Fertility Preservation Strategies in Patients with Lymphoproliferative Diseases

AIM. To assess the tumor spread influence on clinical and laboratory features, hormonal profile, ovarian reserve, and embryologic outcomes in patients with lymphoproliferative diseases (LPD) planning fertility preservation. MATERIALS & METHODS. The study enrolled 64 LPD patients, who, prior to chemotherapy onset, applied for fertility preservation (oocytes and/or embryos) at the Frederic Paulsen Scientific and Educational Center of Assisted Reproductive Technologies of VI Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. Before performing the procedure, a thorough analysis was carried out on the oncological records documenting the characteristics of tumor and the extent of its spread. At baseline, the status of the reproductive system, ovarian reserve, general and gynecological health of patients were assessed. The mean age of patients was 28.7 ± 7.1 years (range 19–39 years), most of them (78.1 %) were under 35 years of age. Most commonly, local stages I/II were identified: stage I was shown by 10 (15.6 %) and stage II was shown by 30 (46.9 %) patients. Tumor spread along both sides of the diaphragm (stage III) was detected in 24 (37.5 %) patients. RESULTS. The mean anti-Müllerian hormone (AMH) level was 2.5 ± 1.3 ng/mL. In 53 % of patients, the AMH level exceeded 2 ng/mL, indicating adequate ovarian reserve. The rate of top-quality blastocysts was 34 % in patients with local stages and 23 % in patients with advanced stages of LPD (p = 0.141). However, the mean number of top-quality blastocysts per patient appeared to be significantly higher in patients with stages I/II, which accounted for 2 (range 1–3) vs. 1 (range 0–2) in patients with advanced stages (p = 0.032). Local LPD stages were characterized by higher AMH and lower follicle-stimulating hormone levels, more oocyte-cumulus complexes, and increased rates of two-pronuclei zygote formation and blastocyst yield. CONCLUSION. Modern reproductive technologieenable fertility preservation in LPD patients with various degrees of tumor spread. A personalized approach with the consideration of both the disease stage and the status of reproductive system can optimize fertility preservation programs and provide patients with the opportunity to restore fertility after chemotherapy completion.