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

Abstract

Purpose To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation. Methods One hundred twenty-nine women aged≤45 years, diagnosed with stage≤3 breast cancer, with normal ovarian reserve who desired fertility preservation were included in the retrospective cohort study. Ovarian stimulation was achieved utilizing letrozole and gonadotropins. Oocyte maturation was triggered with GnRHa or hCG. Baseline AMH levels, number of oocytes, maturation and fertilization rates, number of embryos, and the incidence of OHSS was recorded. Results The serum AMH levels were similar between GnRHa and hCG groups (2.7±1.9 vs. 2.1±1.8; p=0.327). There was one case of mild or moderate OHSS in the GnRHa group compared to 12 in the hCG group (2.1 % vs. 14.4 %, p=0.032). The maturation and fertilization rates, and the number of cryopreserved embryos were significantly higher in the GnRHa group.Conclusions GnRHa trigger improved cycle outcomes as evidenced by the number of mature oocytes and cryopreserved embryos, while significantly reducing the risk of OHSS in breast cancer patients undergoing fertility preservation.

Prediction of efficacy of gonadotropin releasing hormone agonist trigger for final oocyte maturation through post-trigger 12-hour luteinizing hormone, follicle stimulating hormone and progesterone levels in COS: a prospective study

“…Reddy et al corroborated that GnRHa trigger arm yielded significantly more mature oocytes and higher fertilization rates than the h CG trigger arm and resulted in lower estrogen levels and OHSS rate in breast cancer patients. 15 These findings have also been inferred by other recent studies.…”

Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer

“…15 Briefly, letrozole (Novartis Oncology, East Hanover, NJ) 5 mg per day was initiated on cycle day 2 (CD2) followed by gonadotropins (follicle-stimulating hormone; Organon, West Orange, NJ, or follitropin alfa; Serono, Rockville, MD), 150 to 450 IU per day on CD4. 15 Briefly, letrozole (Novartis Oncology, East Hanover, NJ) 5 mg per day was initiated on cycle day 2 (CD2) followed by gonadotropins (follicle-stimulating hormone; Organon, West Orange, NJ, or follitropin alfa; Serono, Rockville, MD), 150 to 450 IU per day on CD4.…”

Embryo Cryopreservation in Breast Cancer Patients

“…Some special considerations should be given to ovarian stimulation for fertility preservation in breast cancer patients. First, the ideal ovarian stimulation regimen for fertility preservation in breast cancer patients should have a low risk of ovarian hyperstimulation syndrome (OHSS), as the majority of these patients will need to start chemotherapy shortly after oocyte retrieval [24,25]. It is also important to reduce estrogen exposure during COH for fertility preservation, as higher hormonal levels may accelerate tumor growth in breast cancer [26].…”

“…Furthermore, the use of antagonist provides the opportunity to use a GnRH agonist to trigger final oocyte maturation, thereby possibly further decreasing the risk of OHSS [24,25]. The use of GnRH agonist trigger can also reduce the time interval from oocyte retrieval to the next menses, because of the suppressive effects that agonists may exert on ovarian response to gonadotropin stimulation [21].…”