The Utility of Decision Trees in Oncofertility Care in Japan

Purpose: To identify the utility and issues associated with the use of decision trees in oncofertility patient care in Japan. Methods: A total of 35 women who had been diagnosed with cancer, but had not begun anticancer treatment, were enrolled. We applied the oncofertility decision tree for women published by Gardino et al. to counsel a consecutive series of women on fertility preservation (FP) options following cancer diagnosis. Percentage of women who decided to undergo oocyte retrieval for embryo cryopreservation and the expected live-birth rate for these patients were calculated using the following equation: expected live-birth rate=pregnancy rate at each age per embryo transferx(1 - miscarriage rate)xNo. of cryopreserved embryos. Results: Oocyte retrieval was performed for 17 patients (48.6%; meanstandard deviation [SD] age, 36.35 +/- 3.82 years). The mean +/- SD number of cryopreserved embryos was 5.29 +/- 4.63. The expected live-birth rate was 0.66. Conclusions: The expected live-birth rate with FP indicated that one in three oncofertility patients would not expect to have a live birth following oocyte retrieval and embryo cryopreservation. While the decision trees were useful as decision-making tools for women contemplating FP, in the context of the current restrictions on oocyte donation and the extremely small number of adoptions in Japan, the remaining options for fertility after cancer are limited. In order for cancer survivors to feel secure in their decisions, the decision tree may need to be adapted simultaneously with improvements to the social environment, such as greater support for adoption.