Single euploid embryo transfer outcomes following cancer and systemic chemotherapy.

Purpose: Systemic chemotherapy may impair future reproduction due to its gonadotoxic effects. There are limited data on pregnancy outcomes in patients with a history of chemotherapy who undergo single euploid embryo transfer (SEET).

Materials and methods: This retrospective cohort study included patients with prior chemotherapy who underwent SEET from 2011 to 2023. Cycles were matched 1:3 with controls by oocyte age, age at SEET, BMI, and year. Wilcoxon rank, chi-square, and adjusted logistic regression were used for analysis. A sub-analysis was performed to compare patients who had SEET using oocytes retrieved pre- and post-chemotherapy.

Results: Fifty-five cycles from 32 patients with prior chemotherapy were matched to 165 control cycles. In the chemotherapy group, 23 cycles (41.8%) used embryos derived from oocytes pre-chemotherapy, while 32 cycles (58.2%) used embryos derived from oocytes post-chemotherapy. Endometrial thickness was significantly lower with prior chemotherapy vs. controls (8 mm vs 9 mm, respectively; p = 0.02). Ongoing pregnancy/live birth rate was similar in patients with prior chemotherapy and controls (56.4% vs. 57.0%, p = 0.94). Adjusted analysis confirmed the findings (aOR 1.5, CI 0.79-2.8, p = 0.21). Pregnancy, clinical pregnancy, and loss rates were similar. The subgroup analysis showed no statistical difference in outcomes in patients who used pre-chemotherapy vs. post-chemotherapy oocytes. However, a trend towards poorer outcomes in patients who used post-chemotherapy oocytes was observed.

Conclusions: Outcomes after SEET in patients with prior chemotherapy are comparable to controls. A possible trend toward reduced success using post-chemotherapy oocytes warrants further investigation. Understanding the potential mechanisms by which chemotherapy may affect future fertility is important for survivorship care.