Gonadotropin-releasing hormone agonist trigger increases the number of oocytes and embryos available for cryopreservation in cancer patients undergoing ovarian stimulation for fertility preservation

Pereira, Nigel; Kelly, Amelia G.; Stone, Logan D.; Witzke, Justine D.; Lekovich, Jovana P.; Elias, Rony T.; Schattman, Glenn; Rosenwaks, Zev

doi:10.1016/j.fertnstert.2017.06.027

Cited by 32 publications

(18 citation statements)

References 30 publications

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“…This syndrome could not only result in a delay in cancer treatment but also amplify the baseline risk for coagulopathy and other cancer-related morbidities ( Turan et al ., 2013 ; Kim et al ., 2015 ; Oktay et al ., 2010 ). Besides this, GnRH agonist trigger usually results in a greater mature (MII) oocyte yield without a reduction in clinical pregnancy or live birth rates in cryopreservation cycles ( Rodriguez-Wallberg & Oktay, 2010 ; Rodgers et al ., 2017 ; Oktay et al ., 2010; Pereira et al ., 2017 ). The most recent studies showed no differences between these two protocols concerning number of retrieved oocytes ( Turan et al ., 2013 ; Kim et al ., 2015 ).…”

Section: Discussionmentioning

confidence: 99%

The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation

Bercaire

Cavagna

Donadio

et al. 2020

JBRA Assisted Reproduction

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Objective: Patients submitted to oncological fertility preservation with letrozole and gonadotropins seem to present a higher rate of immature oocytes and lower fertilization rates in comparison to infertile patients submitted to IVF cycles with gonadotropins. The aim of this study was to evaluate the influence of letrozole on oocyte morphology in patients with breast cancer submitted to fertility preservation. Methods: Retrospective analysis performed at a public tertiary hospital in São Paulo, Brazil. The oocytes were retrieved from patients with breast cancer undergoing fertility preservation (n=69), and from infertile women undergoing in vitro fertilization (n=92). We evaluated 750 oocytes obtained from breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins, and 699 oocytes from patients without breast cancer submitted to ovarian stimulation for in vitro fertilization with gonadotropins only due to male factor infertility. The mature oocytes retrieved were analyzed for the presence of refractile bodies, ooplasm color and regularity, central granulation degree, cortical granules, zona pellucida staining and regularity, perivitelline space, presence of vacuoles or abnormal smooth-surfaced endoplasmic reticle and oocyte retraction. Results: There was a higher incidence of alterations in oocyte morphology in the letrozole group when compared to the control group: increased perivitelline space ( p =0.007), irregular zona pellucida ( p <0.001), refractile bodies ( p <0.001), dark ooplasm ( p <0.001), granular ooplasm ( p <0.001), irregular ooplasm ( p <0.001) and dense central granulation ( p <0.001). Conclusion: Letrozole is a risk factor for worse oocyte morphology. However, the clinical impact of ovarian stimulation protocol with combined use of gonadotropins and letrozole for fertility preservation remains unclear in this setting. These data underline the importance of establishing the predictive potential of morphological dimorphisms of human oocytes in IVF outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation

Bercaire

Cavagna

Donadio

et al. 2020

JBRA Assisted Reproduction

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“…It has also been shown that the elicited flare of LH as well as FSH resembles the natural midcycle surge of gonadotrophins and was found to effectively stimulate final oocyte maturation and ovulation (10), leading to the development of competent embryos as recently demonstrated in PGT-A cycles (11). Moreover, studies in oocyte donors (12) and oncologic fertility-preservation patients (13,14) demonstrated a significant increase in MII oocytes and the number of good-quality embryos in GnRHa-triggered cycles as compared with hCGtriggered cycles. Nonetheless, it is worth noticing that others have not corroborated these findings (15)(16)(17).…”

Section: Gnrha Trigger-improving Oocyte Yield and Embryo Competence?mentioning

confidence: 92%

“…The same group in an extended analysis (13), including 129 breast cancer patients (46 in the GnRHa trigger group versus 83 in the hCG trigger group), confirmed their previous results in terms of more MII oocytes (77.3% versus 67.6%, p ¼ 0.007) and a higher number of cryopreserved embryos (7.7 versus 5.4, p ¼ 0.002) in the GnRHa trigger group. More recently, a larger retrospective cohort study (14) included 341 patient who underwent oocyte freezing for fertility preservation (75.3% breast cancer patients) and reported a higher number of MII oocytes and embryos cryopreserved (11.8 versus 9.9, p ¼ 0.04; and 9.2 versus 6.4, p < 0.001) after GnRHa trigger.…”

Section: Fertility Preservation In Cancer Patientsmentioning

confidence: 99%

Gonadotropin-releasing hormone agonist ovulation trigger—beyond OHSS prevention

Castillo

Haahr

Martínez-Moya

et al. 2020

Upsala Journal of Medical Sciences

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In this review the advantages of the gonadotropin-releasing hormone agonist (GnRHa) trigger are discussed beyond those immediately associated with ovarian hyperstimulation syndrome (OHSS) prevention. The GnRHa trigger concept has sparked the development of novel protocols, enriching the assisted reproductive technology (ART) armamentarium for the benefit of present and future patients. Thus, GnRHa trigger already has a pivotal role, not only for the standard in vitro fertilisation (IVF) patient, but also for patient groups like oocyte donors, cancer patients, patients with poor ovarian reserve, and patients with immature oocyte syndrome and empty follicle syndrome. Herein, we discuss the importance of the GnRHa-elicited midcycle FSH surge and the potential improvement in oocyte yield and embryo competence.

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“…The LBR using GnRHa-triggered cycles is comparable to hCG-triggered cycles provided that a modified luteal phase support is applied [79][80][81]. Importantly, it was shown that the number of MII oocytes and embryos were significantly higher after a GnRHa trigger as compared to an hCG trigger [82][83][84]. The finding was supported by a recent systematic review and meta-analysis in which two RCTs showed a significant increase in the number of good quality embryos after a GnRHa trigger compared to an hCG trigger (MD 0.94, 95% CI 0.01-1.87) [85].…”

Section: Ovulation Triggermentioning

confidence: 96%

Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

Abu-Musa

Haahr

Humaıdan

2020

IJMS

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Poor ovarian response (POR) to controlled ovarian stimulation (OS) presents a major challenge in assisted reproduction. The Bologna criteria represented the first serious attempt to set clear criteria for the definition of POR. However, the Bologna criteria were questioned because of the persistent heterogeneity among POR patients and the inability to provide management strategies. Based on these facts, a more recent classification, the POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) classification, was developed to provide a homogeneous and refined definition of POR that significantly reduces the heterogeneity of the Bologna criteria definition of POR and helps in the clinical handling and counseling of patients. In this review, we discuss the impact of the POSEIDON classification on the clinical management of patients with POR.

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Gonadotropin-releasing hormone agonist trigger increases the number of oocytes and embryos available for cryopreservation in cancer patients undergoing ovarian stimulation for fertility preservation

Abstract: Utilization of a GnRH-agonist trigger increases the number of MII oocytes and 2PN embryos available for cryopreservation in cancer patients undergoing COS for fertility preservation.

Cited by 32 publications

References 30 publications

The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation

The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation

Gonadotropin-releasing hormone agonist ovulation trigger—beyond OHSS prevention

Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

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