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Hatırnaz Ş, Saynur Hatırnaz E, Başbuğ A, Kanat Pektaş M, Erol O, Dahan M, Tan S. In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study. Turk J Obstet Gynecol 2020; 17:247-252. [PMID: 33343970 PMCID: PMC7731609 DOI: 10.4274/tjod.galenos.2020.79446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/04/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming. Materials and Methods: This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming. Results: The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Müllerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase II and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682). Conclusion: Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.
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Affiliation(s)
| | | | - Alper Başbuğ
- Düzce University Faculty of Medicine, Department of Obstetrics and Gynecology, Düzce, Turkey
| | - Mine Kanat Pektaş
- Afyon Health Sciences University Hospital, Clinic of Obstetrics and Gynecology, Afyonkarahisar, Turkey
| | - Onur Erol
- Antalya Training and Research Hospital, Clinic of Obstetrics and Gynecology, Antalya, Turkey
| | - Michael Dahan
- McGill University Faculty of Medicine, Department of Obstetrics and Gynecology, Montreal, Quebec, Canada
| | - Seang Tan
- Originelle Women's Health and Fertility Center, Montreal, Quebec, Canada
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Benoit A, Grynberg M, Morello R, Sermondade N, Grandazzi G, Moutel G. Does a web-based decision aid improve informed choice for fertility preservation in women with breast cancer (DECISIF)? Study protocol for a randomised controlled trial. BMJ Open 2020; 10:e031739. [PMID: 32047010 PMCID: PMC7044978 DOI: 10.1136/bmjopen-2019-031739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Chemotherapy may cause infertility in young survivors of breast cancer. Various fertility preservation techniques increase the likelihood of survivors becoming genetic mothers. Disclosure of cancer diagnosis may impact decision making about fertility preservation. This protocol will develop and test the effectiveness of a web-based decision aid for helping women with breast cancer to make well-informed choices about fertility preservation. METHODS AND ANALYSIS This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients. ETHICS AND DISSEMINATION This study protocol was approved by the Ouest V Research Ethics Board. Results will be spread through peer-reviewed publications, and reported at suitable meetings. TRIAL REGISTRATION NUMBER The ClinicalTrials.gov registry .(NCT03591848).
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Affiliation(s)
- Alexandra Benoit
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Université, Caen, France
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
- U1133, Université Paris Diderot, Paris, France
| | - Rémy Morello
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Biostatistics and Clinical Research Unit, CHU Caen, Caen, France
| | - Nathalie Sermondade
- Department of Cytogenetic and Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Guillaume Grandazzi
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Espace Régional de Réflexion éthique, CHU Caen, Caen, France
| | - Grégoire Moutel
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Espace Régional de Réflexion éthique, CHU Caen, Caen, France
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Gosset A, Cohade C, Grosclaude P, Oumsack E, Dalenc F, Montagut M, Parinaud J, Vaysse C. [Regional state-of-the-art of the access to oncofertility consultation for young women with breast cancer]. ACTA ACUST UNITED AC 2019; 47:732-738. [PMID: 31493561 DOI: 10.1016/j.gofs.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES According to the 2004 Bioethics Act, oncofertility counselling must be systematically offered to all women of childbearing age before they are exposed to potentially gonadotoxic treatment. The main objective of this study was to evaluate the proportion of women under 40 years of age treated with chemotherapy for breast cancer in Midi-Pyrénées who have received an oncofertility consultation. A secondary objective was to assess practitioners' knowledge on the subject. METHODS A cross-reference was made between the databases of the oncology network in Midi-Pyrénées and the two approved centres for the preservation of fertility in the region. A computerized practitioner questionnaire was sent to all surgeons and oncologists who could manage these patients. RESULTS From 2012 and 2017, 667 women aged≤40 years received (neo)adjuvant chemotherapy treatment: only 156 (23.4%) had access to an oncofertility consultation and 58 (8.7%) received preservation. This rate (23.4%) varied according to the age of the patients, ranging from 56.9% for those aged 25-29 to 13.4% for those aged 35-39 and the managing institution. Of the 85 practitioners surveyed, 45 (55%) responded to the questionnaire, and of these 20 (44%) knew that ovarian stimulation treatment could be used even in hormone-dependent breast cancer situations and 13 (29%) of practitioners believed that the time required to preserve fertility was more than 1 month. CONCLUSION Our study revealed a significant disparity in access to oncofertility consultation. It is essential to set up information and awareness-raising actions on the subject.
