Introduction
Many individuals are diagnosed with cancer during childhood, adolescence, and young adulthood. Worldwide, there were approximately 1 335 100 new cancer cases among adolescents and young adults in 20191; the incidence rate was 44.99 per 100 000 people.1 In 2020, the incidence rate for cancer among Hong Kong children and adolescents (aged 0-19 years) was 160 cases per 1 000 000 people.2 There were 177 newly diagnosed cancer cases in this age-group (92 in male patients and 85 in female patients).2 The survival rates for childhood and adolescent cancers are encouraging. In a retrospective cohort study from a research hospital in the United States,3 the 5-year overall survival rate exceeded 83%. Similarly, in Hong Kong, the 5-year survival rate among women diagnosed with breast cancer, the most common cancer in reproductive-age women, was 84% between 2010 and 2017.2
Chemotherapy or pelvic radiotherapy may affect fertility, either temporarily or permanently. Considering advances in cancer treatment and improved post-treatment survival rates, fertility should be discussed at the time of cancer diagnosis, especially for younger patients who have not yet completed their families. International guidelines regarding fertility preservation (FP) recommend that clinicians inform cancer patients about the potential effects of cancer and its treatment on reproductive function, as well as FP options.4 5In a semi-structured phone interview study of female cancer survivors who were diagnosed with invasive cervical cancer, breast cancer, Hodgkin lymphoma, or non-Hodgkin lymphoma at age ≤40 years, participants were interviewed an average of 10 years after diagnosis.6 Those who had wanted children at the time of diagnosis but were unable to conceive subsequently reported distress related to their interrupted fertility.6 Additionally, patients who do not receive accurate and timely information regarding FP are at risk for psychological distress.7 In our recently published cross-sectional questionnaire study of reproductive-age women in Hong Kong who had been diagnosed with breast cancer,8 only 44% of those women were aware of FP; however, 46% of the women felt that fertility concerns affected their cancer treatment decisions.8
The most common FP options include sperm cryopreservation for men and embryo or oocyte cryopreservation for women. Other options for women include pharmacological ovarian protection using gonadotropin-releasing hormone (GnRH) agonists, ovarian tissue cryopreservation, and ovarian transposition. In Hong Kong, FP was previously self-funded and only available through private services. Sperm cryopreservation costs approximately HK$4400 to HK$6600 for 2 years, whereas oocyte and embryo cryopreservation costs are approximately HK$15 000 to HK$20 000.9 Our centre launched the first public FP programme for cancer patients in Hong Kong, beginning in August 2020. Here, we review the two-and-a-half-year experience of providing public FP services to cancer patients in Hong Kong.
Methods
This retrospective study included men and women who attended the Centre of Assisted Reproduction and Embryology at The University of Hong Kong—Queen Mary Hospital for FP services before cancer treatment, from the establishment of our public FP programme in August 2020 until the end of February 2023.
Criteria for public fertility preservation services
During the study period, we provided public FP for cancer patients [lesser than]35 years old, expressed a desire for future fertility, had a survival rate exceeding 50% after cancer treatment, had no living children, and had not undergone prior chemotherapy or pelvic radiotherapy. In women, an antral follicle count of [greater than]7 on pelvic ultrasound was required. These criteria were adapted from The Edinburgh Selection Criteria for ovarian tissue cryopreservation.10
There was no minimum age requirement for FP. Male adolescents could undergo sperm freezing if they were able to provide sperm samples for cryopreservation. For patients aged [lesser than]18 years, we included their parents in discussions prior to proceeding with FP treatment.
During the study period, the public FP programme offered up to 40 cycles of sperm freezing and 20 cycles of oocyte/embryo freezing per year.
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Dorothy TY Chan; Jennifer KY Ko; Kevin KW Lam; YW Tong; Evelyn Wong; Heidi HY Cheng; Sofie SF Yung; Raymond HW Li; Ernest HY Ng
Department of Obstetrics and Gynaecology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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