Fertility preservation
All 32 patients treated with (chemo) radiotherapy received pre-treatment fertility counselling. An overview of patient decisions and treatment flow regarding FP procedures is presented in Supplementary 1 . After counselling, 26 patients (81.3%) started FP procedures whereas 5 patients (15.6%) decided to not preserve fertility and 1 patient (3.1%) with neuroendocrine tumor was advised to not start FP due to oncologic reasons. Personal reasons for not pursuing FP after counseling included fear of postponing cancer treatment or the complexity of gestational carrier procedures.
While 26 patients started FP procedures, oocyte cryopreservation failed in 5 patients due to poor ovarian response. 2 of them underwent emergency ovarian tissue cryopreservation (OTC) and 3 decided to not start alternative FP procedures. Fertility was successfully preserved in 23 (88.5%) of the 26 patients who started FP procedures.
9 patients underwent more than one procedure; i.e. a combination of the aforementioned. Ovarian transposition was performed to retain hormonal function in 5 patients or for fertility preservation purposes in 2 patients. Vaginal oocyte pickup procedures and laparoscopic retrieval of ovarian tissue were performed succesfully in all patients. FP procedures were all performed within 6 weeks after diagnosis, therefore it did not interfere with cancer treatment.