Association of age, AMH, and gonadotropin dosing on IVF outcomes in fertility preservation cycles for patients less than 35 undergoing chemotherapeutic treatment: A retrospective cohort study.
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OBJECTIVE: To evaluate the differences in total number of oocytes and MII oocytes retrieved with gonadotropin dosing in adolescent and young adult patients compared to older patients undergoing fertility preservation cycles for cancer diagnosis. DESIGN: Retrospective cohort. SETTING: Single academic institution. PATIENT(S): All patients less than 35 years old undergoing a fertility preservation cycle who have a cancer diagnosis, or a plan to receive gonadotoxic chemotherapy. INTERVENTION(S): Fertility preservation cycles in patients < 22 years old (younger group) compared with those 22- < 35 years old (older group) stratifying by age, AMH, and average daily gonadotropin dosing. MAIN OUTCOME MEASURE(S): Total oocyte yield, total number of MII oocytes. RESULTS: The younger group had 26% more oocytes retrieved and 28% more MII oocytes retrieved compared with the older group, when adjusting for BMI, chemotherapy prior to treatment and myelodysplasia (aRR 1.28, 95% CI 1.01-1.63). Starting, total, and average daily gonadotropin doses were similar between age groups. Cycles in the younger group (10.0%) were more likely to be canceled compared with the older group (2.8%) (RR 3.52, 95% CI 1.35-0.17); 35.9% of the younger group and 11.7% of the older group had chemotherapy prior to cycle start. CONCLUSION(S): Patients should be encouraged to undergo fertility preservation prior to receiving chemotherapy as this commonly decreases ovarian reserve and leads to a higher likelihood of cycle cancellation.