Oocyte Quality Assessment in Breast Cancer: Implications for Fertility Preservation

Abstract

Background: The aim of this study was to evaluate the effects of breast cancer on the ovarian response and on oocyte quality following controlled ovarian hyperstimulation (COH). Methods: This retrospective case-control study evaluated the effects of breast cancer on the ovarian response and on the oocyte quality. Oncological patients with breast cancer undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male or tubal factor infertility were included in the study. Two hundred and ninety-four women were enrolled: 105 affected by breast cancer and 189 healthy women in the control group. Both groups were comparable in terms of age, BMI, and AMH value. Maximal estradiol levels on the triggering day, duration of stimulation, total amount of gonadotropins administered, number of oocytes retrieved, rate of metaphase 2 oocyte production, and numbers of immature and dysmorphic oocytes were analyzed. Results: Considering factors influencing the oocyte quality, such as age, BMI, AMH, duration of stimulation, E2 level on the triggering day, total FSH cumulative dose, stage, histotype, BRCA status, and hormone receptors, the univariate and multivariate analyses identified breast cancer as a risk factor for the presence of dysmorphic oocytes. Conclusions: The diagnosis of breast cancer does not seem to be associated with the impairment of the ovarian reserve, but is linked to a worsening oocyte quality.

Evaluation of Anti-Mullerian Hormone Levels, Antral Follicle Counts, and Mean Ovarian Volumes in Chemotherapy-Induced Amenorrhea among Breast Cancer Patients: A Prospective Clinical Study

“…High levels of AMH affect the quality and number of follicles and provide better fertility rates [10]. In many studies, it was observed that AMH levels and AFC were affected by chemotherapy and decreased significantly with treatment [8,10,17]. In our study, the AMH and AFC values were significantly decreased during follow-up in breast cancer patients who received adjuvant chemotherapy.…”

“…In addition, the continuation of fertility may be more likely in patients with high pre-treatment AMH levels. Ovum cryopreservation is the most commonly used method for the prevention of fertility [8,15,17,20]. Although there is limited information in the literature, the rate of healthy infants is 20-30% in ovarian cryopreservation and is dependent on the age and ovarian reserve of the oncology patients [33].…”

“…In a study we conducted with 20,000 breast cancer patients in Turkey, 17.2% were younger than 40, and 37.2% were pre-menopausal [6]. Ovarian function is affected to different extents in patients receiving adjuvant chemotherapy for breast cancer, depending on the type of treatment and age of the patient [7][8][9]. The loss of primordial follicles, reduced ovarian reserve, and ovarian atrophy are observed depending on the treatment [9].…”

Outcomes of Fertility Preservation for Female Cancer Patients in a Single Tertiary Center

“…Another study also suggested that breast cancer is associated with poor oocyte quality without impairment of ovarian reserve. 35 In addition, factors influencing the oocyte quality, such as age, body mass index, AMH, breast cancer stage, breast cancer gene (BRCA) status, and hormone receptors, were not significantly associated with dysmorphic oocytes. Therefore, that study concluded that breast cancer is the only risk factor for dysmorphic oocytes.…”

The ultrastructural nature of human oocytes’ cytoplasmatic abnormalities and the role of cytoskeleton dysfunction

“…Some anomalies may be attributed to intrinsic factors such as genetic background and patient's age, while others seem to be related to the suboptimal intrafollicular environment (e.g., oxidative stress, hypoxia, proapoptotic factors, inflammation, and hyperglycemia). Recently breast cancer was identified as a risk factor for the presence of dysmorphic oocytes (29). This evidence suggests that alteration of hormonal receptors and/or signaling pathways might impair follicleoocyte dialogue and compromise the quality of developing female gametes.…”