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

Abstract

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.

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

“…We ultimately enrolled forty-three women, of whom five were also included in our previous study on the quantitative response [ 14 ]. Baseline clinical characteristics of the selected women are presented in Table 1 .…”

“…Randomized controlled trials are required to properly address this issue. This study design is however difficult to implement in the urgent setting of fertility preservation for cancer [ 14 ]. To note, we cannot also exclude some pre-chemotherapy detrimental effects on ovarian function due to the presence of malignant disorders per se.…”

“…Women with the diagnosis of malignant tumors who underwent oocytes cryopreservation in the Infertility Unit of Ospedale Maggiore Policlinico in Milan between January 2017 and March 2021 were reviewed. The present study is an extension of a recent study of our group [14]. The main inclusion criterion was the presence of a unilateral dominant follicle (i.e., mean diameter > 11 mm) or a unilateral corpus luteum on the first day of ovarian hyperstimulation.…”

“…In this regard, one may argue that the presence of dominant follicles or corpora lutea could display detrimental effects on the surrounding growing follicles [ 14 ]. These functional cysts can secrete several factors with paracrine functions that can potentially interfere with the response to ovarian hyperstimulation.…”

“…They include sex steroids and their metabolites [ 15 ], angiogenic factors [ 16 ] and members of the transforming growth factor-beta (TGF-β) superfamily [ 17 ]. Previous evidence from our group failed to highlight a detrimental effect on the quantitative aspect of ovarian response, but data on the quality of the response are lacking [ 14 ].…”