Material & Methods
Patients
From January 2009 to February 2012, 218 FP candidates were referred to our center by their oncologist or obstetrician–gynecologist. All of them were aged 18–40 years. After being informed on the possibilities of FP and the techniques available, 172 patients consented to undergo the procedure. All patients having received oncofertility counseling were invited to participate in our study. All materials and methods received the approval of our internal review board and an informed consent was obtained from all participants.
Questionnaires
Within the 6 months after the oncofertility counseling, participants received a cover letter by mail associated with a 37-item questionnaire (Supplementary Figure 1; see online at www.futuremedicine.com/doi/suppl/10.2217/fon.13.265) elaborated by the authors according to data in the literature and to their own expertise in oncofertility. Before validation and distribution, the questionnaire was submitted to medical and nonmedical employees of our Department of Reproductive Medicine (Hospital Antoine Béclère, Clamart, France) to ensure that the questions could be interpreted as intended. The language used in the questionnaire was French since all patients were native French speakers. The cover letter stated, in part: "We would like you to fill out a questionnaire concerning your recent experience with oncofertility counseling or/and FP and its (their) impact on your coping with cancer treatments." In the case women did not want to fill in the questionnaire, they were allowed to send back a stamped postcard opting out of further contacts. The cover letter also included a telephone number to call if the recipient wanted more information on the study. Women were told that their questionnaires would be kept anonymous. Questionnaires were composed by questions on demographic and medical data, including current age, educational level, relationship status and the number of children, type of cancer, age at diagnosis and type of cancer treatment. In addition, other multiple-choice items, yes/no tests and open-ended questions assessed the following factors: patient's experience regarding the possible negative impact of cancer treatments on their fertility; patient's representation of FP; patient's feeling regarding the opportunity of FP; whether the patient had wished to have more time after the oncofertility counseling to make the decision of undergoing FP; in case of decline of the FP proposal, what were the main reasons having justified such a decision; whether a family member or a significant other had been involved in their decision of undergoing FP; patient's wish regarding the number of desired children; patient's representation of oocytes and/or embryos cryopreserved; patient's coping with cancer treatments; and the outcome of possible unused frozen oocytes and/or embryos.
Techniques of FP
Patients were offered FP using oocyte and/or embryo cryopreservation, as well as ovarian tissue freezing. Oocytes were retrieved at mature (preovulatory follicles) or immature stages (small antral follicles) according to whether controlled ovarian hyperstimulation was or not indicated or feasible. In cases of immature oocyte retrieval, oocytes underwent in vitro maturation before freezing. The choice of the technique was based on patient's age, marital status, the type of pathology (i.e., hormonal dependence), time available before the start of chemo-radiotherapy and its estimated gonadotoxicity. Basically, patients suffering from breast cancer, an estrogen-sensitive disease, were offered in vitro maturation of oocytes procedure when a neoadjuvant chemotherapy was scheduled. In case of adjuvant chemotherapy, since the tumor was removed by surgery, patients had the possibility to undergo oocyte or embryo cryopreservation after controlled ovarian hyperstimulation. For hematological diseases, ovarian stimulation or in vitro maturation was decided according to time frame between the FP counseling and the initiation of the gonadotoxic treatment. In addition, these patients were systematically offered ovarian tissue cryopreservation.
Statistical Analysis
The measures of central tendency and of variability used were the median and the ranges. Differences between groups of patients were evaluated using Student's t-test or χ test, when appropriate. A p-value of <0.05 was considered statistically significant. In addition, thematic qualitative analysis of free text data was conducted for open-ended questions.