Random‐start ovarian stimulation with aromatase inhibitor for fertility preservation in women with Japanese breast cancer

Abstract

Purpose Fertility preservation is an important issue for young cancer patients. Random‐start controlled ovarian stimulation and double ovarian stimulation have been proposed for efficient oocyte retrieval within the limited time before cancer therapy. We aimed to clarify the efficacy of these new protocols within the Japanese population. Methods We performed a retrospective observational study at a multicenter from February 2012 to August 2017. The study entailed 50 cycles with 34 patients who underwent fertility preservation due to breast cancer. Follicular phase or luteal phase ovarian stimulation with aromatase inhibitor was performed. A second ovarian stimulation was started with or without waiting until the next menstruation. We measured the number of retrieved oocytes and cryopreserved oocytes/embryos, the ratio of mature oocytes, and the fertilization rate. Results The numbers of retrieved oocytes and frozen oocytes/embryos were not significantly different between follicular phase and luteal phase ovarian stimulation. The number of retrieved oocytes was not reduced at the second ovum pick up compared to the first ovum pick up in the double ovarian stimulation. Conclusions Random‐start controlled ovarian stimulation and double ovarian stimulation with aromatase inhibitor for breast cancer patients were effective protocols for retrieving a greater number of oocytes within the limited time.

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

“…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).…”

“…In women recruited after January 2017 when collected oocytes were counted separately for the two ovaries (n = 23), the median (IQR) number of oocytes retrieved in the active and resting ovaries was 7 (4-10) and 9 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), respectively (p = 0.38). The median (IQR) ratio between the number of oocytes retrieved and the number of developed follicles was 0.67 (0.57-1.00) and 0.84 (0.67-1.00), respectively (p = 0.24).…”

“…This approach has allowed to overcome most concerns about the possible detrimental impact of a delay in the initiation of radio or chemotherapy on cancer prognosis [7][8][9] . Noteworthy, in selected situations, women have even sufficient time to perform two COS cycles in a row, thus increasing the total number of frozen oocytes 10,11 .…”

“…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.…”

Fertility preservation in BRCA mutation carriers—efficacy and safety issues: a review

“…Moreover, COH can be time consuming as it requires 2-5 weeks for COS [58]. Recent studies have shown stimulating the patient regardless of her menstrual-cycle phase, which is defined as random-start COS, has outcomes similar to conventional early follicular phase-start COS for fertility preservation in cancer patients [59,60]. This protocol would minimize COS cycle to 2-3 weeks, but still time-consuming.…”