Background: While breast cancer among women in general has been well studied, little is known about breast cancer in sexual minority women (SMW). Aside from being at an increased risk for development of, and mortality from, breast cancer compared to their heterosexual counterparts, there is a growing collection of literature that suggests that SMW experience breast cancer differently to heterosexual women. Methods: Qualitative study of both straight and lesbian women with a diagnosis of breast cancer. Focus groups were conducted to assess straight and SMW experiences pertaining to perceived barriers, resources/support from partners as well as attitudes pertaining to breast reconstruction. Results: A sample of 15 participants (10 straight and 5 lesbian women) were included in the present study. Focus group themes focused on support, wishes for support, satisfaction with inclusion of partner, fear, perceived discrimination, quality of life, body image, treatment delay, financial concern, frustration with the system, reconstruction, access to information, and attitudes towards cancer diagnosis. A majority of women in both groups chose to undergo breast reconstruction. Conclusion: In our study, SMW experienced their breast cancer treatment through a uniquely supportive and positive lens, often with higher relationship satisfaction and better self-image when compared to straight women.

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transabdominally with lower-than-expected AFC for her AMH. She elected to have her ovaries released robotically from the abdominal wall by gynecologic oncology at the time of debulking surgery for her recurrent rectal cancer. The released ovaries were sutured bilaterally to the pelvic side wall peritoneum to ensure ovarian stability. The patient proceeded with ovarian stimulation five weeks following her ovarian transposition release procedure using straight start with antagonist protocol and 250 IU of Gonal-F to start.RESULTS: Transvaginal ultrasound following surgery demonstrated excellent visualization of the ovaries in the pelvis. AFC was 18 at the beginning of ovarian stimulation. Ovarian stimulation required 11 days and the patient required a total of 2750 IU of Gonal-F and 450 IU of Menopur. She was triggered with Lupron and 1000 IU of hCG with 18 follicles between 12 mm to 21 mm. A total of 15 oocytes were retrieved, 12 were MII and cryopreserved. The remaining three oocytes included one MI, one germinal vesicle, and one empty cumulus. The patient did well post operatively and did not have any complications.CONCLUSIONS: One concern with release of the ovarian pedicles during transposition reversal is hypermobility of the ovaries precluding safe transvaginal oocyte retrieval. We demonstrate that this procedure can be done safely with attention to suturing of the ovaries to the pelvic side wall at the time of reversal that resulted in a good outcome for this patient.IMPACT STATEMENT: This is the first case of transvaginal oocyte retrieval following ovarian transposition and reversal to be reported in the literature and demonstrate the feasibility and safety of this procedure.

OBJECTIVE: To investigate whether switching GnRH antagonist (GnRHant) to medroxyprogesterone acetate (MPA) could effectively prevent premature LH surge in GnRHant protocols when patients turned out to have a high risk of OHSS during controlled ovarian stimulation (COS) and a freezeall strategy was chosen.DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This study recruited patients (<38 years old) who received a GnRHant protocol in their first IVF/ICSI cycle. Daily rFSH and GnRHant were started on cycle day 2 or 3, and stimulation day 5, respectively. During COS, the patients turned out to be at a high risk of developing OHSS (more than 13 follicles of R11 mm in diameter) before reaching the ovulation trigger criteria. It is our policy to freeze-all in this circumstance. GnRH agonist was used to trigger ovulation. All the grade A or B embryos were vitrified on day 3 and frozen embryo transfer (FET) was performed on the subsequent cycle. In the study group (from August 2016 to July 2017) GnRHant was switched to MPA of 10mg daily till the day of ovulation trigger once freeze-all was determined (switch protocol). In the control group (from August 2015 to July 2016), GnRHant was maintained till the day of ovulation trigger as traditional GnRHant protocols. The primary outcome measure was the incidence of premature LH surge. Secondary outcome measures were the duration of GnRHant/MPA administration, duration/dose of rFSH administration, number of oocytes retrieved, number of embryos frozen, implantation and live birth rate in the first FET cycle.RESULTS: A total of 401 cycles met the inclusion criteria for analysis: 205 in the control group and 196 in the study group. Premature LH surge did not occur in both groups. The characteristics of ovarian stimulation were similar between the two groups except the duration of GnRHant/MPA administration. The duration of GnRHant treatment was significantly lower in the switch protocol compared with the GnRHant protocol (3.1AE1.0 days vs. 6.5AE1.2 days). Majority of the patients (173/196¼88.3%) received 2-4 days of GnRHant treatment before switching to MPA. Majority of the patients (185/ 196¼94.4%) received 2-5 days of MPA treatment. The mean (AESD) duration of MPA administration was 3.6AE1.1 days. No significant differences were observed in the duration (10.6AE1.1 days vs. 10.5AE1.2 days) and dose (1929AE450 IU vs. 2005AE483 IU) of rFSH administration; trigger day serum LH levels (2.0AE1.4 IU/L vs. 1.8AE1.1 IU/L); number of oocytes retrieved (17.0AE6.4 vs. 16.9AE5.9); number of embryos frozen (7.8AE3.1 vs. 7.9AE2.8); or live birth rate (50.5% vs. 49.8%) between switch and GnRHant protocol.CONCLUSIONS: This study showed that MPA could replace GnRHant and effectively prevent premature LH surge after several days of GnRHant This study showed that MPA could replace GnRHant and effectively prevent premature LH surge after several days of GnRHant administration in this group of patients. Switch protocol could individualize freeze-all policy in contrast to freeze-all for all i...

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