Ovarian response and follow-up outcomes in women diagnosed with cancer having fertility preservation: Comparison of random start and early follicular phase stimulation - cohort study

Muteshi, Charles M.; Child, Tim; Ohuma, Eric O; Fatum, Muhammad

doi:10.1016/j.ejogrb.2018.09.007

Cited by 25 publications

(15 citation statements)

References 27 publications

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“…The follow-up time of this study of about 3 years, as well as the percentage of breast cancer, corresponds to our data. The utilisation rates of cryopreserved embryos or oocytes of 8-29% reported by Rodriguez-Wallberg [8] correspond to another European study, in which an utilisation rate of 24% is reported [10]. Interestingly, in this study with 137 women, who underwent hormonal stimulation for fertility preservation reasons between 2003 and 2016, a disposal rate of 12% without utilisation was described for cryopreserved embryos and oocytes in cancer patients.…”

Section: Discussionsupporting

confidence: 83%

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

Goeckenjan

Freis

Glaß

et al. 2020

Arch Gynecol Obstet

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Purpose Due to modern and individualised treatments, women at reproductive age have a high survival rate after cancer therapy. What are pregnancy and birth rates of women after cancer and how often do they use cryopreserved ovarian tissue or gametes? Methods From 2007 to 2015, 162 women aged 26.7 ± 6.9 years were counselled for fertility preservation at a single University Fertility Centre. A questionnaire study was performed in average 3 and 6 years after the diagnosis of cancer. The women were asked about their fertility, partnership, family planning, and pregnancy history. 72 women (51%) answered a written questionnaire in 2016. 59 women were reached again by phone in 2019 (82%). Results The preferred method of fertility preservation was ovarian tissue cryopreservation (n = 36, 50%); none of the women had ovarian hyperstimulation in order to cryopreserve oocytes. About 3 years after treatment, 37 women of 72 women (51%) of the women with a mean age of 29.9 years had a strong wish to conceive. 21/72 (29%) had actively tried to conceive after successful cancer treatment; eight women (11%) were already pregnant or had children. Six years after cancer diagnosis 16/59 (27%) women had ongoing anticancer treatment. 12/59 (20%) were pregnant or had children, while 39% (23/59) had no menstrual cycle. Only one woman used her cryopreserved ovarian tissue, but did not become pregnant. Conclusion After cancer and gonadotoxic treatment, women's desire to have a child is substantial. In this study, the rate of spontaneous pregnancies and births was 20% 6 years after gonadotoxic therapies. Not every woman, however, has the opportunity to conceive: factors impairing fertility include ongoing cancer treatment or persistent disease, no partner, no menstrual cycle, as well as other reasons for infertility.

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Section: Discussionsupporting

confidence: 83%

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

Goeckenjan

Freis

Glaß

et al. 2020

Arch Gynecol Obstet

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“…This difference has attracted little attention despite the fact that newly diagnosed women wanting FP often urgently needs gonadotoxic treatment. COS and oocyte aspiration are usually considered to take around 2 weeks, even with random‐start protocols, whereas ovarian tissue does not need any pretreatment and can be excised as soon as an operation can be scheduled . Most studies on FP, irrespective of whether focus is on freezing mature oocytes/embryos or ovarian tissue, state that the procedure was performed without delaying cancer treatment .…”

Section: Introductionmentioning

confidence: 99%

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility‐preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. Material and methods The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC‐referral to OTC. A literature search for “random start” protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. Results The time from OTC‐referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13‐17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13‐14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later. Conclusions It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

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“…Twenty-nine (32%) women initiated the stimulation in the proliferative phase (presence of a dominant follicle) whereas the remaining 61 (68%) started in the luteal phase (presence of a corpus luteum). In the former group, the median (IQR) time between the initiation of the last menses and the initiation of COS was 11 (8)(9)(10)(11)(12)(13)(14)(15) days. In the latter group, it was 22 (18-27) days (p < 0.001).…”

Section: Resultsmentioning

confidence: 98%

“…The patent clinical advantages of random start protocols have facilitated their rapid spread worldwide. Several case series and comparative studies have been published over the last few years 4,10,[12][13][14][15][16][17][18] . They are reassuring and generally support the feasibility and effectiveness of these protocols.…”

mentioning

confidence: 99%

The presence of dominant follicles and corpora lutea does not perturb response to controlled ovarian stimulation in random start protocols

Filippi

Somigliana

Busnelli

et al. 2020

Sci Rep

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The advent of random start protocols to shorten the time needed to store oocytes in women with malignancies has represented an important improvement in the field of fertility preservation. However, Randomized Controlled Trials are difficult to implement in this area and available evidence that supports this approach remains modest. To shed more light on this issue, we compared the follicular development between the ovary carrying the dominant follicle or the corpus luteum and the contralateral resting ovary in 90 women who underwent random start controlled ovarian stimulation (COS). In fact, ovarian response did not differ between the two ovaries. Subgroup analyses according to the phase of the cycle at the initiation of COS, the type of malignancy, the use of letrozole and the magnitude of the ovarian response did not allow to identify any condition showing a difference in the follicular response between the active and the resting ovaries. In conclusion, follicular growth does not seem to be perturbed by the presence of a dominant follicle or a corpus luteum.

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Ovarian response and follow-up outcomes in women diagnosed with cancer having fertility preservation: Comparison of random start and early follicular phase stimulation - cohort study

Cited by 25 publications

References 27 publications

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

Motherhood after cancer: fertility and utilisation of fertility-preservation methods

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

The presence of dominant follicles and corpora lutea does not perturb response to controlled ovarian stimulation in random start protocols

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