Folliculogenesis in random start protocols for oocytes cryopreservation: quantitative and qualitative aspects

Abstract

Random start protocols are commonly used for oocytes cryopreservation in women with cancer. However, evidence to support their effectiveness is yet modest. This study aims to compare the quality of ovarian response between the ovary carrying the dominant follicle or the corpus luteum (active ovary) and the contralateral ovary (resting ovary). Women with a diagnosis of malignancy who underwent oocytes cryopreservation were reviewed. The main inclusion criterion was the presence of a unilateral dominant follicle or a unilateral corpus luteum on the first day of ovarian hyperstimulation. The primary outcome was the number of mature oocytes retrieved. Intra-patient comparisons between the two ovaries were made using the nonparametric Wilcoxon test for paired data. Forty-three women were included. The number of mature oocytes retrieved from the active and the resting ovaries did not differ, the median [interquartile range—IQR] being 4 [2–7] and 5 [2–8], respectively (p = 0.09). The rate [IQR] of mature oocytes per developed follicle was 58% [40–80%] and 65% [33–87%], respectively (p = 0.42). In addition, no significant difference emerged when repeating the analyses separately for women carrying dominant follicles and for those carrying corpora lutea. This study failed to detect any detrimental effect of the presence of a dominant follicle or a corpus luteus on the ovarian response to hyperstimulation, thus supporting the validity of random start protocols.

Follicular steroidogenesis in random start protocols for oocyte cryopreservation

“…Recently, our group also provided evidence on the validity of random start protocols by comparing ovarian response between the ovary with the functional cyst (dominant follicle or corpus luteum) and the contralateral resting ovary of the same subjects. The results did not show any negative effect on the number of developed follicles and the number of mature oocytes retrieved per ovary [ 20 ].…”

Serum anti-Mullerian hormon seviyesi ve antral follikül sayısının stimule edilmemiş menstruel siklustaki değişiminin saptanması

“…Among ART, protocols in which ovarian stimulation is started randomly at any time of the cycle have been frequently used before chemotherapy or radiotherapy in patients with malignancy who desire fertility (7). In a study that evaluated the ovarian response to hyperstimulation in random start stimulation protocols, no detrimental effect of the presence of corpus luteum or dominant follicle was shown, supporting the applicability of random start protocols (8). In addition, dual stimulation in the same cycle has become a frequently used method as an assisted reproductive treatment method in patients with poor ovarian response in recent years (9).…”

Response to Controlled Ovarian Stimulation Is Not Impaired in Young Patients with a Sarcoma: Results from a Monocentric Case–Control Study

“…Due to potential genetic damage to oocytes, it can only be offered before the beginning of chemotherapy [ 10 ]. In patients with cancer, to avoid excessive delays in cancer treatment initiation, a random-start protocol, which is independent of the menstrual cycle phase, can be adopted without compromising the efficacy of stimulation [ 11 ]. After COS, the final maturation of oocytes is induced and oocytes are retrieved through a transvaginal ultrasound-guided pick-up.…”