In vitro maturation improves oocyte or embryo cryopreservation outcome in breast cancer patients undergoing ovarian stimulation for fertility preservation

Fertility preservation in women with breast cancer

Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol whereas similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.

Fertility conservation in breast cancer patients

Breast cancer is the most common malignant tumor in women. Increasing survival rates after breast cancer, new reproductive techniques and growing interest regarding the quality of life after cancer have brought the possibilities of fertility-preserving treatment to the center of attention of oncologists and affected patients. Many of these women suffer from infertility and premature menopause as a result of chemotherapy. Several measures, for example gonadotropin-releasing hormone analogs, hormonal stimulation to cryopreserve oocytes, ovarian tissue cryoconservation or a combination of the methods, can be undertaken depending on the hormone receptor status of the tumor, and the patient's age and partner status. Embryo cryopreservation is currently the most promising fertility preservation option. Early counseling on fertility-preserving strategies is of utmost importance, so that the fertility-preserving method can be integrated into the oncologic therapy regime.

Random-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles

OBJECTIVE

To report an emergency approach of random-start controlled ovarian hyperstimulation (COH) in the late follicular or luteal phase of the menstrual cycle for embryo cryopreservation in patients with cancer.

DESIGN

Case series.

SETTING

Academic tertiary referral centers.

PATIENT(S)

Three patients with a diagnosis of breast cancer requiring emergency fertility preservation in the late follicular or luteal phase of the menstrual cycle.

INTERVENTION(S)

After baseline pelvic ultrasound and hormonal evaluation, random-start COH was commenced immediately on menstrual cycle days 11, 14, or 17 with use of letrozole 2.5 mg/d and recombinant FSH 150 to 300 IU/d. Gonadotropin-releasing hormone antagonist was administered to prevent ovulation in all cases. Ovulation was triggered with either 250 μg of recombinant hCG or 10,000 IU of urinary hCG.

MAIN OUTCOME MEASURE(S)

Number of oocytes harvested, maturity and fertilization rates, number of embryos frozen.

RESULT(S)

Nine to 17 oocytes were harvested, resulting in the freezing of seven to 10 embryos with the mean maturity and fertilization rates of 58.8% to 77.7% and 69.2% to 87.5%, respectively.

CONCLUSION(S)

In an emergent setting, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising fertilization rates in letrozole cycles.