Background: Lymphoma affects many women of childbearing age. Fertility preservation (FP) prior to chemotherapy offers women an opportunity for future pregnancy if fertility is compromised. Fear of treatment delay is one factor contributing to low rates of referral for fertility preservation.
Methods: We performed a retrospective review of female lymphoma patients who contacted a fertility preservation patient navigator (FPPN) at Northwestern University from May 2006 until August 2015. Our primary objective was to assess the median treatment delay associated with FP. Our secondary objective was to assess progression free survival (PFS). Patients who underwent FP were compared to women that contacted a FPPN but did not undergo preservation.
Results: Thirty-three subjects who underwent FP and 50 controls were analyzed. Among FP patients, 21 had Hodgkin lymphoma, 12 had non-Hodgkin lymphoma; 25 presented for upfront treatment and 8 with relapsed/refractory disease. Controls had a higher median age (29 in control versus 26 in FP, p=0.001); however, there was no difference between groups in histology, treatment setting, or stage. Median follow-up was 39.3 (1.5 – 103.4) months, and did not differ between controls and those undergoing FP (p=0.16). Median time to treatment among FP patients was 28 days (range: 18-76) versus 15.5 days (range: 0-74) for controls, resulting in a median delay of 12.5 days (p< 0.001). The median time to first contact with a fertility specialist was 0 days (range -15 to +11) from hematology consult, with several patients having contact prior to their hematology visit. There was no difference in 5 year PFS between FP patients and controls (71.4% vs. 83.7%, respectively, p=0.11). Median time to complete the stimulation protocol was 11 days (range: 5-14). A median of 14 oocytes (range: 0-37) was retrieved per patient. In 2 women, no oocytes could be successfully retrieved. Five women achieved pregnancy following fertility preservation. Of these, 3 were spontaneous, and 2 required reproductive assistance, one from frozen embryos and one from frozen oocytes. Of three women returning to use their frozen gametes, 2 were successful, and one was unsuccessful.
Conclusions: This study demonstrates that fertility preservation is feasible and results in a small delay in therapy. This approach does not significantly impact PFS in our series.