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Peipert BJ, Potapragada NR, Lantos PM, Harris BS, Reinecke J, Goldman KN. A Geospatial Analysis of Disparities in Access to Oncofertility Services. JAMA Oncol 2023; 9:1364-1370. [PMID: 37561485 PMCID: PMC10416086 DOI: 10.1001/jamaoncol.2023.2780] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/24/2023] [Indexed: 08/11/2023]
Abstract
Importance Fertility preservation (FP), including oocyte and embryo cryopreservation prior to gonadotoxic therapy, is an urgent and essential component of comprehensive cancer care. Geographic proximity to a center offering FP is a critical component of ensuring equitable access for people with cancer desiring future fertility. Objective To characterize the distribution of centers offering FP services in the US, quantify the number of self-identified reproductive-age female individuals living outside of geographically accessible areas, and investigate the association between geographic access and state FP mandates. Design, Setting, and Participants This cross-sectional analysis calculated 2-hour travel time isochrone maps for each center based on latitude and longitude coordinates. Population-based geospatial analysis in the US was used in this study. Fertility clinics identified through the 2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Report were defined as oncofertility centers by meeting 4 criteria: (1) offered oocyte and embryo cryopreservation, (2) performed at least 1 FP cycle in 2018, (3) served people without partners, and (4) had an accredited laboratory. County-level data were obtained from the 2020 US Census, with the primary at-risk population identified as reproductive-age female individuals aged 15 years to 44 years. The analysis was performed from 2021 to 2022. Exposures Location outside of 2-hour travel time isochrone of an oncofertility center. Main Outcomes and Measures Oncofertility centers were compared with centers not meeting criteria and were classified by US region, state FP mandate status, number of assisted reproductive technology cycles performed, and number of FP cycles performed. The number and percentage of at-risk patients, defined as those living outside of accessible service areas by state, were identified. Results Among 456 Centers for Disease Control and Prevention-reporting fertility clinics, 86 (18.9%) did not meet the criteria as an oncofertility center. A total of 3.63 million (5.70%) reproductive-age female individuals lack geographic access to an oncofertility center. States with FP mandates have the highest rates of eligible female patients with geographic access (98.54%), while states without active or pending legislation have the lowest rates (79.57%). The greatest disparities in geographic access to care are most concentrated in the Mountain West and West North Central regions. Conclusions and Relevance Patients face numerous barriers to comprehensive cancer care, including a lack of geographic access to centers capable of offering FP services. This cross-sectional study identified disparities in geographic access and potential opportunities for strategic expansion.
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Affiliation(s)
- Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Nivedita R Potapragada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul M Lantos
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Benjamin S Harris
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Joyce Reinecke
- Alliance for Fertility Preservation, Lafayette, California
| | - Kara N Goldman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Casciani V, Monseur B, Cimadomo D, Alvero R, Rienzi L. Oocyte and embryo cryopreservation in assisted reproductive technology: past achievements and current challenges. Fertil Steril 2023; 120:506-520. [PMID: 37290552 DOI: 10.1016/j.fertnstert.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
Cryopreservation has revolutionized the treatment of infertility and fertility preservation. This review summarizes the milestones that paved the way to the current routinary clinical implementation of this game-changing practice in assisted reproductive technology. Still, evidence to support "the best practice" in cryopreservation is controversial and several protocol adaptations exist that were described and compared here, such as cumulus-intact vs. cumulus-free oocyte cryopreservation, artificial collapse, assisted hatching, closed vs. open carriers, and others. A last matter of concern is whether cryostorage duration may impact oocyte/embryo competence, but the current body of evidence in this regard is reassuring. From social and clinical perspectives, oocyte and embryo cryopreservation has evolved from an afterthought when assisted reproduction was intended for immediate pregnancy with supernumerary embryos of secondary interest to its current purpose, which primarily is to preserve fertility long-term and more comprehensively allow for family planning. However, the initial consenting process, which still is geared to short-term fertility care, may no longer be relevant when the individuals that initially preserved the tissues have completed their reproductive journey. A more encompassing counseling model is required to address changing patient values over time.
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Affiliation(s)
- Valentina Casciani
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Brent Monseur
- Stanford Fertility and Reproductive Health, Stanford University, Sunnyvale, California
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Ruben Alvero
- Stanford Fertility and Reproductive Health, Stanford University, Sunnyvale, California
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.
