Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer

Letourneau, Joseph M.; Sinha, Nikita; Wald, Kaitlyn; Harris, E. J.; Quinn, Molly M.; Imbar, Tal; Mok-Lin, Evelyn; Chien, Amy Jo; Rosen, Mitchell P.

doi:10.1093/humrep/dex276

Cited by 63 publications

(44 citation statements)

References 19 publications

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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%

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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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Section: Introductionmentioning

confidence: 99%

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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“…Both groups of women began chemotherapy within 6 weeks of their breast cancer diagnosis. 30 The women who underwent oocyte retrieval were referred to a reproductive specialist significantly earlier (~9 days) after their breast cancer diagnosis than the women who did not undergo oocyte retrieval, a finding which reconfirms the importance of early referral to reproductive specialists. Also, while the FertiPROTEKT guideline 13 does not recommend preoperative ovarian stimulation for patients with estrogen receptor-positive (ER-positive) breast cancer, 37 ER-positive patients in this study underwent ovarian stimulation, which yielded an important finding: the use of letrozole suppressed the peak estradiol levels at a mean of 889 ± 655 pg/ mL.…”

Section: Random-start Protocolmentioning

confidence: 71%

“…There was no significant difference in the duration from diagnosis to the initiation of chemotherapy between 58 patients with breast cancer who underwent ovarian stimulation and oocyte retrieval in a random‐start protocol prior to the initiation of neoadjuvant chemotherapy and 29 patients with breast cancer who did not undergo oocyte retrieval. Both groups of women began chemotherapy within 6 weeks of their breast cancer diagnosis . The women who underwent oocyte retrieval were referred to a reproductive specialist significantly earlier (~9 days) after their breast cancer diagnosis than the women who did not undergo oocyte retrieval, a finding which reconfirms the importance of early referral to reproductive specialists.…”

Section: Recent Issues In Assisted Reproductive Technology For Fertilmentioning

confidence: 77%

Recent advances in oncofertility care worldwide and in Japan

Takai

2018

Reprod Medicine & Biology

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BackgroundOncofertility is a crucial facet of cancer supportive care. The publication of guidelines for the cryopreservation of oocytes and ovarian tissue is becoming increasingly prevalent in Japan and an updated overview is necessary.MethodsIn order to provide an updated overview of oncofertility care, original research and review articles were searched from the PubMed database and compared in order to present clinical care in Japan.ResultsIn Western countries, various methods for ovarian stimulation, such as the combined use of aromatase inhibitors and random‐start protocols, have been reported. Although ovarian tissue cryopreservation, mainly performed via the slow‐freezing method, also has yielded >100 live births, the optimal indications and procedures for the auto‐transplantation of cryopreserved tissue have been under investigation. In Japan, however, vitrification is prevalent for ovarian tissue cryopreservation, although its efficacy has not yet been established. The quality of network systems for providing oncofertility care in Japan varies greatly, based on the region.ConclusionThere remain many issues in the optimization of oncofertility care in Japan. Along with the regional oncofertility networks, the creation of “oncofertility navigators” from healthcare providers who are familiar with oncofertility, such as nurses, psychologists, and embryologists, could be useful for supplementing oncofertility care coordination, overcoming the issues in individual regions.

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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%

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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Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer

Abstract: This study was supported by departmental research funding within the University of California, San Francisco Department of Obstetrics, Gynecology and Reproductive Sciences. There are no conflicts of interest to declare.

Cited by 63 publications

References 19 publications

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

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

Recent advances in oncofertility care worldwide and in Japan

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

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