Response to ovarian stimulation in patients facing gonadotoxic therapy

Abstract

Chemotherapy naïve patients undergoing embryo/oocyte banking for fertility preservation (FP) were assessed for response to ovarian stimulation. Fifty FP patients facing gonadotoxic therapy were matched by age, race, cycle number, date of stimulation and fertilization method to patients undergoing IVF for infertility or oocyte donation. There were no differences in baseline FSH, anti-Müllerian hormone, antral follicle count and total gonadotrophin dose. FP patients had more immature oocytes (2.2 versus 1.1; P = 0.03) and lower fertilization rates per oocyte retrieved (52% versus 70%; P = 0.002.) There were no differences in numbers of oocytes retrieved, mature oocytes or fertilized embryos. Subgroup analysis revealed that FP patients taking letrozole required higher gonadotrophin doses (3077 IU versus 2259 IU; P = 0.0477) and had more immature oocytes (3.4 versus 1.2; P = 0.03) than matched controls. There were no differences in gonadotrophin dose or oocyte immaturity among FP patients not taking letrozole. Chemotherapy naïve FP patients had ovarian reserve, response to stimulation and oocyte and embryo yield similar to controls. Patients who received letrozole required higher gonadotrophin doses and produced more immature oocytes, suggesting that response to ovarian stimulation may be impaired in patients with hormone-sensitive cancers receiving letrozole.

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience

“…Among all patients, no differences were seen between cancer patients and controls with respect to stimulation parameters and IVF outcomes including total ampules of gonadotropins used, peak estradiol level, number of oocytes retrieved, fertilization rate, and number of 2pn embryos obtained. The similarity between cancer patients and controls with respect to mean number of oocytes retrieved [26,[29][30][31][32][33] as well as number of 2pn embryos obtained [26,34] is consistent with the existing literature. However, contrary to our results, the literature to date suggests that cancer patients typically receive a lower mean-dose of gonadotropins [34,35], achieve a lower peak estradiol level [27,[34][35][36], and according to some studies, have a lower mean number of oocytes retrieved [27,34,36] compared to controls.…”

“…Limitations of this study include the small sample size of 63 cancer patients, and particularly the small sample size once results were stratified by stimulation protocol, although this still represents a relatively large cohort when compared to previously published literature [26,[29][30][31][32][33]. Additionally, although the number (21) of cancer patients who underwent transfer is one of the largest reported in the literature, the numbers are still quite small, making it difficult to generalize results obtained in this study to a broader population.…”

Outcomes of ovarian stimulation after treatment with chemotherapy

“…Ovarian stimulation was performed using either luteal-phase GnRH agonist or GnRH antagonist protocols as previously described [20]. The starting dose of gonadotropin dose was selected based on patient age, AMH, and baseline AFC.…”

Reproductive medicine in cancer patients: what is real?

“…К важнейшим из таких мероприятий относится предоставление возможности реализации репродуктивной функции женщинам с онкозаболеваниями после выполнения противоопухолевого лечения. Хорошо известно, что химио-и радиотерапия злокачественных новообразований часто сопровождаются утратой фертильности из-за необратимого угасания функции яичников [5][6][7][8][9], что, собственно, и обусловливает необходимость получения и продолжительного экстракорпорального сохранения генетического материала с перспективой его дальнейшего использования на этапе достигнутой стойкой ремиссии или полного выздоровления.…”

“…Весьма перспективными многие сторонники более «мягкой» стимуляции у онкологических больных считают протоколы с ингибиторами ароматазы (ИА), назначаемыми самостоятельно (по аналогии с кломифеном) или в комбинации с небольшими дозами р-ФСГ [8,[23][24][25]. Очевидная польза в применении ИА состоит в том, что эти препараты (фемара, аримедекс) оказываются способными тормозить конверсию андрогенов в эстрогены, что сдерживает подъем эстрогенов, сопровождающий суперовуляцию.…”