Fertility preservation with ovarian stimulation and time to treatment in women with stage II–III breast cancer receiving neoadjuvant therapy

Chien, A. Jo; Chambers, Julia; McAuley, Fiona M.; Kaplan, Tessa; Letourneau, Joseph M.; Hwang, Jimmy J.; Kim, Miok; Melisko, Michelle; Rugo, Hope S.; Esserman, Laura J.; Rosen, Mitchell P.

doi:10.1007/s10549-017-4288-3

Cited by 49 publications

(52 citation statements)

References 30 publications

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“…To date, the available data on the transfer of cryopreserved oocytes or embryos after breast cancer therapy are limited [18,25,[27][28][29]. Embryo or oocyte transfer rates of 6-25% are reported [18,25,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

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Section: Discussionmentioning

confidence: 99%

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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“…COS and oocyte aspiration are usually considered to take around 2 weeks, even with random‐start protocols, whereas ovarian tissue does not need any pretreatment and can be excised as soon as an operation can be scheduled . Most studies on FP, irrespective of whether focus is on freezing mature oocytes/embryos or ovarian tissue, state that the procedure was performed without delaying cancer treatment . However, it is obviously of interest to the patient to keep the time interval between referral to OTC and the actual procedure as short as possible.…”

Section: Introductionmentioning

confidence: 99%

“…8 Most studies on FP, irrespective of whether focus is on freezing mature oocytes/embryos or ovarian tissue, state that the procedure was performed without delaying cancer treatment. [9][10][11] However, it is obviously of interest to the patient to keep the time interval between referral to OTC and the actual procedure as short as possible. The aim of the present study was to determine the period of time from referral to OTC to the excision and cryopreservation of ovarian tissue in a cohort of Danish women undergoing OTC.…”

Section: Introductionmentioning

confidence: 99%

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility‐preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. Material and methods The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC‐referral to OTC. A literature search for “random start” protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. Results The time from OTC‐referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13‐17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13‐14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later. Conclusions It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

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“…Assumptions that fertility preservation will delay and adversely affect cancer treatment are not supported by existing, albeit limited, evidence. Letourneau et al demonstrated no difference in time to neoadjuvant chemotherapy in women with breast cancer who underwent fertility preservation compared with those who did not (38 days vs 39 days, respectively; P = .7) and Chien et al similarly found no difference (42 days vs 36 days, respectively; P = .5) . Research also counters concerns that fertility preservation may impair long‐term survival, but to the best of our knowledge current evidence is limited to one investigation .…”

Section: Discussionmentioning

confidence: 97%

“…Letourneau et al demonstrated no difference in time to neoadjuvant chemotherapy in women with breast cancer who underwent fertility preservation compared with those who did not (38 days vs 39 days, respectively; P = .7) 52 and Chien et al similarly found no difference (42 days vs 36 days, respectively; P = .5). 53 Research also counters concerns that fertility preservation may impair long-term survival, but to the best of our knowledge current evidence is limited to one investigation. 54 Among 262 women of reproductive age who were diagnosed with breast cancer, Moravek et al demonstrated no significant difference in mortality between those who underwent oocyte or embryo cryopreservation before treatment compared with those who did not (1.8% vs 3.4%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Fertility‐related experiences after breast cancer diagnosis in the Sister and Two Sister Studies

Bressler

Mersereau

Anderson

et al. 2019

Cancer

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Background Commonly used chemotherapies can be toxic to the ovaries. To the authors’ knowledge, the majority of studies evaluating receipt of fertility counseling for women in their reproductive years have been performed in specific settings, thereby limiting generalizability. Methods A nationwide sample of US women diagnosed with breast cancer before age 45 years completed a survey assessing the prevalence of fertility counseling. Age‐adjusted log‐binomial regression was used to estimate prevalence ratios (PRs) and 95% CIs for fertility counseling. Results Among 432 survivors diagnosed between 2004 and 2011, 288 (67%) had not discussed the effects of treatment on fertility with a health care provider before or during treatment. Fertility discussion was associated with younger age (PR, 3.49 [95% CI, 2.66‐4.58] for aged <35 years vs ≥40 years) and lower parity (PR, 1.81 [95% CI, 1.29‐2.53] for parity 1 vs 2). Approximately 20% of respondents reported that they were interested in future fertility (87 of 432 respondents) at the time of their diagnosis, but not all of these individuals (66 of 87 respondents) received counseling regarding the impact of treatment on their fertility, and few (8 of 87 respondents) used fertility preservation strategies. Among 68 women with a fertility interest who provided reasons for not taking steps to preserve fertility, reasons cited included concern for an adverse impact on cancer treatment (56%), lack of knowledge (26%), decision to not have a child (24%), and cost (18%). Conclusions Across multiple treatment settings, the majority of women of reproductive age who are diagnosed with breast cancer did not discuss fertility with a health care provider or use fertility preservation strategies. Discussing the potential impact of cancer treatment on future fertility is an important aspect of patient education.

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Fertility preservation with ovarian stimulation and time to treatment in women with stage II–III breast cancer receiving neoadjuvant therapy

Abstract: Fertility preservation with OS can be performed in the neoadjuvant setting without delay in initiation of systemic therapy and should be discussed with all early-stage BC patients of reproductive age.

Cited by 49 publications

References 30 publications

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Fertility‐related experiences after breast cancer diagnosis in the Sister and Two Sister Studies

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