Emergency Fertility Preservation in Hematological Diseases: Ovarian Response and Real-World Outcomes From China.

PURPOSE: This study investigated ovarian response, safety, and reproductive outcomes in patients with hematological diseases undergoing controlled ovarian stimulation (COS) for emergency fertility preservation (FP).

METHODS

We retrospectively analyzed female patients with hematological diseases receiving COS for emergency FP at our center from January 2016 to February 2025. Outcomes were compared by menstrual cycle phase at stimulation initiation, protocols, and chemotherapy exposure, with follow-up data on hematologic disease status, utilization of cryopreserved oocytes/embryos, ovarian function, marital, and reproductive collected.

RESULTS

No statistically significant differences in ovarian response were detected according to the phase of the menstrual cycle at stimulation initiation or between the gonadotropin-releasing hormone antagonist (GnRH-ant) and progestin-primed ovarian stimulation (PPOS) protocols. Chemotherapy exposure within 3 months was associated with lower oocyte and mature oocyte yield. Most patients underwent hematopoietic stem cell transplantation (HSCT), and 92.31% developed premature ovarian insufficiency (POI). Six patients underwent warming of oocytes/embryos, achieving two live births including one twin.

CONCLUSIONS

During emergency FP in patients with hematological diseases, random-start COS using either GnRH-ant or PPOS protocols yields comparable outcomes, supporting its feasibility and flexible application in time-constrained settings. Recent chemotherapy exposure may adversely affect COS outcomes and should be considered when planning treatment.