The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women

Checa, Miguel Ángel; Corchado, Anna Robles; Cuadri, Margalida E. Sastre I.; Comadran, Mireia González; Brassesco, M.; Carreras, Ramón

doi:10.1016/j.rbmo.2012.02.020

Cited by 50 publications

(38 citation statements)

References 24 publications

(29 reference statements)

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“…We observed that the number of mature and oocytes, was significantly (about 40%) lower when Letrozole was used (Table 2). Although an early timing of hCG administration as been held responsible for the higher percentage of immature oocytes in letrozole stimulation (8), in this study also the overall number of retrived oocytes was lower in patients than in controls stimulated without Letrozole.Indeed the number of oocytes obtained in our study by the Le+Gn regimen was lower than previously published (8,19), suggesting a more cautious attitude for COH in Italy and/or a higher proportion of poorly-responding women among Italian patients. It must be remarked, in fact, that about one third of the patients included in our survey was older than 38 at the time of stimulation.…”

Section: Discussioncontrasting

confidence: 79%

“…On the other side the number of oocytes available for freezing is a key issue in determining the chances to preserve fertility especially with the slow -freezing technique, which was applied in the majority of cases in this studyOktay (18) reported a better oocytes recovery with the Le+Gn protocol compared with Tamoxifen-alone and Tamoxifen-plus-Gn in breast cancer patients. However a lower number of retrieved oocytes was observed in Le+Gn-stimulated breast cancer patients compared with Gn-only-stimulated healthy controls (8), and in Le+Gn-stimulated breast cancer patients compared with women with hormonal-independent cancers stimulated by Gn alone (19).…”

Section: Discussionmentioning

confidence: 81%

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Is Letrozole needed for controlled ovarian stimulation in patients with estrogen receptor-positive breast cancer?

Revelli

Porcu

Levi-Setti

et al. 2013

Gynecological Endocrinology

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SummaryObjective: To assess the advantages and disadvantages of using Letrozole for controlled ovarian stimulation (COH) in young patients with estrogen receptorpositive (ER+) breast cancer, wishing to cryopreserve oocytes. Design: Retrospective cohort analysis.Setting: Sixteen Italian Units for Reproductive Medicine and In Vitro Fertilization.Methods: Data of 50 ER+ breast cancer patients undergoing COH to cryopreserve oocytes before gonadotoxic chemotherapy with a Letrozole plus gonadotropins (Le+Gn) protocol were compared with those of 25 young women with ER-breast cancer, submitted to COH using a protocol with gonadotropins alone (Gn-only). Results:The Le+Gn protocol implied a significantly lower total Gn consumption and allowed to maintain significantly lower circulating E2 levels at all checkpoints throughout stimulation (peak E2 value 446 ± 357 vs.1553 ± 908 pg/ml, respectively; p=0.001). On the other side, the Le+Gn protocol allowed a significantly lower yield of oocytes available for cryostorage (6.6 ± 3.5 vs. 8 ± 5, respectively; p=0.038).. Conclusions:In breast cancer patients, the association of Letrozole to Gn significantly reduces the number of oocytes available for cryostorage in comparison with the use of Gn alone. On the other side, it is associated with significantly lower E2 levels during the whole stimulation cycle, a safety issue that has been traditionally considered advantageous in case of ER+ cancers.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 81%

Is Letrozole needed for controlled ovarian stimulation in patients with estrogen receptor-positive breast cancer?

Revelli

Porcu

Levi-Setti

et al. 2013

Gynecological Endocrinology

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“…Moreover, as animal models suggest, estrogen may also play a role in stimulating the growth of estrogen receptor–negative breast cancers [23]. Conventional stimulation protocols with gonadotropins are therefore modified to include administration of the aromatase inhibitor letrozole [9,24] or the selective estrogen modulator tamoxifen [25]. These protocols have been used with success in reducing the estradiol excesses that are normally seen with conventional protocols, and short-term follow-up data for these protocols have not shown any detrimental effects on survival [10].…”

Section: Discussionmentioning

confidence: 99%

Oncofertility: combination of ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval

Dittrich

Lotz

Mueller³

et al. 2013

Reprod Biol Endocrinol

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BackgroundNew anticancer treatments have increased survival rates for cancer patients, but often at the cost of sterility. Several strategies are currently available for preserving fertility. However, the chances of achieving a pregnancy with one technique are still limited. A combination of methods is therefore recommended in order to maximize women’s chances of future fertility. In this retrospective study, ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval were combined and the quality of the ovarian tissue, the numbers and quality of oocytes, time requirements, and the safety of the strategy were examined.MethodsFourteen female patients suffering from malignant diseases underwent one in vitro fertilization cycle. Different stimulation protocols were used, depending on the menstrual cycle. Transvaginal oocyte retrieval was scheduled 34–36 h after human chorionic gonadotropin administration. Immediately afterwards, ovarian tissue was extracted laparoscopically.ResultsA mean of 10 oocytes were retrieved per patient, and 67% of the oocytes were successfully fertilized using intracytoplasmic sperm injection. No periprocedural complications and no complications leading to postponement of the start of chemotherapy occurred. The ovarian tissues were of good quality, with a normal age-related follicular distribution and without carcinoma cell invasion.ConclusionsAn approach using ovarian stimulation first, followed by laparoscopic collection of ovarian tissue, is a useful strategy for increasing the efficacy of fertility preservation techniques. The ovarian tissue is not affected by prior ovarian stimulation.

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“…Whether for oocyte or embryo cryopreservation, the use of ovarian stimulation has caused concern for women with hormone dependent cancers, such as breast cancer [64]. However, current practice supports ovarian stimulation utilizing tamoxifen or letrozole for patients with estrogen-sensitive cancers [64, 65].…”

Section: Established Fertility Preservation Methods For Femalesmentioning

confidence: 99%

“…However, current practice supports ovarian stimulation utilizing tamoxifen or letrozole for patients with estrogen-sensitive cancers [64, 65]. A recent study in the Netherlands found no significant differences in breast cancer risk between non-IVF and IVF-treated women (73).…”

Section: Established Fertility Preservation Methods For Femalesmentioning

confidence: 99%

New promising strategies in oncofertility

Hudson

Stanley

Nahata

et al. 2017

Expert Review of Quality of Life in Cancer Care

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Introduction Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments. Areas Covered Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies. Expert Commentary There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.

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The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women

Cited by 50 publications

References 24 publications

Is Letrozole needed for controlled ovarian stimulation in patients with estrogen receptor-positive breast cancer?

Is Letrozole needed for controlled ovarian stimulation in patients with estrogen receptor-positive breast cancer?

Oncofertility: combination of ovarian stimulation with subsequent ovarian tissue extraction on the day of oocyte retrieval

New promising strategies in oncofertility

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