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The Women s Clinic Logistics – who, when and how Milton Ka Hong Leong MDCM DSc(McGill) FRCS(C) FRCOG FACOG FHKCOG Director, IVF Centre HK Sanatorium &

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Presentation on theme: "The Women s Clinic Logistics – who, when and how Milton Ka Hong Leong MDCM DSc(McGill) FRCS(C) FRCOG FACOG FHKCOG Director, IVF Centre HK Sanatorium &"— Presentation transcript:

1 The Women s Clinic Logistics – who, when and how Milton Ka Hong Leong MDCM DSc(McGill) FRCS(C) FRCOG FACOG FHKCOG Director, IVF Centre HK Sanatorium & Hospitals Specialist in Reproductive Medicine Adjunct Professor, Department Obstetrics & Gynecology McGill University,Montreal, CANADA

2 The Women s Clinic Breast Cancer Patients Clinical Summaries

3 The Women s Clinic Patient RT age 37 Cancer: Left Stage II ductal carcinoma microinvasive in ¼ SLN dissection Date of surgery25.7.2006 Day seen8.8.2006 (LMP 18.7.2006) EC:one natural cycle 21.8.2006 2 letrazole cycles – 7.9.2006, 27.9.2006 3 eggs total collected (0, 1, 2) 3 eggs vitrified

4 The Women s Clinic Patient WM Age 32 Cancer: right breast stage 2A Date of surgery 25.11.2006 Day seen11.2.2006 (LMP 27.11.2006) EC:natural cycle unstimulated on day 9 11 immature oocytes 4 fertilized 3 embryo frozen

5 The Women s Clinic Patient TW age 36 Cancer: right breast 2.1 cm Stage IIa 0/7 sentinel node positive ERO PRO Day of surgery16.5.2007 Day seen22.6.2007 (LMP 22.5.2007) Couple had 2 IVF treatments in London Stimulated cycle low dose FSH, 10 oocytes, 7 fertilized, 6 embryos frozen Antagonist treatment following egg collection

6 The Women s Clinic Patient WM age 35 Cancer:right breast 1.2 cm Gr III ductal carcinoma 3/24 axillary nodes positive Day surgery1.11.2007 Day seen20.11.2007 (LMP 3.11.2007) U/S showed follicles 17, 10 and 8 mm EC 22.11.2007- 2 immature eggs, fertilized 2 embryos frozen

7 The Women s Clinic Patient TP age 36 Cancer: left breast 2.6 cm Gr III ductal carcinoma 0/6 axillary lymph nodes positive Date surgery:20.1.2007 Date seen:17.2.2007 (LMP 14.2.2007) U/S – small follicles. EC planned but patient had to settle business at home. When return 21.2.2007 preovulatory with large single follicle. Patient choose to delay chemotherapy Stimulated cycle 3/07: low dose FSH – antagonist given immediately 13 oocytes - 10 fertilized, 9 embryos frozen

8 The Women s Clinic Patient WY age 35 Cancer: stage IIB Left 4 cm Grade I ductal carcinoma 2/30 axillary node positive Date surgery16.11.2005 Date seen5.12.2005 (LMP 22.11.2005) U/S multiple antral follicles 4-7 mm EC10.12.2005 18 oocytes obtained IVM 10/18 matured 6 embryos frozen

9 The Women s Clinic Patient BY Age 38 Cancer: left breast 1.4 GRII ductal carcinoma 0/3 axillary node positive Date surgery1.4.2006 Day seen22.4.20063.4.2006 Patient refused chemotherapy ??? for pregnancy Patient has history of subfertility, and 3 IVF at QMH, poor responder 8.5.2006IVM, no stimulation, 3 oocytes 2 embryos frozen 22.8.20062 embryos thawed and replaced, no pregnancy

10 The Women s Clinic What We can Learn From Case Reports 1.Breast cancer patients all 2.Lead time 2-3 weeks 3.Not optimised (cycle restriction)

11 The Women s Clinic Female Patients Cycle timing can make difference 2 collections v.s. 1 or none in the window between OT and Chemotherapy

12 The Women s Clinic Preservation Of Fertility Male cancer patients Semen collection – no time restriction Prepuberty – needs surgery No proof effective

13 The Women s Clinic Testicular Tissue Freezing Valid technique (Fischer Hamburg HKSH Data) For patients who has too low sperm count in ejaculate

14 The Women s Clinic Preservation of Fertility Female Patients Respect menstrual cycle Timing is critical

15 The Women s Clinic Preservation of Fertility Female patients Cryopreservation eggs Cryopreservation embryos Cryopreservation ovarian tissue Protection of ovaries from irradiation

16 Sperm cryopreservation for Cancer patients Year1994-2007 Total no. cases57 Age range15-40 OutcomeStill freezing35 cases Thawed and used3 casesCase 1- IVF twin with live birth Case 2- IVF singleton with live birth Case 3- Undergoing 1 st IVF treatment Discarded - Patient request - Patient diseased *14 cases 5 cases *Most have normal SA post Ca treatment

17 Oocyte cryopreservation slow freezing Year2002-2007 Female Age (mean)37.3 years No. oocyte freezing cases13-- all for unexpectedly failed sperm collection on day of OR No. oocyte thawing cases10 No. oocyte thawing cycles11 No. ET cycles9- total 12 embryos Survival rate63.8% (44/69) Fertilization rate46.5% (20/43) No. embryos transfer (mean)1.3 Pregnancy rate per thawed oocyte2.9% (2/69) Pregnancy rate per ET22.2% (2/9)* Implantation rate16.7% (2/12) * 1st live-birth in HK from cryopreserved oocyteTjer et al Fert Steril 2005

18 The Women s Clinic HKSH experience Breast cancer patients: 7 Embryos cryopreservation: 6 Oocyt cryopreservation: 1 Used:0 Semen cyropreservation for cancer patient: 9 Used:1 Pregnancy: 1

19 The Women s Clinic Wish List An integrated comprehensive service which will coordinate and triage cancer patients need with treatment plan. Treatment plan will have full consideration of fertility preservation if patient so desires.

20 The Women s Clinic What can we do 1.24/7/365 Hotline or call no. 2.Immediate counseling appointment 3.Coordinate cycle, integrating cancer therapy and fertility treatment 4.Public awareness


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