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Yamazaki H, Sugino K, Noh JY, Katoh R, Matsuzu K, Masaki C, Akaishi J, Hames KY, Tomoda C, Suzuki A, Ohkuwa K, Kitagawa W, Nagahama M, Rino Y, Ito K. Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis. Endocrine 2022; 76:78-84. [PMID: 35064544 DOI: 10.1007/s12020-021-02969-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE There is no sufficient data about the clinical course and outcome in thyroid cancer patients who become pregnant after diagnosis of distant metastasis (DM). The current study was conducted to collect information regarding the clinical and reproductive characteristics, and outcomes in thyroid cancer patients who became pregnant after being diagnosed with DM. METHODS Records of 125 differentiated thyroid cancer (DTC) patients with age ≤45 years at DM diagnosis who had visited Ito Hospital from January 2005 to June 2021 were retrospectively reviewed. Among those 125 patients, 28 who became pregnant after DM diagnosis were classified as pregnancy group, and the remained 97 patients were classified as comparator group. RESULTS In pregnancy group, the median age at malignancy diagnosis, DM diagnosis, and first pregnancy after DM diagnosis was 25 years (range, 4-41 years), 27 years (range, 11-41 years), and 32 years (range, 25-45 years), respectively. Fifty-five pregnancies and 40 live births were reported. Other pregnancy outcomes were miscarriage (n = 14) and induced abortion (n = 1). The 10-year progression-free survival (PFS) rates of pregnant and comparator group were 92.1% and 74.4%, respectively (p = 0.018). The multivariate analysis showed that multiple 131I treatment was independent negative prognostic factor for PFS (p = 0.046). CONCLUSIONS DTC patients with age ≤45 years at DM diagnosis had good survival even though they became pregnant. Our results add to the information required for counseling thyroid cancer patients who have concerns about their fertility in the future.
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Affiliation(s)
- Haruhiko Yamazaki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Jaeduk Yoshimura Noh
- Department of Internal Medicine, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Ryohei Katoh
- Department of Pathology, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Chie Masaki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Junko Akaishi
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kiyomi Yamada Hames
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Chisato Tomoda
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Akifumi Suzuki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
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Yamazaki R, Ono M, Sugie T, Inokuchi M, Ishikawa S, Horage Y, Kojima Y, Iwasa T, Hara T, Nagata Y, Kato K, Michikura Y, Kuramoto T, Uchida S, Horie A, Fujiwara H, Matsuzaki T. Case-based survey: The impact of breast-cancer treatment on fertility in Japan. J Obstet Gynaecol Res 2021; 48:553-562. [PMID: 34933405 DOI: 10.1111/jog.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the impact of breast-cancer treatment on fertility. METHODS We conducted a retrospective, case-based survey of treatments administered for infertility and pregnancy outcomes after patients underwent treatment for breast cancer. Surveys were distributed to breast oncology facilities and reproductive endocrinology and infertility (REI) facilities. RESULTS As high as 60% of the pregnancies in women under the age of 35 years occurred spontaneously. Additionally, the fertility rates decreased as age increased (under 35 years of age: 40%, 35-39 years of age: 21%, 40-44 years of age: 10%, respectively). In women who became pregnant after treatment for breast cancer, conception was achieved within 1 to 3 years after beginning to try for pregnancy. CONCLUSIONS After treatment for breast cancer, women can expect spontaneous pregnancy, especially if they are under 35 years of age. It is important for patients 35 years of age and older to commence assisted reproductive technology in a timely manner when pursuing fertility after treatment for breast cancer.
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Affiliation(s)
- Rena Yamazaki
- Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.,Department of Obstetrics and Gynecology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Tomoharu Sugie
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Satoko Ishikawa
- Department of Breast Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Yuki Horage
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuyuki Kojima
- Department of Breast Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuaki Hara
- Division of Reproductive Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | | | | | | | | | - Soko Uchida
- Department of Gynecology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Akihito Horie
- Department of Gynecology & Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Toshiya Matsuzaki
- Department of Obstetrics and Gynecology, Yoshinogawa Medical Center, Yoshinogawa, Tokushima, Japan
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