Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer

Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience

“…Predicting which patients are at risk for developing OHSS can be challenging, and several parameters have been investigated such as elevated E2 levels and the number of follicles recruited [34]. However, the use of aromatase inhibitors may limit the predictive value of E2 levels given their profound suppression in fertility preservation cycles [16]. Despite the significantly lower absolute peak E2 levels, OHSS was still diagnosed in 13 of the 129 participants in our study.…”

“…The supraphysiologic estrogen (E2) levels resulting from traditional stimulation protocols have precluded most oncologists and breast cancer patients from pursuing fertility preservation, fearing the high estrogenic state can promote cancer growth or recurrence [12,13]. In an effort to mitigate the potential effects of elevated E2 levels, novel ovarian stimulation protocols utilizing aromatase inhibitors have been developed [14][15][16]. In one study, the risk of breast cancer recurrence in women who underwent COS utilizing aromatase inhibitors was similar to the control group who declined fertility preservation after 2 years of follow-up [17].…”

Fertility after breast cancer treatment

“…It is reasonable to assume that the preservation of future fertility is likely to be a priority for women desiring pregnancy under the age of 40 years. Therefore, there are currently several potential options for women facing premature ovarian failure and desiring preservation of fertility, including all available assisted technologies, such as in-vitro fertilization and embryo transfer (IVF-ET), in vitro maturation, oocyte and embryo cryopreservation, and cryopreservation of ovarian tissue [16,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

“…It was found that tamoxifen or letrozole in combination with low doses of FSH stimulation showed similar superiority regarding on the number of embryos, in comparison with tamoxifen alone, although the letrozole protocol may be prefered because it results in a lower peak of estradiol. In a recent study, it was suggested that in the short term, aromatase inhibitors and gonadotrophins are safe and effective agents for ovarian stimulation in fertility preservation cycles, supporting the use of aromatase inhibitors for ovarian hyperstimulation in women with breast cancer before initiating adjuvant chemotherapy [48].…”

Live birth after 6 years of oocyte vitrification in a survivor with breast cancer

“…However, breast cancer at the reproductive age is considered a worst and invasive prognosis, for which chemotherapy using high doses of alkylating agents and radiotherapy with ionizing radiation should be applied. Such approach is known to reduce the primordial follicle reserve and cause premature ovarian failure, possibly with genetic damage to growing eggs [3].…”