Fertility Preservation in Breast Cancer Patients: A Prospective Controlled Comparison of Ovarian Stimulation With Tamoxifen and Letrozole for Embryo Cryopreservation

Oktay, Kutluk; Büyük, Erkan; Libertella, Natalie; Akar, Münire Erman; Rosenwaks, Zev

doi:10.1200/jco.2005.05.037

Cited by 507 publications

(285 citation statements)

References 30 publications

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“…While oocyte collection can also be performed without ovarian stimulation, the embryo yield is extremely low. For women with hormonesensitive tumors, alternative hormonal stimulation strategies such as letrozole or tamoxifen have been developed to reduce the potential risk of estrogen exposure [49]. New methods, such as in vitro follicle maturation and ovarian tissue cryopreservation and transplantation, are under active investigation [50,51].…”

Section: Methodsmentioning

confidence: 99%

Pregnancy after breast cancer: if you wish, ma’am

Pagani

Partridge

Korde

et al. 2011

Breast Cancer Res Treat

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A growing number of young breast cancer survivors consider reproductive health issues, including subsequent fertility and pregnancy, of great importance, but many questions regarding safety remain unanswered. We conducted a comprehensive literature search and review of published articles, control-matched, population-based, and co-operative group reports that addressed various aspects of pregnancy after breast cancer (patients' expectations, fertility damage, assessment and preservation, maternal and fetal outcome, breast feeding). Overall, available data support pregnancy and breast feeding after breast cancer as safe and feasible for women at low risk of recurrence. This retrospective and population-based evidence is, however, frequently incomplete; usually not representative of the entire population, it can be biased by patients' related effects or underpowered and is often not controlled for biological factors and risk determinants in the statistical model used. Before making any definitive assumption on this delicate and fundamental aspect of a woman's life after breast cancer, we should demonstrate without any reasonable doubt that the scattered information available today is scientifically sound. The Breast International Group and North American Breast Cancer Group are planning a global prospective study in young women with endocrine responsive, early breast cancer who desire pregnancy, to assess both patients' and pregnancy outcomes. The trial will include an observational phase investigating the feasibility and impact of a temporary treatment interruption to allow conception and an experimental phase investigating the optimal duration of the subsequent endocrine treatment after delivery or the last failed attempt to get pregnant.

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Section: Methodsmentioning

confidence: 99%

Pregnancy after breast cancer: if you wish, ma’am

Pagani

Partridge

Korde

et al. 2011

Breast Cancer Res Treat

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“…One established parameter for this evaluation is the evaluation of the AMH-level (AntiMueller-Hormone). A thinkable usage of Letrozol or Tamoxifen with gonadotropin treatment for stimulation is possible [48]. This combination produces comparable results to standard in vitro fertilization, without a significant increase in estradiol levels and delay in the initiation of chemotherapy [49], but has to be seen critical in regard of flexibility of stimulation as well as recurrence and a higher rate of motoric disorders and cardiac malformations [36].…”

Section: Possibilities Of Ovarian Protectionmentioning

confidence: 97%

Controversies in preservation of ovary function and fertility in patients with breast cancer

Gerber

Dieterich

Müller

et al. 2007

Breast Cancer Res Treat

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Improved treatment of breast cancer in premenopausal patients increased survival rates, but the therapy may influence fertility and ovarian function. Currently there is a big public and individual interest of breast cancer affected women in preservation of ovarian function and fertility. Chemotherapy induced amenorrhea (CIA) has many objective (osteoporosis, cardiovascular, urogenital atrophy, cognitive etc.) and subjective (hot flushes, sleep disturbances, change of mood etc.) consequences. In patients with breast cancer who wish to avoid a CIA and to preserve their fertility ovarian protection by GnRH agonists, cryopreservation of operative sampled ovarian tissue or obtained fertilized or non-fertilized eggs after stimulation and puncture or embryos after in vitro fertilization are technically possible. However there are no evidence-based recommendations for preservation of fertility or ovarian function in breast cancer patients. Except the cryopreservation of embryos all other procedures are experimental. It is also undefined who is going to carry the costs. Moreover, there are recent data that the reappearance of ovarian hormones may stimulate occult tumor cells in hormone sensitive breast cancer. Therefore it seems necessary to inform breast cancer patients about the possible negative effects of preservation of ovarian function.

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“…However, results from animal experiments cannot simply be extrapolated to the human situation [2]. Table 3 shows the key characteristics of the four randomized studies carried out to show a protective effect of GnRH analogues on ovarian function [4][5][6][7]. The age of patients included was inconsistent.…”

Section: Potential Preservation Of Ovarian Function With Gnrh Analogumentioning

confidence: 99%

“…The broad age range of patients included in these studies most probably was responsible for the inconsistent findings. GnRH-treatment was performed for 2 years in one study [7] while in the three others ovarian blockade was performed during chemotherapy only [5][6][7]. Unfortunately, the adjuvant chemotherapy regimen administered had in part not represented the international standard [6] (Tab.…”

Section: Potential Preservation Of Ovarian Function With Gnrh Analogumentioning

confidence: 99%

Fertility preservation and infertility treatment in breast cancer patients

Petru

2010

Wien Med Wochenschr

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About 12% of breast cancer cases occur before the age of 35 years. Thus, young patients may consider preservation of ovarian function during cytotoxic therapy and/or childbearing after treatment. Besides the exposure to cytotoxic agents over several months, a significant number of patients will need sequential antihormonal therapy for years. Thus, even young patients at diagnosis may have to postpone pregnancy for years. At that time, the probability of pregnancy may per se be considerably reduced. Young patients per se carry a worse prognosis compared to their postmenopausal counterparts. Ovaries may harbor viable tumor cells. Premenopausal patients have a higher prevalence of BRCA gene mutation than older patients. Thus, even if the ovaries are preserved, the risk of developing cancer in the ovary may be high. Normal menstrual cyclicity after chemotherapy/antihormonal therapy does not preclude premature ovarian failure. After antineoplastic therapy, it is recommended to wait at least for two months before the evaluation of the ovarian function. The most reliable parameter to assess the ovarian reserve is the anti-muellerian factor (AMH; Muellerian Inhibiting Factor, MIF). Four randomized studies have investigated the protective effect of the GnRH analogue goserelin on ovarian function. Due to the inconsistent results observed, the concurrent administration of GnRH analogues with cytostatic chemotherapy now has to be considered experimental and cannot be recommended. Emergency in vitro fertilization may be performed between breast cancer diagnosis and the start of chemotherapy in selected cases. Extracorporal in vitro fertilization may be performed and the resultant embryo cryopreserved to preserve fertility.

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Fertility Preservation in Breast Cancer Patients: A Prospective Controlled Comparison of Ovarian Stimulation With Tamoxifen and Letrozole for Embryo Cryopreservation

Abstract: The combination of low-dose FSH with tamoxifen (TamFSH-IVF) or letrozole (Letrozole-IVF) results in higher embryo yield compared with Tam-IVF. Recurrence rates do not seem to be increased, but the letrozole protocol may be preferred because it results in lower peak E2 levels.

Cited by 507 publications

References 30 publications

Pregnancy after breast cancer: if you wish, ma’am

Pregnancy after breast cancer: if you wish, ma’am

Controversies in preservation of ovary function and fertility in patients with breast cancer

Fertility preservation and infertility treatment in breast cancer patients

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