Fertility preservation in female oncology patients: the influence of the type of cancer on ovarian stimulation response

Pontes

et al. 2017

Aim of the studyThe authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen.Material and methodsForty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35–36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger.ResultsThe mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10.ConclusionsThe authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.

Section: Discussionmentioning

confidence: 99%

A specific controlled ovarian stimulation (COS) protocol for fertility preservation in women with breast cancer undergoing neoadjuvant chemotherapy

Pontes

et al. 2017

“…Alvarez et al assessed the influence of different type of cancer on the ovarian response to COS analysing the results of 306 patients. Patients with gynaecological cancer had fewer oocytes retrieved comparing to patients with haematological or breast cancer (Alvarez & Ramanathan, 2016)…”

mentioning

confidence: 94%

Ovarian response to controlled ovarian stimulation for fertility preservation before oncology treatment: A retrospective cohort of 157 patients

et al. 2017

This is a retrospective cohort study aiming to examine the response of oncology patients undergoing controlled ovarian stimulation (COS) for fertility preservation and to review the incidence of short-term complications. The study group consisted by all oncology patients undergoing ovarian stimulation for fertility preservation (n = 157) between April 2009 and April 2016. Patients undergoing COS for IVF/ICSI for male factor only infertility in the same time period (n = 2,128) provided a comparator group. Oncology patients underwent COS to retrieve eggs for storage and future use. The cancer patients had a very similar distribution of oocyte yield to the comparator group. Those with ovarian cancer did have significantly lower oocyte recovery than those with other cancers (age-adjusted difference 7, 95% CI: 2-12). None of the patients in the study group were admitted with ovarian hyperstimulation syndrome or any other complication of COS or oocyte retrieval. This is one of the largest reported cohorts of patients treated for fertility preservation before oncology treatment. Our data have demonstrated a good response to stimulation, offering a reasonable chance of pregnancy in the future. In contrast to previous studies, we have demonstrated a similar number of oocytes retrieved to that of women undergoing IVF/ICSI treatment for male factor infertility.

Geburtshilfe Frauenheilkd

“…This cytotoxicity is reversible in organs with a high cell division rate, such as bone marrow, gastro-intestinal tract or thymus, for example. The ovaries, on the other hand, are damaged by chemotherapy to varying degrees because of their limited number of cells with no potential for replication or regeneration of the follicles 8 , 9 . This can result in permanent infertility of the affected women, see Tables 1 and 2 .…”

Section: Introductionmentioning

confidence: 99%

“…B. Knochenmark, GI-Trakt oder Thymus, reversibel. Die Ovarien hingegen werden aufgrund ihrer begrenzten Zellzahl mit fehlender Replikation und Regeneration der Follikel durch die Chemotherapie in unterschiedlichem Ausmaß geschädigt 8 , 9 . Dies kann zu einer permanenten Infertilität der betroffenen Frauen führen, siehe Tab.…”

Section: Introductionunclassified

Fertility Preservation in Female Patients with Breast Cancer – a Current Overview

Guenther¹,

Alkatout²,

Junkers

et al. 2017

Many premenopausal patients who develop breast cancer have not yet completed their family planning, so measures of fertility protection to preserve their fertile potential would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles – irrespective of whether in a neoadjuvant or adjuvant setting – and this can sometimes result in permanent infertility. Depending on which cytostatic agents are used and on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified as low, moderate or high. Options of fertility preservation include: a) cryopreservation of fertilised or unfertilised oocytes. After ovarian hyperstimulation, mature oocytes are retrieved by transvaginal follicle aspiration, after which they are cryopreserved, either unfertilised or on completion of IVF or ICSI treatment. During b) cryopreservation of ovarian tissue, about 50% of the ovarian cortex of one ovary is resected with the aid of a laparoscopic procedure and cryopreserved. The application of c) GnRH agonists as a medicinal therapy option is an attempt at endocrine ovarian suppression in order to protect oocytes, granulosa cells and theca cells from the cytotoxic effect of chemotherapy.