In vitro fertilization outcomes after cancer

癌症后体外受精的结果

• 批准号: 10222590
• 负责人: BARBARA Joan LUKE
• 金额: $ 12.46万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222590
• 关键词: Address; Affect; Age; Assisted Reproductive Technology; Birth; Birth Certificates; Birth Rate; Blood Vessels; Child; Clinic; Conceptions; Congenital Abnormality; Consensus; Counseling; Couples; Data; Databases; Decision Making; Diagnosis; Embryo; Embryo Transfer; Exposure to; Failure; Fees; Female of child bearing age; Fertility; Fertilization in Vitro; Fetal Growth Retardation; Financial cost; Freezing; Future; Grouping; Growth; Guidelines; Late Effects; Length; Life; Link; Live Birth; Malignant Neoplasms; Oocytes; Outcome; Pathologic; Patients; Persons; Pilot Projects; Pregnancy; Pregnancy Outcome; Procedures; Process; Protocols documentation; Provider; Radiation; Recording of previous events; Records; Reporting; Research; Sample Size; Seminal fluid; Societies; Survival Rate; System; Time; United States; Uterus; Woman; aged; cancer care; cancer diagnosis; cancer therapy; cohort; cost; egg; embryo cryopreservation; evidence base; fertility preservation; follow-up; high risk; neoplasm registry; oocyte cryopreservation; oocyte retrieval; pregnancy hypertension; pregnant; premature; preservation; reproductive; response; sound; study population; success

ABSTRACT The proposed research will enhance cancer care for the ~75,000 women diagnosed with cancer at reproductive ages each year by providing contemporary evidence on fertility preservation outcomes. Accepted, non-experimental preservation options are limited to embryo and oocyte cryopreservation, both of which ultimately require in vitro fertilization (IVF) to achieve pregnancy. Fertility preservation counseling has been recommended by national cancer care guidelines for over a decade; however, there is inadequate evidence to allow patients and their providers to make informed decisions. In non-oncologic settings, IVF success rates range from 45% to 11% from the youngest to the oldest women. Our preliminary analyses and other studies suggest that response to IVF treatment may be worse among women with a cancer history. To address this evidence gap, we propose using detailed IVF data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), a national IVF database that includes >90% of IVF procedures since 2004, linked to State cancer registries and vital records (birth certificates) in 14 States. This proposed project will expand our pilot study in 3 States to 14 States to form a cohort of >663,000 U.S. women who had IVF cycles during 2004-16 and contribute close to five million person-years of follow-up. The study population will include an estimated 13,000 women with a cancer history, followed for up to 13 years after diagnosis. Within this cohort, we will 1.) Compare IVF cycle outcomes (oocytes retrieved, % of embryos that survive freeze/thaw, conception rates, and # of cycles required for conception) between three groups: those who initiate IVF before cancer treatment; after cancer treatment; and without a cancer history. We will also 2.) Compare IVF live birth rates and outcomes (length of gestation, birthweight, fetal growth restriction, gestational hypertension, and congenital malformations) in the three groups. Finally, we will 3.) Investigate the association between storage time of cryopreserved oocytes or embryos and IVF conception and live birth rates for women who return for thawing oocytes or embryos; and evaluate rates of spontaneous conception (i.e., live births without embryo transfer) for those who do not return. The proposed research is ideally timed to evaluate newly-accepted oocyte cryopreservation and dissemination of random-start IVF protocols to reduce the potential for cancer treatment delays. The research will provide a critical evidence base to women who must make time sensitive decisions about fertility preservation while faced with a potentially life threatening and financially devastating cancer diagnosis.

抽象的 拟议的研究将增强约75,000名被诊断为癌症的妇女的癌症护理 每年通过提供有关生育保存结果的当代证据，每年的生殖年龄。公认， 非实验性保存选项仅限于胚胎和卵母细胞冷冻保存，这两个 最终需要体外受精（IVF）才能实现怀孕。生育保存咨询已经 由国家癌症护理指南推荐了十多年；但是，有证据不足 允许患者及其提供者做出明智的决定。在非肿瘤学环境中，IVF成功率 从最年轻的女性到最小的女性的45％至11％不等。我们的初步分析和其他研究 表明在患有癌症史的女性中对IVF治疗的反应可能会更糟。 为了解决这一证据差距，我们建议使用辅助生殖协会的详细IVF数据 技术诊所结果报告系统（SART CORS），一个国家IVF数据库，包括90％ 自2004年以来，IVF程序与14个州的州癌症注册机构和重要记录（出生证明）有关。 该拟议的项目将在3个州扩大我们的试点研究至14个州，以组成> 663,000的美国队列 在2004 - 16年度进行IVF周期并贡献了近500万人年的随访妇女。这 研究人群将包括估计有13,000名患有癌症史的女性，随后最多13年 诊断后。在此队列中，我们将1。）比较IVF周期结果（检索卵母细胞，胚胎的百分比 在三组之间生存的冻结/融化，构思率和构想所需的周期的＃）： 那些在癌症治疗前启动IVF的人；癌症治疗后；并且没有癌症史。我们将 也2.）比较IVF的实时出生率和结果（妊娠，出生体重，胎儿生长限制的长度， 三组中的妊娠高血压和先天性畸形）。最后，我们将3。）调查 冷冻保存卵母细胞或胚胎的存储时间与IVF概念和活产率之间的关联 对于返回融化卵母细胞或胚胎的妇女；并评估自发概念的速度（即 没有胚胎转移的出生）对于那些不返回的人。 拟议的研究是评估新认可的卵母细胞冷冻保存和传播的时间的时间 随机启动的IVF方案，以减少癌症治疗延迟的潜力。这项研究将提供 对必须对生育能力保存的时间敏感决定的妇女的关键证据基础 面对潜在的威胁生命和财务破坏性的癌症诊断。