Specific Protocols of Controlled Ovarian Stimulation for Oocyte Cryopreservation in Breast Cancer Patients

Abstract

Background Fertility preservation is an important concern in breast cancer patients. In the present investigation, we set out to create a specific protocol of controlled ovarian stimulation (cos) for oocyte cryopreservation in breast cancer patients.Methods From November 2014 to December 2016, 109 patients were studied. The patients were assigned to a specific random-start ovarian stimulation protocol for oocyte cryopreservation. The endpoints were the numbers of oocytes retrieved and of mature oocytes cryopreserved, the total number of days of ovarian stimulation, the total dose of gonadotropin administered, and the estradiol level on the day of the trigger.Results Mean age in this cohort was 31.27 ± 4.23 years. The average duration of cos was 10.0 ± 1.39 days. The mean number of oocytes collected was 11.62 ± 7.96 and the mean number of vitrified oocytes was 9.60 ± 6.87. The mean estradiol concentration on triggering day was 706.30 ± 450.48 pg/mL, and the mean dose of gonadotropins administered was 2610.00 ± 716.51 IU. When comparing outcomes by phase of the cycle in which cos was commenced, we observed no significant differences in the numbers of oocytes collected and vitrified, the length of ovarian stimulation, and the estradiol level on trigger day. The total dose of follicle-stimulating hormone and human menopausal gonadotropin administered was statistically greater in the group starting cos in the luteal phase than in the group starting in the late follicular phase.Conclusions Our results suggest that using a specific protocol with random-start ovarian stimulation for oocyte cryopreservation in breast cancer patients is effective and could be offered to young women undergoing oncologic treatment.

The presence of dominant follicles and corpora lutea does not perturb response to controlled ovarian stimulation in random start protocols

“…In general, our study supports the validity of random start protocols and results are in line with previous evidence on this subject 4,10,[12][13][14][15][16][17][18] . However, to the best of our knowledge, our study design has not been previously used to investigate this issue and adds new information.…”

“…The patent clinical advantages of random start protocols have facilitated their rapid spread worldwide. Several case series and comparative studies have been published over the last few years 4,10,[12][13][14][15][16][17][18] . They are reassuring and generally support the feasibility and effectiveness of these protocols.…”

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

“…Some previous studies have demonstrated that a letrozole plus gonadotropin protocol is effective for safely inducing patients with breast tumor before initiating adjuvant chemotherapy ( Cavagna et al ., 2018 ), without increasing rates of its recurrence and without decreasing oocyte yield. Nonetheless, fertility preservation should always be initiated in agreement with the patient’s oncologist ( Reddy & Oktay, 2012 ; Rodriguez-Wallberg & Oktay, 2010 ; Rodgers et al ., 2017 ; Taylan & Oktay, 2017 ; Ben-Haroush et al ., 2011 ; Checa Vizcaino et al ., 2012 ; Keskin et al ., 2014 ).…”

“…Controlled ovarian stimulation for fertility preservation in patients with breast cancer was performed in a random-start protocol, as proposed by our group in a previous study ( Cavagna et al ., 2018 ), by using letrozole 5 mg/day orally in combination with recombinant or urinary follicle stimulating hormone (FSH) 150-300 IU/day subcutaneously, associated or not with luteinizing hormone (LH), according to ovarian reserve and patient’s age, in order to optimize the ovarian response of these patients. Pituitary blockade was obtained with GnRH antagonist (cetrorelix acetate or ganirelix acetate 0.25 mg/day) subcutaneously in the presence of at least one follicle with ≥ 14 mm diameter.…”

Oocyte cryopreservation: a narrative review

“…The random-start protocol 24 initiates ovarian stimulation at the time of patient presentation rather than waiting for spontaneous menstruation. It is equally effective as conventional start protocol in terms of the total number of mature oocytes retrieved, oocyte maturity rate and fertilisation rate, irrespective of whether the stimulation is started in the late follicular phase or the luteal phase [25][26][27][28] .…”