Challenges and Considerations in Optimizing Ovarian Stimulation Protocols in Oncofertility Patients

Abstract

The scope of cancer treatment in women of childbearing age has changed in the last decade. Fertility preservation is no longer an afterthought but central to multi-disciplinary cancer treatment planning and should be addressed due to the cytotoxic effects of cancer therapy. However, oncology patients present as a unique treatment challenge as the physician must balance the urgency of fertility preservation with the risks of delaying cancer therapy. Controlled ovarian stimulation (COS) is routinely applied in assisted reproductive technology but can be contraindicated in women with estrogen-receptor-positive tumors. This paper reviews some of the challenges to consider when using COS and newer stimulation protocols to minimize risks and optimize outcomes in oncofertility patients.

Educational needs of fertility healthcare professionals using ART: a multi-country mixed-methods study

“…Therefore, patients with cancer now represent a large proportion of women who undergo ART procedures (Letourneau et al 2012). This study supports previous evidence that patients with cancer are among the most challenging profiles for inducing OS (Coyne et al 2014). The challenge with ovarian stimulation in patients with cancer can be explained by the risk of compromising the efficacy of chemotherapy when OHSS occurs shortly after oocytes are retrieved (Koch and Ledger 2013).…”

Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach

“…It involves cryopreservation of in vitro-fertilized mature oocytes via slow freezing or vitrification which is preferred due to a better post-thaw survival rate [42][43][44]. Embryo freezing requires prior ovarian stimulation, mature oocyte retrieval, and sperm for in vitro fertilization (IVF) [45][46][47][48][49][50]. Therefore, it is not suitable for prepubertal girls due to inactive hypothalamic-pituitary-ovarian (HPO) axis and not suitable for single women refusing sperm donation for any reason.…”

Implementation of an Oncofertility Program: Key Elements, Challenges, and Solutions of the Oncofertility Treadmill

“…The final step in the ovarian hyperstimulation process, the trigger, is largely determined by the risk of ovarian hyperstimulation syndrome (OHSS). 11 OHSS primarily presents with minor symptoms such as abdominal fullness, nausea, and vomiting. However, more severe presentations include electrolyte imbalance and fluid overload, resulting in ascites or pulmonary edema that may lead to hospitalization.…”