Fertility preservation in breast cancer with oral progestin: is it an option? A pilot study

Abstract

Objective: To compare the effectiveness of oral progestins and injectable gonadotropin-releasing hormone antagonist medication in cancer fertility preservation in patients with breast cancer. Methods: A cross-sectional study with 40 breast cancer patients submitted to cancer fertility preservation, who were divided into two groups according to histochemical analysis of progesterone receptors to define luteinizing hormone block: if positive, use of gonadotropin-releasing hormone antagonist, if negative, use of oral progestins. The mean age, medication days, antral follicle count, number of oocytes in metaphase II and the occurrence of ovarian hyperstimulation syndrome were compared. Results: A total of 20 patients both in the group using gonadotropin-releasing hormone antagonist, and in the group with oral progestins, respectively, had a mean age of 33.9 (32-35.8) and 33.8 (32-35.6) years; days of medications of 11 (9.7-12.3) and 12.8 (11.6-13.9), p=0.037; antral follicle count of 9 (7.11-12) and 8.5 (6-11.9), p=0.370; metaphase II oocyte number of 4 (2.1-9.8) and 7.5 (3.1-10), p=0.348; and ovarian hyperstimulation syndrome of 2 (10%) and 5 (25%) cases, p=0.212. Conclusion: The use of oral progestins, in spite of requiring longer treatment time, is effective in relation to the protocol with gonadotropin-releasing hormone antagonist, and offers greater comfort at a lower cost in breast cancer patients with negative progesterone receptors, submitted to cancer fertility preservation.

Risk of ovarian hyperstimulation syndrome in women with malignancies undergoing treatment with long-acting gonadotropin-releasing hormone agonist after controlled ovarian hyperstimulation for fertility preservation: a systematic review

“…The studies by Oishi et al ., 14 Oliveira et al . 15 and Hanada et al . 16 were excluded because of the wrong intervention, as they did not use long-acting GnRHa after ovulation induction.…”

“…Seven studies were excluded from data extraction and review. The studies by Oishi et al, 14 Oliveira et al 15 and Hanada et al 16 were excluded because of the wrong intervention, as they did not use long-acting GnRHa after ovulation induction. The study by Massarotti et al 17 was excluded because of the wrong intervention, as the authors used the long-acting GnRHa to trigger ovulation after COH and did not use the medication after the ovulation induction.…”