1. 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. Breast Cancer Patients
Clinical Summaries

3. Patient RT age 37 Cancer: Left Stage II ductal carcinoma
microinvasive in ¼ SLN dissection
Date of surgery
Day seen (LMP )
EC: one natural cycle
2 letrazole cycles – ,
3 eggs total collected (0, 1, 2)
3 eggs vitrified

4. Patient WM Age 32 Cancer: right breast stage 2A
Date of surgery
Day seen (LMP )
EC: natural cycle unstimulated on day 9
11 immature oocytes 4 fertilized
3 embryo frozen

5. Patient TW age 36 Cancer: right breast 2.1 cm Stage IIa
0/7 sentinel node positive ERO PRO
Day of surgery
Day seen (LMP )
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. Patient WM age 35 Cancer: right breast 1.2 cm Gr III ductal carcinoma
3/24 axillary nodes positive
Day surgery
Day seen (LMP )
U/S showed follicles 17, 10 and 8 mm
EC immature eggs, fertilized
2 embryos frozen

7. Patient TP age 36 Cancer: left breast 2.6 cm Gr III ductal carcinoma
0/6 axillary lymph nodes positive
Date surgery:
Date seen: (LMP )
U/S – small follicles. EC planned but patient had to settle business at home.
When return 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. Patient WY age 35 Cancer: stage IIB Left 4 cm Grade I ductal carcinoma
2/30 axillary node positive
Date surgery
Date seen (LMP )
U/S multiple antral follicles 4-7 mm
EC oocytes obtained IVM 10/18 matured
6 embryos frozen

9. Patient BY Age 38 Cancer: left breast 1.4 GRII ductal carcinoma
0/3 axillary node positive
Date surgery
Day seen
Patient refused chemotherapy ??? for pregnancy
Patient has history of subfertility, and 3 IVF at QMH, poor responder
IVM, no stimulation, 3 oocytes
2 embryos frozen
embryos thawed and replaced,
no pregnancy

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

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

12. Preservation Of Fertility
Male cancer patients
Semen collection – no time restriction
Prepuberty – needs surgery
No proof effective

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

14. Preservation of Fertility
Female Patients
Respect menstrual cycle
Timing is critical

15. Preservation of Fertility
Female patients
Cryopreservation eggs
Cryopreservation embryos
Cryopreservation ovarian tissue
Protection of ovaries from irradiation

16. Sperm cryopreservation for Cancer patients
Year
Total no. cases 57
Age range
15-40
Outcome
Still freezing
35 cases
Thawed and used
3 cases
Case 1- IVF twin with live birth
Case 2- IVF singleton with live birth
Case 3- Undergoing 1st IVF treatment
Discarded
Patient request
- Patient diseased
*14 cases
5 cases
*Most have normal SA post Ca treatment

17. Oocyte cryopreservation slow freezing
Year
Female Age (mean)
37.3 years
No. oocyte freezing cases 13 -
- all for unexpectedly failed sperm collection on day of OR
No. oocyte thawing cases 10
No. oocyte thawing cycles 11
No. ET cycles 9
- total 12 embryos
Survival rate
63.8% (44/69)
Fertilization rate
46.5% (20/43)
No. embryos transfer (mean)
1.3
Pregnancy rate per thawed oocyte
2.9% (2/69)
Pregnancy rate per ET
22.2% (2/9)*
Implantation rate
16.7% (2/12)
* 1st live-birth in HK from cryopreserved oocyte Tjer et al Fert Steril 2005

18. 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. 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. What can we do 24/7/365 Hotline or call no.
Immediate counseling appointment
Coordinate cycle, integrating cancer therapy and fertility treatment
Public awareness