Uptake and Outcome of Artificial Reproductive Techniques Following Allogeneic Stem Cell Tranplantation: A Single Centre Experience.

Infertility is common following allogeneic stem cell transplant (allo-SCT). Very little data are available on the use and success of artificial reproductive techniques in patients who have undergone allo-SCT as treatment for cancer.

We have performed a retrospective survey to assess the uptake of gamete/embryo storage prior to SCT, their use following SCT and the success rate of these techniques. Two hundred patients (95 female) who received allo-SCT between 1979 and 2007 responded to a questionnaire at a median of 12 years (range 2-30 years) post transplant. The median age at SCT was 35 years (range 17-61 years).

Ninety-four men (90%) recalled being counselled about post transplant infertility. Seventy-two recalled being offered sperm storage and 36 men stored sperm prior to allo-SCT. Of the 68 men who did not store sperm, 43 did not wish to have children after SCT; 37/43 had completed their families or did not want children, 4/43 considered themselves too old and 2/43 were homosexual. Of the remainder the reasons were various; no semen storage available in country of residence (n=1), pre-pubertal at first allo-SCT (n=1), previous chemotherapy had induced infertility (n=4), sperm of insufficient quality to permit storage (n=7), insufficient time pre-transplant to arrange storage (n=5), unknown (n=8). Of the 36 men who stored sperm, 21 attempted pregnancy post SCT. 14 men fathered a total of 24 children (17 successful pregnancies including 7 twin pregnancies). In these men intracytoplasmic sperm injection (ICSI) was used in 12 pregnancies and inter-uterine insemination was used in 2 pregnancies. The method was not specified in 3 pregnancies. The median number of attempts for a successful pregnancy was 1 (range 1-10). The median number of attempts for men who were unsuccessful was 2 (1-4). In addition, three men fathered children with donated sperm and one man conceived naturally post transplant. Fifty-nine women (63%) recalled being counselled about post transplant infertility. Of these, 32 were offered storage of gametes/embryos. Ten patients undertook storage; oocytes (n=1), ovarian tissue (n=1), embryos (n=6) or a combination of these (n=2). The women who did not store gametes/embryos most had either completed their families (n=28), were too old (n=17) or there was insufficient time prior to transplant (n=13). In 6 cases, the technology was not available or insufficiently advanced to be successful at the time of SCT. Other given reasons included chemotherapy induced infertility, concerns about medical co-morbidity and worries about contamination of the stored tissue with malignant cells. Three women attempted to become pregnant with stored embryos. One was successful on her second attempt after a spontaneous abortion. One had 3 attempts and although succeeded in becoming pregnant unfortunately miscarried at 12 weeks. The third woman had one failed attempt. Of the other patients, one woman had 2 successful pregnancies with donated eggs and one woman adopted her child. Two women delayed their transplant in order to have children.

The uptake of gamete storage was relatively high for male patients. Over half of men who had not already completed their families elected to store sperm. Subsequently two thirds of these men were successful in fathering children with stored sperm. Unfortunately the potential for women to store gametes/embryos is much lower. Less than a fifth of young women who had not completed their families undertook gamete / embryo storage prior to SCT and only one patient proceeded to have a successful pregnancy.

No relevant conflicts of interest to declare.