In vitro fertilization with cryopreserved oocytes or embryos after cancer: The role of gestational carriers.

Abstract

Fertility preservation counseling is recommended for reproductive-age cancer patients. Gestational carriers are individuals who carry a pregnancy for someone else. This service creates a path to biological children when cancer treatment necessitates the removal of the uterus. The authors examined the involvement of gestational carriers among women diagnosed with cancer. Using data from eight statewide cancer registries linked with the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, the authors identified women with a cancer diagnosis who subsequently initiated in vitro fertilization (IVF) procedures during 2004 to 2018. Modified Poisson models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Discrete Cox regression models were used to calculate hazard ratios (HR) and CI. Multivariable models adjusted for age, state, and calendar year. Among 1095 women with cancer who used IVF with cryopreserved oocytes or embryos to attempt pregnancy, 19.1% worked with a gestational carrier. Involving gestational carriers was more common among those who initiated IVF for fertility preservation versus after cancer treatment (PR, 1.96; 95% CI, 1.54-2.50) and had chemotherapy versus no chemotherapy (PR, 1.92; 95% CI, 1.50-2.47). Using donor oocytes or embryos (vs. autologous) was more common among women who worked with a gestational carrier (PR, 1.62; 95% CI, 1.17-2.24). Working with a gestational carrier was not associated with conception (HR, 1.06; 95% CI, 0.82-1.37). Approximately one in five women diagnosed with cancer who used IVF to attempt pregnancy worked with a gestational carrier. The results of this study emphasize the need for information on gestational carriers during fertility preservation counseling.