Controlled ovarian hyperstimulation for fertility preservation in women with breast cancer: Practical issues

Abstract

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer.

Donor side effects experienced under minimal controlled ovarian stimulation (COS) with in vitro maturation (IVM) versus conventional COS forin vitrofertilization (IVF) treatment

“…In the case of PCOS patients, the high response of polycystic ovaries to gonadotropins creates a challenge in managing the response to COS, potentially resulting in OHSS and ovarian torsion in severe cases (34). For women with hormone-sensitive cancers, such as estrogen receptor-positive breast cancer, the prolonged ovarian simulations are also not recommended (35), as the administration of gonadotropins over 10–14 days to achieve multi-follicular development results in increased serum estradiol levels (36). In this retrospective study of minimal COS, no instance of ovarian torsion, OHSS, or hospitalization as a result of treatment was noted and acquisition of mature oocytes via IVM was accomplished with 2 to 4 days of minimal COS. Based on these findings, minimal COS and IVM may be an effective treatment strategy for improving patient safety during treatment for women at risk of OHSS and for women requiring abbreviated, low dose stimulation due to medical contraindication.…”

Investigation of an efficient method of oocyte retrieval by dual stimulation for patients with cancer

“…Despite recent reports 10,11,[13][14][15]19 on dual stimulation, none mention the period between the first oocyte retrieval and start of the second ovarian stimulation. Even after oocyte retrieval, many ovaries remain normal-sized in poor ovarian responders.…”

“…4 Ovarian tissue cryopreservation is used worldwide, and the number of pregnancies after its implantation gradually increases, demonstrating its effectiveness. [5][6][7] Various ovarian stimulation methods, including random start [8][9][10][11] and dual stimulation, [10][11][12][13] can minimize the impact of ovarian stimulation on the timing of cancer treatment initiation. For the random start method, ovarian stimulation is initiated by injections of folliclestimulating hormone (FSH) and other substances regardless of the menstrual cycle; therefore, it is very beneficial for patients who are about to begin cancer treatment as it shortens the duration of ovarian stimulation.…”

“… 14 , 15 In this study, we defined a poor responder as a case that meets the Bologna criteria 15 and a good responder as any other case where the ovary responds well to the ovarian‐stimulating hormone. For patients with cancer, the dual stimulation method is usually performed in good responders 11 but frequently results in ovarian hyperstimulation syndrome (OHSS) after the first oocyte retrieval procedure. 16 This can lead to reluctance to start the second oocyte retrieval using ovarian stimulation, and the delay may have potential consequences for the scheduling of subsequent chemotherapy.…”