Ten Year Single-Center Experience in Fertility Preservation of 459 Patients Suffering from Acute Leukaemia

Patients with acute leukaemias suffer from a life threatening disease that has to be treated immediately. Fertility preservation is recommended in these patients, but quite often not possible.

Methods

This study is a retrospective analysis of 459 patients suffering from acute leukaemia, 221 with acute myeloid leukaemia (AML) or high risk MDS, 238 with acute lymphoblastic leukaemia (ALL) diagnosed between 2002 and 2012 in the University clinics Lausanne, Switzerland. Patients were aged between 0 and 93 years. Of course, not all of these patients were send to the preservation laboratry because of their age or their performance status.

Results

Of 221 AML cases, 113 were male and 108 female. 46 male patients were between 14 and 60 years of age, of these, 14 were sent for cryopreservation. 12 sperm samples could be frozen, 2 were sample failures due to azoospermia. Of the frozen samples, 7 were destroyed (6 because of death of the patient, 1 according to wish of patient), 4 are still frozen without tempting procreation and 1 was used for in vitro fertilization (IVF) resulting in a healthy child in 2010. 32 female patients were between 17 and 45. No sample of ovocytes was taken, 1 sample of ovarian tissue could be frozen, that was afterwards destroyed because of death of the patient.

Of 238 ALL cases, 123 were male and 115 female. 55 male patients were between 14 and 60 years of age, of these 19 were sent for cryopreservation. 16 sperm samples could be frozen, 2 were sample failures due to azoospermia, 1 because of ejaculation failure. Of the frozen samples, 11 were destroyed (8 because of death of the patient, 2 due to missing payment and 1 according to the wish of the patient). 5 samples are still frozen, 1 was used for a IVF resulting in a healthy child in 2009. 12 female patients were between 17-45. No sample taking was tempted.

Discussion

In a 10-year period in our institution, of 459 patients suffering from acute leukaemia, 145 of these within the age range defined by our institution to qualifying to cryoconservation. Only 29 samples were taken (20%), non of these in paediatric patients. These samples were leading to 2 IVFs. Of note, one male patient whose samples were taken and resulted in one of the IVFs was suffering from ALL and had an allogenous stem cell transplantation with full conditioning. This patient fathered after the IVF two other healthy children without assisted fertilization. The other patient whose sperm sample was taken for a IVF suffered from AML, he too fathered a child spontaneously after the IVF.

The data show that only 20% of eligible acute leukaemia patients had the opportunity to freeze sperm or ovocytes samples. Certainly, this was not possible for a lot of patients due to performance status, but more effort has to be done to improve sampling in these patients.