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Affiliation(s)
- A Gosset
- Département de médecine de la reproduction, CHU de Toulouse, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse, France
| | - C Cohade
- Département de médecine de la reproduction, CHU de Toulouse, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse, France
| | - P Grosclaude
- Registre des cancers du Tarn, institut Claudius-Regaud, institut universitaire du cancer de Toulouse-Oncopole, 31059 Toulouse, France; Inserm, UMR1027, université de Toulouse, université Paul-Sabatier, 31000 Toulouse, France
| | - E Oumsack
- Registre des cancers du Tarn, institut Claudius-Regaud, institut universitaire du cancer de Toulouse-Oncopole, 31059 Toulouse, France
| | - F Dalenc
- Département d'oncologie médicale, institut Claudius-Regaud, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Montagut
- Service d'assistance médicale à la procréation, Clinique Croix du Sud, 20, route de Revel, 31000 Toulouse, France
| | - J Parinaud
- Département de médecine de la reproduction, CHU de Toulouse, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse, France
| | - C Vaysse
- Département de chirurgie gynécologique et oncologique, institut universitaire du cancer de Toulouse-Oncopole, CHU deToulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Bénard J, Calvo J, Comtet M, Benoit A, Sifer C, Grynberg M. [Fertility preservation in women of the childbearing age: Indications and strategies]. ACTA ACUST UNITED AC 2016; 45:424-44. [PMID: 27021926 DOI: 10.1016/j.jgyn.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
Advances on cryopreservation techniques now allow considering oocyte, embryo or ovarian tissue freezing for female fertility preservation. Originally developed for patients suffering from cancer, fertility preservation has rapidly invaded others medical fields, and represents now the standard of care for all young patient diagnosed with a disease that could impair fertility or having to receive possibly gonadotoxic treatment. As a result, autoimmune diseases, some genetic pathologies or iterative pelvic surgeries, at risk of premature ovarian failure, have become common indications of fertility preservation. In addition, the social egg freezing aiming at preventing the age-related fertility decline is still debated in France, although authorized in numerous countries. This review will discuss the different strategies of fertility preservation in young girls and women of reproductive age, regarding different medical or non-medical indications.
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Affiliation(s)
- J Bénard
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France
| | - J Calvo
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Comtet
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benoit
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Sifer
- Service de cytogénétique et biologie de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Grynberg
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France; Unité Inserm U1133, université Paris-Diderot, 75013 Paris, France.
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Valdelièvre C, Sonigo C, Comtet M, Simon C, Eskenazi S, Grynberg M. [Impact of gonadotropins in women suffering from cancer]. Bull Cancer 2016; 103:282-8. [PMID: 26917466 DOI: 10.1016/j.bulcan.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/23/2015] [Indexed: 12/21/2022]
Abstract
The role of gonadotropins in the genesis of malignant diseases, in particular gynecologic cancers, is still controversial. The production of ovarian steroids, as a consequence of FSH and LH actions, may constitute a bias to draw reliable conclusions. Over the past decades, the use of exogenous gonadotropins has markedly increased in cancer patients, candidates for fertility preservation, and in survivors facing infertility as a consequence of gonadotoxic treatments. In gynecologic cancers, high serum estradiol levels may be problematic and can therefore be overcome by specific protocols of ovarian stimulation. However, exogenous gonadotropin administration in cancer patients should systematically be included in a multidisciplinary approach. The present article discusses the possible role of gonadotropins as tumorigenic factors and the use of exogenous gonadotropins in females suffering from cancer.
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Affiliation(s)
- Constance Valdelièvre
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France
| | - Charlotte Sonigo
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France
| | - Marjorie Comtet
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France
| | - Cynthia Simon
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France
| | - Sarah Eskenazi
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France
| | - Michaël Grynberg
- Hôpital Jean-Verdier, service de médecine de la reproduction, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France; Université Paris-Diderot, unité Inserm U1133, 75013 Paris, France.
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