors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents