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Gayete-Lafuente S, Turan V, Oktay KH. Oocyte cryopreservation with in vitro maturation for fertility preservation in girls at risk for ovarian insufficiency. J Assist Reprod Genet 2023; 40:2777-2785. [PMID: 37715873 PMCID: PMC10656385 DOI: 10.1007/s10815-023-02932-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE To assess the feasibility and outcomes of oocyte cryopreservation with in vitro maturation (IVM) in post-pubertal girls undergoing fertility preservation (FP) for primary ovarian insufficiency (POI) risk. METHODS Ovarian stimulation was performed with an antagonist protocol or progesterone priming. Ultrasound monitoring was performed transabdominally. Oocytes were retrieved transvaginally under IV sedation. Immature oocytes were subjected to IVM for up to 36 h. All MII oocytes were vitrified. The main outcome measure was the total number of mature oocytes cryopreserved. The secondary outcome was the increase in the mature oocyte yield after IVM. RESULTS Indications for FP included mosaic Turner syndrome (mTS; n = 10), malignancy (n = 3), and POI risk (n = 2). The mean ± SD age, antral follicle count (AFC), and AMH levels were 14.2 ± 1.4 years, 8 ± 5.2 and 1.3 ± 1.3 ng/mL. In girls with mTS, the ovarian reserve was low for age (AFC 7.4 ± 4.7 and AMH 1.4 ± 1.6 ng/mL). Oocyte cryopreservation was possible in all girls with a range of 1-27 mature oocytes obtained, even in those who were previously exposed to chemotherapy or with low ovarian reserve, and no surgical complications were encountered. After IVM, the median mature oocyte yield increased significantly from 7.5 to 10.5 (p = 0.001). CONCLUSIONS Oocyte cryopreservation appears to be feasible and safe in girls as young as 12 years of age at risk for POI The utility of IVM increases the yield of cryopreserved mature oocytes. Prior exposure to chemotherapy or low ovarian reserve should not be an automatic reason to exclude these girls from FP consideration.
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Affiliation(s)
- Sonia Gayete-Lafuente
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, 310 Cedar Street, FMB Room 224. New Haven, CT, USA
| | - Volkan Turan
- Innovation Institute for Fertility Preservation, NY and CT, USA
- Istanbul Health and Technology University School of Medicine, Istanbul, Turkey
| | - Kutluk H Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, 310 Cedar Street, FMB Room 224. New Haven, CT, USA.
- Innovation Institute for Fertility Preservation, NY and CT, USA.
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Turan V, Gayete-Lafuente S, Bang H, Oktay KH. Outcomes of random-start letrozole protocol with PGT-A in women with breast cancer undergoing fertility preservation. J Assist Reprod Genet 2023; 40:2401-2408. [PMID: 37488389 PMCID: PMC10504207 DOI: 10.1007/s10815-023-02882-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE : To compare the cycle characteristics and outcomes of random-start-controlled ovarian stimulation (RSCOS) protocols to the outcomes of standard-start-controlled ovarian stimulation (SSCOS) cycles and to report the utility of PGT-A in these cycles. METHODS One hundred and seventeen who underwent SSCOS and 39 who underwent RSCOS for oocyte and/or embryo cryopreservation before breast cancer chemotherapy were retrospectively evaluated. Mean number of embryos and blastocyst euploidy rates were the main outcome measures. RESULTS A majority of RSCOS cycles were initiated in the luteal phase (66.6% luteal vs. 33.3% follicular). While the total dose of gonadotropins was significantly higher in the RSCOS (3720.8 ± 1230.0 vs. 2345.1 ± 803.6 IU; P < 0.001), the mean number of mature oocytes and embryos was similar to SSCOS. However, there was a trend for a higher number of mean embryos with luteal start RSCOS (6.9 ± 2.7 in late follicular start vs. 9.4 ± 4.2 in luteal start, P = 0.08). PGT-A was performed in 48% of the cases that underwent embryo cryopreservation in RSCOS (12 women, mean age = 35.3 ± 4.1; 87 blastocysts), revealing a euploidy rate of 36.2 ± 22.3% per patient. This rate was comparable to a 45% aneuploidy rate from similarly aged published data. Of the 7 RSCOS patients who returned for frozen embryo transfer, 5 delivered and one has an ongoing pregnancy, while in SSCOS, 18 out of 40 cycles resulted in live birth. CONCLUSION Our data suggests that RSCOS fertility preservation cycle outcomes are similar to those with SSCOS and result in age-appropriate euploidy rates.
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Affiliation(s)
- Volkan Turan
- Innovation Institute for Fertility Preservation, New Haven and NY, CT and NY, USA
- Department of Obstetrics and Gynecology, Istanbul Health and Technology University School of Medicine, Istanbul, Turkey
| | - Sonia Gayete-Lafuente
- Innovation Institute for Fertility Preservation, New Haven and NY, CT and NY, USA
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Kutluk H Oktay
- Innovation Institute for Fertility Preservation, New Haven and NY, CT and NY, USA.
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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Özcan A, Gülseren V, Özcan E, Toz E, Turan V. Assessment of the ovarian reserve in patients with beta-thalassemia major: a prospective longitudinal study. J Turk Ger Gynecol Assoc 2023; 24:159-164. [PMID: 37351586 PMCID: PMC10493813 DOI: 10.4274/jtgga.galenos.2023.2022-12-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/19/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Repeated blood transfusions in women with beta-thalassemia major (BTM) may lead to iron overload and increase oxidative stress, consequently resulting in ovarian damage. The aim was to evaluate alterations in ovarian reserve in transfusion-dependent BTM patients over a time period of one year and to compare levels of anti-Mullerian hormone (AMH) in women with BTM and their healthy peers. Material and Methods This longitudinal prospective study was conducted in women with transfusion-dependent BTM at a tertiary level hospital. The hospital database was interogated for women diagnosed with BTM between 1996 and 2021. AMH levels were assessed at baseline and one year later. Results Forty-one women with BTM were identified, of whom 25 (60.9%) had amenorrhea and 16 (39.1%) had normal cycles. The mean AMH level of all women was 2.7±1.8 ng/mL at baseline, significantly lower than the age-matched nomogram value of 4.0±0.4 ng/mL for a healthy population (p=0.001). The baseline AMH level of patients with amenorrhea were significantly lower than patients with normal menstrual cycles (2.1±1.8 vs. 3.6±1.5 ng/mL, p=0.009). After one-year follow-up, there was a trend towards a decrease in the AMH levels of patients with normal menstrual cycles. Conclusion Serum AMH values are decreased in patients with transfusion-dependent BTM. BTM patients should be educated about the possible effects of repeated blood transfusions on fertility.
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Affiliation(s)
- Aykut Özcan
- Department of Obstetrics and Gynecology, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Varol Gülseren
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Esin Özcan
- Clinic of Pediatric Hematology and Oncology, University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emrah Toz
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Volkan Turan
- Department of Obstetrics and Gynecology, İstanbul Health and Technology University Faculty of Medicine, İstanbul, Turkey
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Oktay KH, Turan V, Bedoschi G, Abdo N, Bang H, Goldfarb S. A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants. Cancer Med 2023; 12:19225-19233. [PMID: 37698031 PMCID: PMC10557848 DOI: 10.1002/cam4.6527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Better tools for post-chemotherapy amenorrhea risk assessment are needed for fertility preservation decision-making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post-chemotherapy in women with breast cancer. METHODS 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline-Cyclophosphamide-based (AC-based) or Cyclophosphamide-Methotrexate +5-Fluorouracil regimen. Pre- and/or post-chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6-18 months. RESULTS In multivariable-adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post-chemotherapy was predictive of amenorrhea with <18 month follow-up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6-18 months; the AMH >2.0 ng/mL group showed attenuated time-trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86-0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04-1.20, p = 0.003). CONCLUSIONS In addition to the pre- and post-treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post-chemotherapy.
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Affiliation(s)
- Kutluk H. Oktay
- Department of Obstetrics and Gynecology and Reproductive SciencesYale University School of MedicineNew HavenConnecticutUSA
| | - Volkan Turan
- Department of Obstetrics and GynecologyIstanbul Health and Technology University School of MedicineIstanbulTurkey
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology, Ribeirao Preto School of MedicineUniversity of Sao PauloRibeirao PretoBrazil
| | - Nadia Abdo
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Shari Goldfarb
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CenterNew YorkNew YorkUSA
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Abstract
PURPOSE OF REVIEW We reviewed the most recent developments including the safety and effectiveness data and success rates in individualized ovarian stimulation protocols for adult and postpubertal females with cancer. RECENT FINDINGS In women with breast cancer, aromatase inhibitor- and tamoxifen-supplemented stimulation protocols increase the margin of safety by limiting estrogen exposure. The outcomes of ovarian stimulation appear similar between cancer and noncancer populations, even with the recently developed random-start protocols, which allow initiation of ovarian stimulation anytime during the menstrual cycle. Based on lower anti-Mullerian hormone levels and primordial follicle density, carriers of BRCA pathogenic variants ( BRCApv ) have decreased ovarian reserve in comparison to women without those variants and may lose larger portion of their ovarian reserve post chemotherapy. Oocyte cryopreservation is also emerging as a suitable fertility preservation approach for selected postpubertal girls as young as 12 years of age. SUMMARY Individualized ovarian stimulation approaches combined with improvements in cryopreservation techniques increased the success and safety margin to preserve fertility with oocyte freezing. Women with BRCApv , on the other hand, may be at disadvantage as they have lower ovarian reserve and may lose larger portion of their ovarian reserve post chemotherapy compared to women who do not carry these variants.
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Affiliation(s)
- Kutluk H Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
- Innovation Institute for Fertility Preservation, New York and CT, USA
| | - Volkan Turan
- Department of Obstetrics and Gynecology, Istanbul Health and Technology University School of Medicine, Istanbul, Turkey
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Arikan G, Turan V, Kurekeken M, Goksoy HS, Dogusan Z. Autologous bone marrow-derived nucleated cell (aBMNC) transplantation improves endometrial function in patients with refractory Asherman's syndrome or with thin and dysfunctional endometrium. J Assist Reprod Genet 2023; 40:1163-1171. [PMID: 36662355 PMCID: PMC10239402 DOI: 10.1007/s10815-023-02727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The purpose was to evaluate the effect of intrauterine injection of aBMNC on the endometrial function in patients with refractory Asherman's syndrome (AS) and/or thin and dysfunctional endometrium (TE). STUDY DESIGN This is a prospective, experimental, non-controlled study MATERIAL AND METHODS: The study was carried out between December 2018 and December 2020 on 20 patients, who were of age < 45 years and had oligo/amenorrhea and primary infertility due to refractory AS and/or TE. One hundred ml BM was extracted. aBMNC cells were separated according to generic volume reduction protocol by using the Cell Separation System SEPAX S-100 table top centrifuge system. We have evaluated CD34+, mononuclear cell (MNC), and total nucleated cell (TNC) counts. The transplantation aBMNC was performed by two intrauterine injections at an interval of one week, transvaginally into the endometrial-myometrial junction by an ovum aspiration needle. Midcyclic endometrial thickness (ET) and gestations after transplantation were evaluated. RESULTS The mean TNC, MNC, and CD34+ cells were 11.55 ± 4.7 × 108, 3.85 ± 2.01 × 108, and 7.00 ± 2.88 × 106 at first injection, respectively, and 6.85 ± 2.67 × 108, 2.04 ± 1.11 × 108, and 3.44 ± 1.31 × 106 at second injection, respectively. The maximum posttransplantation ET was significantly higher than the maximum pretransplantation ET: 2.97 ± 0.48 vs. 5.76 ± 1.19 (mean ± standard deviation, p < 0.01). Twelve patients had frozen-thaw embryo transfers after the study. In 42% (n = 5 of 12) of the patients, pregnancy was achieved. One of the five patients delivered a healthy baby at term. CONCLUSIONS Autologous BMNC transplantation may contribute to endometrial function in patients with AS and/or TE.
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Affiliation(s)
- Gurkan Arikan
- Department of Obstetrics and Gynecology, Altinbaş University, Medical Park Bahçelievler Hospital, Kültür Sok. No. 1 E5 Yolu, 34160 Bahçelievler, Istanbul, Turkey.
| | - Volkan Turan
- Department of Obstetrics and Gynecology, Altinbaş University, Medical Park Bahçelievler Hospital, Kültür Sok. No. 1 E5 Yolu, 34160 Bahçelievler, Istanbul, Turkey
- Istanbul Health and Technology University, Faculty of Medicine, Istanbul, Turkey
| | - Meryem Kurekeken
- Department of Obstetrics and Gynecology, Altinbaş University, Medical Park Bahçelievler Hospital, Kültür Sok. No. 1 E5 Yolu, 34160 Bahçelievler, Istanbul, Turkey
- Reproductive Medicine and Infertility Center, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Hasan Sami Goksoy
- Department of Hematology, Yeni Yuzyil University Gaziosmanpaşa Hospital, Istanbul, Turkey
| | - Zeynep Dogusan
- Bone Marrow Transplantation Center, Yeni Yuzyil University Gaziosmanpaşa Hospital, Istanbul, Turkey
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Goldfarb SB, Turan V, Bedoschi G, Abdo N, Chang C, Bang H, OKTAY KUTLUKH. Abstract P6-05-02: PRESENCE OF BRCA MUTATIONS AND PRE-CHEMOTHERAPY SERUM ANTI-MULLERIAN HORMONE LEVELS PREDICT RISK OF AMENORRHEA IN WOMEN WITH BREAST CANCER. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
OBJECTIVE: The likelihood of post-chemotherapy (ChT) amenorrhea is still empirically determined. Our aim was to determine the predictors of amenorrhea risk post- ChT in women with breast cancer(ca). As acute amenorrhea (< 12mo post-ChT) can be temporary, we used amenorrhea status 12 and 18 months post-ChT as the primary endpoint.
MATERIALS AND METHODS: 102 women aged 18-44, with regular cycles and stage I-III breast ca were prospectively and longitudinally followed for their menstrual pattern changes at 6, 12, and 18mo after the completion of adjuvant ChT with an Anthracycline-Cyclophosphamide-based (AC) or Cyclophosphamide-Methotrexate +5-Fluorouracil regimen on an IRB-approved protocol. Prior ChT, ovarian surgery, pelvic RT, family history of POI, and infertility diagnosis were the exclusion criteria. AMH was measured pre- and immediately post- ChT. Amenorrhea was defined as no bleeding for 4 consecutive cycles. Preand/or post-ChT AMH levels, age and BMI at the onset of ChT, BMI, tamoxifen use, regimen type (AC-based vs. not), and BRCA mutation (m) status (positive vs. not) were evaluated for the prediction of amenorrhea risk.
RESULTS: In multivariable-adjusted logistic regression models, age (p=0.03) and AMH (p=0.03) were significant predictors of amenorrhea at 12mo, and BRCAm status (p=0.03) at 18 mo; these models yielded areas under the ROC curve of 0.77 and 0.76, respectively. An undetectable AMH post-ChT was best predictive of amenorrhea with shorter follow-up, but not at 18mo. In longitudinal analysis (with data at 0, 6, 12, and 18 months) estimating ‘time-trends’, a baseline AMH < 2.0 ng/ml (optimal cut-off from ROC curve) and BRCAm status were associated with the risk of amenorrhea. The baseline AMH ≥2.0 group showed attenuated time-trend vs. the AMH < 2.0 ng/ml group (ratio of ORs=0.91, 95% CI=0.86-0.97, p=0.002), while the BRCA-positive group showed a steeper time-trend in the odds ratio (OR) of amenorrhea, compared to the non-positive group (ratio of ORs=1.12,95% CI=1.04-1.20, p=0.003) (Table 1). Sensitivity analyses demonstrated the robustness of these findings, for example, yielding an 8-10% increased risk of amenorrhea for BRCAm carriers, with p-values of 0.008- 0.04.
CONCLUSIONS: Age, pre-and post-ChT AMH levels, and BRCAm status are potential predictors of amenorrhea at 12 and 18mo post-ChT. These predictors may help better guide fertility preservation decision-making in women with breast ca. The higher likelihood of amenorrhea in women with BRCAm suggests that they may be more prone to lose their ovarian function post-ChT and should be accordingly counseled.
Table 1. Longitudinal analysis at 0, 6, 12 and 18 months for the difference in amenorrhea trend between groups dichotomized by baseline factors.
Citation Format: Shari B. Goldfarb, Volkan Turan, Giuliano Bedoschi, Nadia Abdo, Cassandra Chang, heejung Bang, KUTLUK H. OKTAY. PRESENCE OF BRCA MUTATIONS AND PRE-CHEMOTHERAPY SERUM ANTI-MULLERIAN HORMONE LEVELS PREDICT RISK OF AMENORRHEA IN WOMEN WITH BREAST CANCER [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-02.
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Affiliation(s)
| | | | | | | | | | - heejung Bang
- 6Department of Biostatistics, UC Davis School of Medicine
| | - KUTLUK H. OKTAY
- 7DEPARTMENT OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE SCIENCES, YALE UNIVERSITY SCHOOL OF MEDICINE, New Haven, Connecticut
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Gokce S, Herkiloglu D, Cevik O, Turan V. Evaluation of Intrafollicular Syndecan 1, Glypican 3, and Spermidine Levels in Women with Diminished Ovarian Reserve. Reprod Sci 2023; 30:569-575. [PMID: 36131221 DOI: 10.1007/s43032-022-01085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
We aimed to evaluate the levels of Spermidine, Syndecan 1, and Glypican 3 (GPC3) in the follicle fluid of women with diminished ovarian reserve (DOR) and to examine the relationship of these markers with the number of embryos and clinical pregnancy. A total of 27 women with DOR and 34 women with normal ovarian reserve who underwent in vitro fertilization procedure were included in this prospectively designed study. Spermidine, Syndecan 1, and GPC3 levels were studied in the follicle fluid samples taken from the women at the time of oocyte retrieval by ELISA method, and their relations with the cycle outcomes were examined. The mean age was found as 38.1 ± 7.4 years in the DOR group and 35.1 ± 5.2 years in the control group (p = 0.027). When adjusted for age and body mass index, while the median Spermidine level was significantly higher (p < 0.001), both Syndecan 1 (p < 0.001) and GPC3 (p = 0.006) were significantly lower in the DOR group compared with control group. The cut-off value of Spermidine for clinical pregnancy prediction was found as 74.08 ng/mL with 78.9% sensitivity and 57.1% specificity [OR: 5 (95% CI: 1.4-17.6); AUC: 0.621; p = 0.138], while it was 0.96 ng/mL with 84.2% sensitivity and 59.5% specificity [OR: 7.8 (95% CI: 2-31.1); AUC: 0.701; p = 0.004] for GP3 and 1.15 ng/mL with 78.9 sensitivity and 57.1% specificity [OR: 5 (95% CI: 1.4-17.6); AUC: 0.680; p = 0.009] for Syndecan 1. Intrafollicular spermidine, Syndecan 1, and GPC3 levels may have a role in ovarian aging. Further randomized controlled studies in a larger population are needed for the relationship of these markers with cycle and pregnancy outcomes.
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Affiliation(s)
- Sefik Gokce
- Department of Obstetrics and Gynecology, Gaziosmanpasa Hospital of Yeni Yuzyil University, Istanbul, Turkey.
| | - Dilsad Herkiloglu
- Department of Obstetrics and Gynecology, Gaziosmanpasa Hospital of Yeni Yuzyil University, Istanbul, Turkey
| | - Ozge Cevik
- Department of Biochemistry, Aydin Adnan Menderes University, Aydin, Turkey
| | - Volkan Turan
- Istanbul Health and Technology University School of Medicine, İstanbul, Turkey
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Yildiz S, Bildik G, Benlioglu C, Turan V, Dilege E, Ozel M, Kim S, Oktem O. Breast cancer treatment and ovarian function. Reprod Biomed Online 2023; 46:313-331. [PMID: 36400663 DOI: 10.1016/j.rbmo.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study was to provide an update on ovarian function and the mechanisms of gonadal damage after exposure to chemotherapy in breast cancer survivors. The alkylating agents are toxic to both primordial and growing follicles. However, anti-metabolite drugs are more likely to destroy preantral and antral follicles. Younger patients are more likely to have a higher ovarian reserve, and therefore, more likely to retain some residual ovarian function after exposure to gonadotoxic regimens. However, there can be significant variability in ovarian reserve among patients of the same age. Furthermore, patients with critically diminished ovarian reserve may continue to menstruate regularly. Therefore age and menstrual status are not reliable indicators of good ovarian reserve and might give a false sense of security and result in an adverse outcome if the patient is consulted without considering more reliable quantitative markers of ovarian reserve (antral follicle count and anti-Müllerian hormone) and fertility preservation is not pursued. In contrast to well-documented ovarian toxicity of older chemotherapy regimens, data for newer taxane-containing protocols have only accumulated in the last decade and data are still very limited regarding the impact of targeted therapies on ovarian function.
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Affiliation(s)
- Sule Yildiz
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Gamze Bildik
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston TX 77054, USA
| | - Can Benlioglu
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Volkan Turan
- Istanbul Tema Hospital, Assisted Reproduction Unit, Istanbul
| | - Ece Dilege
- Department of General Surgery, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Melis Ozel
- Department of Gynecology and Obstetrics Klinikum Ingolstadt, Bavaria, Germany
| | - Samuel Kim
- Eden Centers for Advanced Fertility, Fullerton CA 92835, USA
| | - Ozgur Oktem
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey.
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Turan V, Lafuente SG, Arkfeld CK, Oktay KH. COMPARISON OF RANDOM START CONTROLLED OVARIAN STIMULATION WITH STANDARD START IN LETROZOLE GONADOTROPIN CYCLES FOR FERTILITY PRESERVATION IN WOMEN WITH BREAST CANCER. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lafuente SG, Turan V, Oktay K. OOCYTE CRYOPRESERVATION WITH IN VITRO MATURATION, A FEASIBLE OPTION FOR FERTILITY PRESERVATION IN ADOLESCENTS WITH MOSAIC TURNER SYNDROME. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oktay KH, Turan V, Bedoschi G, Goldfarb S, Bang H. PRESENCE OF BRCA MUTATIONS AND A PRE-CHEMOTHERAPY AMH LEVEL OF < 2ng/ML STRONGLY PREDICT RISK OF AMENORRHEA IN WOMEN WITH BREAST CANCER. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arkfeld C, Gayete-Lafuente S, Turan V, Oktay K. P-477 Ovarian stimulation and PGT-A outcomes with random start letrozole protocol for fertility preservation in breast cancer patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Data on random start letrozole ovarian stimulation (RSL) in breast cancer patients is scant. We studied RSL outcomes from a single-center with fertility preservation expertise.
Summary answer
RSL appears to result in high oocyte and embryo/blastocyst yield, with an age-appropriate aneuploidy rate.
What is known already
With increasing utility of neoadjuvant chemotherapy regimens in breast cancer, young women have limited time to undergo fertility preservation (FP) by oocyte or embryo cryopreservation. Random start stimulation protocols were developed to complete an ovarian stimulation cycle in the shortest time possible before cancer patients started chemotherapy. In addition, letrozole protocols were developed to mitigate the potential risks of high estrogen levels during ovarian stimulation in breast cancer patients. Even though both random start and letrozole supplemented ovarian stimulation have been studied individually, there is limited data on combining both strategies in random start letrozole (RSL) protocols.
Study design, size, duration
We reviewed our records from 2014 to 2021. We included the first FP cycle of all breast cancer patients undergoing RSL ovarian stimulation for oocyte or embryo cryopreservation. Cancer stages were grouped as 0-4, 0 being ductal carcinoma in situ (DCIS). Twenty-eight cycles met the criteria. Main outcome measures were number of oocytes retrieved and embryos cryopreserved. Secondary outcome measures were fertilization, blastocyst, and euploidy rates for the embryo cryopreservation group.
Participants/materials, setting, methods
Ovarian stimulation began on cycle days 3-26 with letrozole 5 mg/day initiated simultaneously with rFSH. The rFSH dose was based on age and antral follicle counts (AFC). Oocyte maturation was triggered with leuprolide acetate, rhCG or both 35h prior to retrieval.
Main results and the role of chance
The mean age was 33.5±4.9 years (range 26-40) and BMI 22.3±2.9(18.4-30.3). The mean breast cancer stage at FP was 1.7±0.9 (0-4), with 42.3% being stage-I disease. 77% of cases were estrogen receptor positive. AMH was 2.7±2.4 (0.16-7.9) and AFC 18.5±8.9(4-42). Ovarian stimulation began on cycle-day 13.7±7.3(2-26). 15(54%) cycles were started in the follicular and 13(46%) in the luteal-phase. The mean total rFSH dose was 3880±1615.4 IU(1275-8325) with a stimulation length of 11.8±2.4 days(8-19).
Mean oocytes retrieved were 16.4±6.9(1-36) with a maturity rate of 71.4±17.9%(35.7-94.4). From 13 patients, 10.4±4.7(1-22) oocytes were cryopreserved. Among the 15 patients proceeding to embryo cryopreservation, the fertilization rate was 96.9±6.8%(80-100), resulting in 7.1±4.4(1-15) embryos. 24 embryos were cryopreserved on day-3 and 82 as blastocysts. PGT-A was performed in 72% of the cases, with euploidy rate of 37.7±24.4%(0-63.6). There was no difference in oocyte or embryo yield between follicular and luteal start patients. Likewise, fertilization rates and euploidy rates were similar. The comparative results are summarized in Table 1.
To date, two patients conceived utilizing cryopreserved embryos. Both pregnancies resulted in healthy term babies.
Limitations, reasons for caution
Though our report is one of the largest series of RSL, it can be strengthened with longer follow up that includes pregnancy outcomes in a greater proportion of patients.
Wider implications of the findings
This is the first detailed report of the RSL protocol utility with PGT-A results in a breast-cancer population. RSL appears to result in high oocyte-yield, fertilization, and blastocyst formation rates, with age-appropriate euploidy. Additionally, the outcomes appear to be similar between patients undergoing follicular and luteal phase start RSL.
Trial registration number
not applicable
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Affiliation(s)
- C Arkfeld
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
| | - S Gayete-Lafuente
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
| | - V Turan
- Istanbul Health and Technology University School of Medicine, Obstetrics and Gynecology , Istanbul, Turkey
| | - K Oktay
- Yale, Obstetrics- Gynecology and Reproductive Sciences , New Haven, U.S.A
- Innovation Fertility Preservation and IVF, Reproductive Endocrinology and Infertility , New York, U.S.A
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Gokce S, Herki̇loglu D, Cevi̇k O, Turan V. Role of chemokines in early pregnancy loss. Exp Ther Med 2022; 23:397. [PMID: 35495608 PMCID: PMC9047033 DOI: 10.3892/etm.2022.11324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to compare decidual protein levels and gene expression levels of chemokines between patients with early pregnancy loss and those with voluntary abortion. A total of 15 patients between 6 and 10 gestational weeks, who presented with negative fetal heartbeat to the obstetrics and gynecology outpatient clinics of Gaziosmanpasa Hospital (Yeni Yuzyil University, Istanbul, Turkey) and who had no additional systemic disease and 13 patients between 6 and 10 gestational weeks, who presented with positive fetal heartbeat for voluntary abortion were included in the present study. CX3CL1, CCL17, CXCR4, chemokine ligand 12 (CXCL12) and intercellular adhesion molecule (ICAM)5 protein expression levels were determined by ELISA and gene expression levels by reverse transcription-quantitative PCR in fresh materials recovered after therapeutic curettage. CX3CL1, CCL17, CXCR4, CXCL12 protein levels were significantly higher and ICAM protein level was significantly lower in pregrant women with missed abortion compared with those with voluntary abortion. While the amount of increase in mean CX3CL1, CCL17, CXCR4 and CXCL12 gene expression levels in the tissues of pregnant women with missed abortion was statistically higher than the pregnant women who underwent voluntary abortion, the amount of increase in ICAM5 gene expression was found to be lower (P<0.001) in those with missed abortion. In conclusion, the findings of the present study suggested that CCL17, CX3CL1, CXCL12, CXCR4 and ICAM5 may be associated with missed abortion and may play an important role in placental invasion and the continuation of pregnancy.
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Affiliation(s)
- Sefi̇k Gokce
- Department of Obstetrics and Gynecology, Gaziosmanpasa Hospital of Yeni Yuzyil University, Istanbul 34245, Turkey
| | - Di̇lsad Herki̇loglu
- Department of Obstetrics and Gynecology, Gaziosmanpasa Hospital of Yeni Yuzyil University, Istanbul 34245, Turkey
| | - Ozge Cevi̇k
- Department of Biochemistry, School of Medicine, Aydin Adnan Menderes University, Aydin 09010, Turkey
| | - Volkan Turan
- Department of Obstetrics and Gynecology, School of Medicine, Health and Technology University, Istanbul 34015, Turkey
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Turan V, Lambertini M, Lee DY, Wang E, Clatot F, Karlan BY, Demeestere I, Bang H, Oktay K. Association of Germline BRCA Pathogenic Variants With Diminished Ovarian Reserve: A Meta-Analysis of Individual Patient-Level Data. J Clin Oncol 2021; 39:2016-2024. [PMID: 33891474 PMCID: PMC8260903 DOI: 10.1200/jco.20.02880] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether germline BRCA (gBRCA) pathogenic variants are associated with decreased ovarian reserve. MATERIALS AND METHODS An individual patient-level data meta-analysis was performed using five data sets on 828 evaluable women who were tested for gBRCA. Of those, 250 carried gBRCA, whereas 578 had tested negative and served as controls. Of the women with gBRCA, four centers studied those affected with breast cancer (n = 161) and one studied unaffected individuals (n = 89). The data were adjusted for the center, age, body mass index, smoking, and oral contraceptive pill use before the final analysis. Anti-Müllerian hormone (AMH) levels in affected women were drawn before presystemic therapy. RESULTS The mean age of women with versus without gBRCA1/2 (34.1 ± 4.9 v 34.3 ± 4.8 years; P = .48) and with gBRCA1 versus gBRCA2 (33.7 ± 4.9 v 34.6 ± 4.8 years; P = .16) was similar. After the adjustments, women with gBRCA1/2 had significantly lower AMH levels compared with controls (23% lower; 95% CI, 4 to 38; P = .02). When the adjusted analysis was limited to affected women (157 with gBRCA v 524 without, after exclusions), the difference persisted (25% lower; 95% CI, 9 to 38; P = .003). The serum AMH levels were lower in women with gBRCA1 (33% lower; 95% CI, 12 to 49; P = .004) but not gBRCA2 compared with controls (7% lower; 95% CI, 31% lower to 26% higher; P = .64). CONCLUSION Young women with gBRCA pathogenic variants, particularly those affected and with gBRCA1, have lower serum AMH levels compared with controls. They may need to be preferentially counseled about the possibility of shortened reproductive lifespan because of diminished ovarian reserve.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
- Department of Obstetrics and Gynecology, Health and Technology University School of Medicine, Istanbul, Turkey
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Erica Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Florian Clatot
- Department of Medical Oncology, Henri Becquerel Centre, Rouen, France
| | - Beth Y. Karlan
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Isabelle Demeestere
- Fertility Clinic, Research Laboratory on Human Reproduction, CUB-Erasme, and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA
| | - Kutluk Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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Turan V, Sonmezer M, Sonmezer M. Ongoing pregnancy and healthy live births following very short ovarian stimulation of incidentally observed big antral follicles in oligoamenorrheic patients with extremely decreased ovarian reserve. JBRA Assist Reprod 2021; 25:324-327. [PMID: 33507715 PMCID: PMC8083869 DOI: 10.5935/1518-0557.20200095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the present case series our aim is to present seven patients with extremely decreased ovarian reserve and oligomenorrhea, conceived with in vitro fertilization following a very short ovarian stimulation of incidentally detected big antral follicles. The study included women pursuing in vitro fertilization due to premature ovarian failure risk. When an incidental growing antral follicle was detected under ultrasound, immediate ovarian stimulation was initiated if the blood estradiol, luteinizing hormone and progesterone levels were correlated. Serum anti-Mullerian hormone measurements of all patients were consistent with extremely diminished ovarian reserve (ranged between 0.01 and 0.09ng/ml) and FSH levels varied between 13-104IU/l. The mean stimulation length ranged between 2-4 days. A total of 8 oocytes were retrieved; 6 MII, 1 GV and 1 degenerated. All 6 MII oocytes were fertilized with intracytoplasmic sperm injection. Two patients conceived after fresh embryo transfer, whereas the one conceived following frozen thawed embryo transfer. The ongoing pregnancy rate was 50% per transfer, and two of them resulted in a healthy live birth. In conclusion, close monitoring of oligoamenorrheic infertile patients who are at high risk of imminent ovarian failure using ultrasound and blood hormone levels is very important. Albeit low, the possibility of having a healthy pregnancy following “a very short ovarian stimulation” in such a specific patient group is emphasized.
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Affiliation(s)
- Volkan Turan
- Health and Technology University School of Medicine, Istanbul, Turkey
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Titus S, Szymanska KJ, Musul B, Turan V, Taylan E, Garcia-Milian R, Mehta S, Oktay K. Individual-oocyte transcriptomic analysis shows that genotoxic chemotherapy depletes human primordial follicle reserve in vivo by triggering proapoptotic pathways without growth activation. Sci Rep 2021; 11:407. [PMID: 33431979 PMCID: PMC7801500 DOI: 10.1038/s41598-020-79643-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Gonadotoxic chemotherapeutics, such as cyclophosphamide, can cause early menopause and infertility in women. Earlier histological studies showed ovarian reserve depletion via severe DNA damage and apoptosis, but others suggested activation of PI3K/PTEN/Akt pathway and follicle ‘burn-out’ as a cause. Using a human ovarian xenograft model, we performed single-cell RNA-sequencing on laser-captured individual primordial follicle oocytes 12 h after a single cyclophosphamide injection to determine the mechanisms of acute follicle loss after gonadotoxic chemotherapy. RNA-sequencing showed 190 differentially expressed genes between the cyclophosphamide- and vehicle-exposed oocytes. Ingenuity Pathway Analysis predicted a significant decrease in the expression of anti-apoptotic pro-Akt PECAM1 (p = 2.13E-09), IKBKE (p = 0.0001), and ANGPT1 (p = 0.003), and reduced activation of PI3K/PTEN/Akt after cyclophosphamide. The qRT-PCR and immunostaining confirmed that in primordial follicle oocytes, cyclophosphamide did not change the expressions of Akt (p = 0.9), rpS6 (p = 0.3), Foxo3a (p = 0.12) and anti-apoptotic Bcl2 (p = 0.17), nor affect their phosphorylation status. There was significantly increased DNA damage by γH2AX (p = 0.0002) and apoptosis by active-caspase-3 (p = 0.0001) staining in the primordial follicles and no change in the growing follicles 12 h after chemotherapy. These data support that the mechanism of acute follicle loss by cyclophosphamide is via apoptosis, rather than growth activation of primordial follicle oocytes in the human ovary.
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Affiliation(s)
- S Titus
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - K J Szymanska
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - B Musul
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - V Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - E Taylan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - R Garcia-Milian
- Bioinformatics Support Program, Yale School of Medicine, New Haven, CT, USA
| | - S Mehta
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - K Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
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Oktay KH, Turan V, Bedoschi G, Taylan E, Bang H, Dickler M, Goldfarb S. IMPACT OF ADJUVANT CHEMOTHERAPY OR TAMOXIFEN ALONE ON THE OVARIAN RESERVE OF YOUNG WOMEN WITH BREAST CANCER: A PROSPECTIVE LONGITUDINAL STUDY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Turan V, Oktay K. BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging. Hum Reprod Update 2020; 26:43-57. [PMID: 31822904 DOI: 10.1093/humupd/dmz043] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/26/2019] [Accepted: 11/05/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Oocyte aging has significant clinical consequences, and yet no treatment exists to address the age-related decline in oocyte quality. The lack of progress in the treatment of oocyte aging is due to the fact that the underlying molecular mechanisms are not sufficiently understood. BRCA1 and 2 are involved in homologous DNA recombination and play essential roles in ataxia telangiectasia mutated (ATM)-mediated DNA double-strand break (DSB) repair. A growing body of laboratory, translational and clinical evidence has emerged within the past decade indicating a role for BRCA function and ATM-mediated DNA DSB repair in ovarian aging. OBJECTIVE AND RATIONALE Although there are several competing or complementary theories, given the growing evidence tying BRCA function and ATM-mediated DNA DSB repair mechanisms in general to ovarian aging, we performed this review encompassing basic, translational and clinical work to assess the current state of knowledge on the topic. A clear understanding of the mechanisms underlying oocyte aging may result in targeted treatments to preserve ovarian reserve and improve oocyte quality. SEARCH METHODS We searched for published articles in the PubMed database containing key words, BRCA, BRCA1, BRCA2, Mutations, Fertility, Ovarian Reserve, Infertility, Mechanisms of Ovarian Aging, Oocyte or Oocyte DNA Repair, in the English-language literature until May 2019. We did not include abstracts or conference proceedings, with the exception of our own. OUTCOMES Laboratory studies provided robust and reproducible evidence that BRCA1 function and ATM-mediated DNA DSB repair, in general, weakens with age in oocytes of multiple species including human. In both women with BRCA mutations and BRCA-mutant mice, primordial follicle numbers are reduced and there is accelerated accumulation of DNA DSBs in oocytes. In general, women with BRCA1 mutations have lower ovarian reserves and experience earlier menopause. Laboratory evidence also supports critical role for BRCA1 and other ATM-mediated DNA DSB repair pathway members in meiotic function. When laboratory, translational and clinical evidence is considered together, BRCA-related ATM-mediated DNA DSB repair function emerges as a likely regulator of ovarian aging. Moreover, DNA damage and repair appear to be key features in chemotherapy-induced ovarian aging. WIDER IMPLICATIONS The existing data suggest that the BRCA-related ATM-mediated DNA repair pathway is a strong candidate to be a regulator of oocyte aging, and the age-related decline of this pathway likely impairs oocyte health. This knowledge may create an opportunity to develop targeted treatments to reverse or prevent physiological or chemotherapy-induced oocyte aging. On the immediate practical side, women with BRCA or similar mutations may need to be specially counselled for fertility preservation.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology, Uskudar University School of Medicine, Istanbul, Turkey.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Kutluk Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Abstract
e24059 Background: As societal shifts have led to more women delaying childbearing, a diagnosis of breast cancer is increasingly more likely to occur prior to the completion of family building. Therefore, understanding impact of chemo on future fertility is of the utmost importance. This study evaluates the trends in AMH over time in women receiving different chemo regimens for breast cancer. Methods: This is an IRB approved prospective study of 164 women, < 45 years old with non-metastatic breast cancer who were enrolled at time of diagnosis. Patients received chemo and had prospective serum AMH measured at baseline,12, 18 & 24 mos post-chemo. Of those, 99/164 completed 2-yr follow up. Pts were divided according to their chemotherapy regimen: ddAC-T, CMF and other (e.g. TH). Results: Mean age in ddAC-T (n = 118), CMF (n = 22) and other (n = 23) chemo groups were 37.1±4.6, 41.1±3.2 and 37.6±4.3 yrs, respectively (p = 0.001). AMH sharply declined between baseline & 12 mos post-chemo in all groups (p = 0.005). There was no difference in rate of decline between the groups, after adjusting for age. Age was an important predictor of AMH. Older age at study entry was associated with lower AMH with a decrease of 9% per life year (p = 0.0005). AMH recovered from 12 to 18 mos post-chemo in all groups. 18 mos after chemo, AMH recovery was observed in 61%, 59% & 65% in ddAC-T, CMF & other groups, respectively. In the ddAC-T arm there was a 1.9 fold increase in AMH while there was a 1.4 and 3.3 fold increase in the CMF and other arms, respectively. At 2-yrs post-chemo, AMH recovery rate reached 67%, 69% & 77% in ddAC-T, CMF & other groups, respectively. However, 12% in ddAC-T and 23% in CMF had undetectable AMH. Baseline AMH was 1.59 fold higher in pts whose AMH increased compared to those whose AMH decreased between 12 & 18 mos (p = 0.035). AMH recovery was associated with higher baseline AMH. Age, BMI & chemo type did not correlate with AMH recovery and tamoxifen treatment did not impact AMH recovery. Conclusions: Our data show that anthracycline plus taxane, taxane-based and CMF chemo regimens compromise ovarian reserve in breast cancer patients in similar fashion. As surviving ovarian follicles resume production of AMH, most of ovarian reserve recovery occurs by 18 mos post-chemo with some minor recovery from 18-24 mos. Baseline AMH level is the most important predictor of AMH recovery. Hence in women undergoing gonadotoxic chemo, ovarian reserve should be assessed by AMH before and 12 months after treatment to determine extent of damage. The novel information provided in this study is valuable for counseling cancer pts about fertility preservation. Clinical trial information: NCT00823654 .
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Affiliation(s)
| | | | | | | | - Nadia Abdo
- Memorial Sloan Kettering Cancer Center, New York, NY
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Mümüşoğlu S, Tanaçan A, Turan V, Bozdağ G. Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turk J Obstet Gynecol 2020; 17:65-72. [PMID: 32341834 PMCID: PMC7171541 DOI: 10.4274/tjod.galenos.2019.89656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/05/2019] [Indexed: 12/01/2022] Open
Abstract
Although hydrothorax may accompany abdominal ascites in women with severe ovarian hyperstimulation syndrome (OHSS), there are few cases reported with isolated pleural effusion. Herein, we report two patients with isolated hydrothorax without any significant abdominal fluid following infertility treatment, along with a systematic review of the literature to describe risk factors for this rare entity. Two women with isolated pleural effusion without significant abdominal ascites were reported. The available literature was screened from Ovid-SP and PubMed to review OHSS cases with isolated hydrothorax. Two women aged 28 and 31 years were admitted to hospital with chest pain, tachypnea, and tachycardia after infertility treatment. They had right pleural effusion without abdominal fluid and the symptoms relieved after thoracentesis. Similar to our cases, we identified 24 case reports (n=41 women) in the literature according to eligible criteria. On the day of triggering, estradiol (E2) level was <4000 pg/mL in 81% of reported cases and hematocrit (HCT) was <45% in 44% of cases at the time of diagnosis. Isolated hydrothorax is an unpredictable event, which may even complicate women with low E2 levels or HCT concentrations. Physicians should keep in mind the possibility of isolated hydrothorax when respiratory symptoms are significant but abdominal ascites is not evident.
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Oktay K, Taylan E, Rodriguez-Wallberg KA, Bedoschi G, Turan V, Pacheco F. Goserelin does not preserve ovarian function against chemotherapy-induced damage. Ann Oncol 2019; 29:512-513. [PMID: 29112733 DOI: 10.1093/annonc/mdx695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- K Oktay
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, USA.
| | - E Taylan
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, USA
| | - K A Rodriguez-Wallberg
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - G Bedoschi
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - V Turan
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Department of Obstetrics and Gynecology, GOP Hospital, Yeni Yuzyil University School of Medicine, Istanbul, Turkey
| | - F Pacheco
- Innovation Institute for Fertility and In Vitro Fertilization, New York; Classiclínica, Porto Alegre, Brazil
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Turan V, Quinn MM, Dayioglu N, Rosen MP, Oktay K. The impact of malignancy on response to ovarian stimulation for fertility preservation: a meta-analysis. Fertil Steril 2019; 110:1347-1355. [PMID: 30503134 DOI: 10.1016/j.fertnstert.2018.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/13/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the impact of cancer diagnosis on response to ovarian stimulation for fertility preservation. DESIGN Meta-analysis. SETTING Not applicable. PATIENT(S) An electronic-based search was performed with the use of PubMed until May 2018 limited to English-language articles. In the final analysis, 10 case-controlled retrospective cohort studies were included, comparing ovarian response to stimulation between women with cancer and age-matched healthy women (control group). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of total oocytes retrieved, number of mature oocytes, fertilization rate and two pronuclei embryos obtained. RESULT(S) Ten studies that included a total of 713 women with cancer were analyzed in the cancer group (722 cycles), and 1,830 healthy women (1,835 cycles) qualified as controls for the meta-analysis. The pooled results showed no impact of cancer diagnosis on the mean number of total oocytes (P=.517; 95% CI -0.23 to 0.12), mature oocytes (P=.104; 95% CI -0.23 to 0.01), and two pronuclei embryos (P=.136; 95% CI -0.32 to 0.04) and fertilization rates (P=.273; 95% CI -0.29 to 0.183). When the analysis was limited to women with breast cancer diagnosis, there was also no difference in the mean number of total oocytes (P=.812; 95% CI -0.28 to 0.36) and mature oocytes (P=.993; 95% CI -0.16 to 0.16) between the two groups. CONCLUSION(S) This meta-analysis indicates that cancer diagnosis is not associated with reduced response to ovarian stimulation.
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Affiliation(s)
- Volkan Turan
- Yeni Yuzyil University School of Medicine, Department of Obstetrics and Gynecology, Division Reproductive Endocrinology and Infertility, Istanbul, Turkey
| | - Molly M Quinn
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Nurten Dayioglu
- Yeni Yuzyil University School of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Mitchell P Rosen
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Kutluk Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Innovation Fertility Preservation and IVF, New York, New York.
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Turan V, Bedoschi G, Rodriguez-Wallberg K, Sonmezer M, Pacheco FS, Oktem O, Taylor H, Oktay K. Utility of Gonadotropin-Releasing Hormone Agonists for Fertility Preservation: Lack of Biologic Basis and the Need to Prioritize Proven Methods. J Clin Oncol 2019; 37:84-86. [DOI: 10.1200/jco.18.00420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Volkan Turan
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Giuliano Bedoschi
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Kenny Rodriguez-Wallberg
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Murat Sonmezer
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Fernanda Silva Pacheco
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Ozgur Oktem
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Hugh Taylor
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
| | - Kutluk Oktay
- Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University
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Oktay K, Turan V, Palomaki G, Munne S, Sawarkar S, Escudero T. Comparison of embryo aneuploidy rates and patterns between brca mutation carriers and infertile women. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mumusoglu S, Turan V, Uckan H, Suzer A, Sokmensuer LK, Bozdag G. The Impact of a Long-Acting Oral Sphingosine-1-Phosphate Analogue on Ovarian Aging in a Rat Model. Reprod Sci 2017; 25:1330-1335. [PMID: 29137549 DOI: 10.1177/1933719117741376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In animal studies, intravenous continuous infusion or peritoneal injection of sphingosine-1-phosphate (S1P) has been shown to decrease chemotherapy- and radiotherapy-induced apoptosis on primordial follicles. Although a long-acting oral form of an S1P analogue (FTY720, fingolimod) has been recently developed and utilized in women with multiple sclerosis, there are no data exploring its ability to avoid spontaneous follicle apoptosis. Thirty 10-month-old female rats were randomly assigned to 3 groups to investigate whether fingolimod would be able to decrease the spontaneous ovarian follicle apoptosis ratio. An oral analogue form of S1P was administered for 60 days at a dose of 0.1 mg/kg (n = 10) or dose of 1 mg/kg (n = 10) per day. The control group (n = 10) received physiological serum via an orogastric feeding tube. The main outcome measures were anti-Müllerian hormone (AMH) level and nonapoptotic follicle ratio. While low-dose S1P group had comparable AMH levels to high-dose S1P group and controls, high-dose S1P group had higher mean levels of AMH, reaching marginal significance with controls (5.72 ± 0.61 vs 4.81 ± 0.85 ng/mL, P = .050). For the nonapoptotic primordial follicle ratio, both low-dose S1P group (67.0% ± 16.4% vs 29.9% ± 19.5%, P < .001) and high-dose S1P group (51.1% ± 11.5% vs 29.9% ± 19.5%, P = .023) had superior rates when compared with controls. Interestingly, low-dose S1P groups also had a statistically higher nonapoptotic primordial follicle ratio than high-dose S1P group ( P = .047). Our findings suggest that a long-acting oral analogue of S1P might decrease spontaneous follicular apoptosis based on the nonapoptotic primordial follicle ratio and AMH levels when compared with placebo.
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Affiliation(s)
- Sezcan Mumusoglu
- 1 Obstetric and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Volkan Turan
- 2 Obstetric and Gynecology, School of Medicine, Yeni Yuzyil University, Istanbul, Turkey
| | - Hasan Uckan
- 1 Obstetric and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysegul Suzer
- 3 Histology and Embryology, School of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Gurkan Bozdag
- 1 Obstetric and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey
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Turan V, Bedoschi G, Emirdar V, Moy F, Oktay K. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes. Reprod Sci 2017; 25:26-32. [PMID: 28874104 DOI: 10.1177/1933719117728800] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aromatase inhibitors (AI) have been introduced to reduce estrogen exposure in women with estrogen-sensitive cancer undergoing ovarian stimulation for oocyte/embryo cryopreservation. There have been questions regarding whether the addition of AI and the presence of BRCA mutations affect cycle outcomes. We sought to determine the impact of letrozole and BRCA mutations on fertility preservation (FP) cycle outcomes of patients undergoing ovarian stimulation with an antagonist protocol. METHODS The data were generated by the secondary analysis of a prospective database of all females diagnosed with cancer who underwent embryo or oocyte cryopreservation for FP. The final analysis included 145 patients stimulated with an antagonist protocol either using letrozole combined with recombinant follicle-stimulating hormone (rFSH; LF, n = 118) or rFSH alone (FA, n = 24). RESULTS The mean number of total (15.6 [7.9] vs 10.2 [7.8]; P = .004) and mature oocytes (10.4 [5.1] vs 7.8 [3.5]; P = .044) and embryos frozen (7.7 [5.3] vs 5.3 [2.7]; P = .043) were significantly higher after LF stimulation versus FA. In the LF group, women with BRCA mutations produced significantly fewer oocytes (11.0 [8.0] vs 16.4 [7.7], P = .015) and embryos (5.1 [4.4] vs 8.2 [4.7], P = .013), compared to those who were mutation negative. After adjusting for age, body mass index, baseline FSH level, and BRCA status, LF protocol still resulted in higher number of total oocytes (95% confidence interval [CI]: 1.9 to 3.6; P = .002) mature oocyte (95% CI: 0.3 to 1.4; P = .028), and embryo yield (95% CI: 0.7 to 1.4; P = .015). CONCLUSION In women with cancer undergoing FP, letrozole appears to enhance response to ovarian stimulation while the presence of BRCA mutations is associated with lower oocyte and embryo yield.
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Affiliation(s)
- Volkan Turan
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,2 Department of Obstetrics and Gynecology, GOP Hospital, Yeni Yuzyil University School of Medicine, Istanbul, Turkey
| | - Giuliano Bedoschi
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,3 Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Volkan Emirdar
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA
| | - Fred Moy
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA
| | - Kutluk Oktay
- 1 Innovation Institute for Fertility and In Vitro Fertilization, New York, NY, USA.,4 Laboratory of Molecular Reproduction and Fertility Preservation, Yale University School of Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, New Haven, CT, USA
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Mumusoglu S, Ata B, Turan V, Demir B, Kahyaoglu I, Aslan K, Seyhan Ata A, Yilmaz B, Yakin K, Avci B, Uncu G, Bozdag G. Does pituitary suppression affect live birth rate in women with congenital hypogonadotrophic hypogonadism undergoing intra-cytoplasmic sperm injection? A multicenter cohort study. Gynecol Endocrinol 2017; 33:728-732. [PMID: 28447505 DOI: 10.1080/09513590.2017.1318278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In this retrospective multicenter cohort study, women with congenital hypogonadotrophic hypogonadism (CHH) (n = 57) who underwent intra-cytoplasmic sperm injection in-between 2010-2014 were compared to age-matched controls with tubal factor infertility (n = 114) to assess ovarian stimulation cycle and pregnancy outcomes. Live birth rates (LBRs) per started cycle were 31.6 and 24.6% in CHH and controls groups, respectively (p = 0.36). Comparable success rates were also confirmed with the logistic regression analysis (OR: 1.44, 95% CI: 0.78-2.67, p = 0.24). Of the 57 women with CHH, 19 were stimulated with the gonadotropin-releasing hormone (GnRH) antagonist protocol, 13 with the long-GnRH-agonist protocol. Pituitary suppression (PS) was not employed in the remaining 25 cases. Compared to women with PS, women without PS had significantly higher embryo implantation rates (21.6 versus 52.6%, p = 0.03). Although there was a trend favoring no PS, LBRs (25.0 versus 40.0%, p = 0.26) per cycle were short of statistical significance. LBRs per cycle (57.1 versus 31.2%, p = 0.11) and miscarriage rates (11.1 versus 16.7%, p = 0.75) were similar between CHH women who were given estrogen + progesterone and progesterone alone to support the luteal phase. In conclusion, the optimal stimulation protocol appears to be exogenous gonadotropin stimulation alone, without PS, and progesterone-only luteal phase support in CHH patients.
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Affiliation(s)
- Sezcan Mumusoglu
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
| | - Baris Ata
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Volkan Turan
- c Department of Obstetrics and Gynecology , Yeni Yuzyil University School of Medicine, GOP Hospital , Istanbul , Turkey
| | - Berfu Demir
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Inci Kahyaoglu
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Kiper Aslan
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Ayse Seyhan Ata
- f Women's Health and Assisted Reproduction Center of American Hospital , Istanbul , Turkey
| | - Bulent Yilmaz
- g Department of Obstetrics and Gynecology , Katip Celebi University School of Medicine , Izmir , Turkey
- h Department of Obstetrics and Gynecology , Tepecik Education and Research Hospital , Izmir , Turkey , and
| | - Kayhan Yakin
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Berrin Avci
- i Department of Histology Embryology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Uncu
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Bozdag
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
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Oktay K, Baltaci V, Sonmezer M, Turan V, Unsal E, Baltaci A, Aktuna S, Moy F. Oogonial Precursor Cell-Derived Autologous Mitochondria Injection to Improve Outcomes in Women With Multiple IVF Failures Due to Low Oocyte Quality: A Clinical Translation. Reprod Sci 2016; 22:1612-7. [PMID: 26567266 DOI: 10.1177/1933719115612137] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mitochondrial dysfunction has been suggested as a major cause of age-induced decline in oocyte quality. In the past, donor oocyte cytoplasmic transfer showed some success but was abandoned due to the concerns with heteroplasmy. Recent studies indicated presence of oogonial precursor cells (OPCs) in the human ovary, which could be an autologous source of "healthy mitochondria." We sought to investigate the clinical efficacy of OPC-derived autologous mitochondrial injection (AMI) to improve oocyte quality in women with multiple in vitro fertilization (IVF) failures. METHODS The OPCs were isolated from laparoscopically obtained ovarian cortical pieces by cell sorting using a monoclonal anti-vasa homolog (anti-DDX) antibody. They were then disrupted and mitochondria were isolated. Reconstituted mitochondria were injected into each oocyte during intracytoplasmic sperm injection. Paired comparisons were made between the first failed cycles and the post-AMI cycles. RESULTS Of the 15 women undergoing ovarian stimulation, 2 were canceled and 3 decided to pool oocytes for later AMI. In remaining 10 (mean age 34.7 ± 4.1), AMI significantly improved fertilization rates (49.7 ± 31.3 vs 78.3 ± 18.9; P = .03) with a trend for better embryo grades (2.3 ± 0.3 vs 3.1 ± 0.7; P = .08). Four of 10 women conceived after single frozen embryo transfer and 3 after confirmation of diploidy via array comparative genomic hybridization (aCGH) (clinical pregnancy/embryo transfer = 4/10). CONCLUSION These data show encouraging results for AMI in comparison to previous failed IVF cycles.
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Affiliation(s)
- Kutluk Oktay
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Innovation Institute for Fertility Preservation and IVF, New York, NY, USA GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Volkan Baltaci
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Murat Sonmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Turan
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Innovation Institute for Fertility Preservation and IVF, New York, NY, USA
| | - Evrim Unsal
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Aysun Baltaci
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Suleyman Aktuna
- GenArt Women's Health and Reproductive Biotechnology Centre, Ankara, Turkey
| | - Fred Moy
- Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Deparment of Pathology, New York Medical College, Valhalla, NY, USA
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Oktay K, Turan V, Bedoschi G. Reply to M. Lambertini et al. J Clin Oncol 2016; 35:807-809. [PMID: 27893322 DOI: 10.1200/jco.2016.70.6101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
| | - Volkan Turan
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
| | - Giuliano Bedoschi
- Kutluk Oktay, Volkan Turan, and Giuliano Bedoschi, New York Medical College and Innovation Institute for Fertility Preservation, New York, NY
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Demeestere I, Turan V, Oktay K. Pregnancy Rate and Preservation of Cyclic Ovarian Function With Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy--Reply. JAMA Oncol 2016; 2:546-7. [PMID: 27077899 DOI: 10.1001/jamaoncol.2015.5743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Isabelle Demeestere
- Erasme Hospital, Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla3Innovation Institute for Fertility Preservation and In Vitro Fertilization, Ne
| | - Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla3Innovation Institute for Fertility Preservation and In Vitro Fertilization, Ne
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Oktay K, Turan V. Failure of Ovarian Suppression With Gonadotropin-Releasing Hormone Analogs to Preserve Fertility: An Assessment Based on the Quality of Evidence. JAMA Oncol 2016; 2:74-5. [PMID: 26426406 DOI: 10.1001/jamaoncol.2015.3252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla2Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla2Innovation Institute for Fertility Preservation and IVF, New York, New York
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Abstract
CONTEXT AND OBJECTIVE There has been increased attention to the issue of fertility preservation (FP). We aimed to investigate the long-term safety of FP via controlled ovarian stimulation with letrozole supplementation (COSTLES) prior to breast cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, nonrandomized, controlled study conducted between the years 2002 and 2014. A total of 337 women diagnosed with stage 3 or less invasive breast cancer were enrolled during a FP consultation before chemotherapy. Of those, 120 elected to undergo COSTLES for FP prior to chemotherapy (FP group). The remaining 217 patients did not undergo any FP procedure and served as the controls. MAIN OUTCOME MEASURE The primary end point was cancer recurrence defined as the detection of locoregional tumor (chest wall, regional nodal disease), distant metastases, or contralateral invasive breast cancer. RESULTS The baseline characteristics at enrollment were similar between the FP and control groups except for the less frequent lymph node involvement (P = .02) in the former. The mean follow-up after diagnosis was 5.0 years in the FP group and 6.9 years in the control group. In the FP group, the hazard ratio for recurrence after ovarian stimulation was 0.77 (95% confidence interval 0.28–2.13), and the survival was not compromised compared with controls (P = .61). Neither BRCA gene mutation status (P = .57) nor undergoing FP before or after breast surgery (P = .44) affected survival outcomes in the FP group. Likewise, none of the tumor characteristics including the estrogen receptor status affected the survival rates after the COSTLES. CONCLUSIONS COSTLES is unlikely to cause a substantially increased recurrence risk in breast cancer during the 5 years after diagnosis.
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Affiliation(s)
- Jayeon Kim
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Volkan Turan
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Kutluk Oktay
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
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Akopuz A, Turan V, Ozcan A, Kopuz Y, Toz E, Kurt S. A novel marker for the assessment of the treatment result in pelvic inflammatory disease. Minerva Ginecol 2016; 68:117-123. [PMID: 25323419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Although various laboratory tests have been studied with an intended use in the diagnosis of pelvic inflammatory disease (PID) and the assessment of treatment response, the neutrophil/lymphocyte ratio (NLR) has not been investigated in PID. We aimed to explore the value of blood NLR in diagnosis of PID and assessment of the treatment response. METHODS Sixty-five patients followed-up and treated with the diagnosis of PID in Izmir Tepecik Training and Research Hospital were retrospectively reviewed. The NLR measured before treatment and after clinical remission in the patients diagnosed with PID were assessed and compared with controls (N.=65). RESULTS In the patient group, the NLR measured before treatment was statistically significantly higher than the NLR measured after clinical remission (6.9±6.4 vs. 2.03±0.8, P<0.001). Similarly, comparison of the NLR measured in the patient group before treatment with the control group showed that this ratio was statistically significantly higher in the patient group before treatment (6.9±6.4 vs. 1.9±0.5, P<0.001). A comparison of the NLR measured after clinical remission did not reveal a statistically significant difference when compared with control group (1.9±0.5 vs. 2.03±0.8, P=0.981). CONCLUSIONS The NLR increases in patients diagnosed with PID and returns to normal levels when the patients enter clinical remission. Since there is currently no laboratory test available that indicates clinical improvement by returning to normal levels, as achieved by the NLR, and since it is an inexpensive and easy-to-apply test, we suggest that the NLR can be conveniently used to show clinical improvement in PID.
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Affiliation(s)
- Aycan Akopuz
- Department of Obstetrics and Gynecology Tepecik Research and Training Hospital, Izmir, Turkey -
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Unsal E, Turan V, Aktuna S, Hurdag C, Bereketoglu G, Canillioglu Y, Baltacı A, Ozcan S, Karayalcin R, Batırbaygil H, Baltacı V. Effects of pentoxifylline and platelet activating factor on sperm DNA damage. Eur J Obstet Gynecol Reprod Biol 2016; 197:125-9. [DOI: 10.1016/j.ejogrb.2015.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/16/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Oktay K, Bedoschi G, Pacheco F, Turan V, Emirdar V. First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. Am J Obstet Gynecol 2016; 214:94.e1-9. [PMID: 26601616 DOI: 10.1016/j.ajog.2015.10.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ovarian tissue cryopreservation is an experimental fertility preservation method and the transplantation techniques are still evolving. OBJECTIVE We attempted to improve the technique with the utility of a human decellularized extracellular tissue matrix (ECTM) scaffold, robot-assisted minimally invasive surgery, and perioperative pharmacological support. STUDY DESIGN We prospectively studied 2 subjects with hemophagocytic lymphohistiocytosis (patient A) and non-Hodgkin lymphoma (patient B) who underwent ovarian tissue cryopreservation at the age of 23 years, before receiving preconditioning chemotherapy for hematopoietic stem cell transplantation. Both experienced ovarian failure postchemotherapy and we transplanted ovarian cortical tissues to the contralateral menopausal ovary 7 and 12 years later, using a human ECTM scaffold and robotic assistance. The ECTM scaffold tissue compatibility was shown in preclinical studies. Patients also received estrogen supplementation and baby aspirin preoperatively to aid in the revascularization process. RESULTS Ovarian follicle development was observed approximately 10 (patient A) and 8 (patient B) weeks after ovarian tissue transplantation. Following 8 and 7 cycles of in vitro fertilization, 9 and 10 day-3 embryos were cryopreserved (patients A and B, respectively). While the baseline follicle-stimulating hormone (range 3.6-15.4 mIU/mL) levels near normalized by 7 months and remained steady postovarian transplantation in patient A, patient B showed improved but elevated follicle-stimulating hormone levels throughout (range 21-31 mIU/mL). Highest follicle yield was achieved 14 (8 follicles; patient A) and 11 (6 follicles; patient B) months postintervention. Patient A experienced a chemical pregnancy after the third frozen embryo transfer attempt. She then conceived following her first fresh in vitro fertilization embryo transfer and the pregnancy is currently ongoing. Patient B conceived after the first frozen embryo transfer attempt and delivered a healthy girl at term. CONCLUSION We report the first pregnancies after the minimally invasive transplantation of previously cryopreserved ovarian tissue with an ECTM scaffold. This approach seems to be associated with steady ovarian function after a follow-up of up to 2 years.
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Affiliation(s)
- Kutluk Oktay
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - Giuliano Bedoschi
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Faculdade de Medicina de Ribeirao Preto-Universidade de Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fernanda Pacheco
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Classiclinica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Volkan Turan
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Volkan Emirdar
- Innovation Institute for Fertility and In Vitro Fertilization, New York, NY; Laboratory of Molecular Reproduction and Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, NY
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Özcan A, Kopuz A, Turan V, Sahin C, TÖZ E, Aksoy S, Ozeren M. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure? Ginekol Pol 2016; 87:54-8. [DOI: 10.17772/gp/57833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Indexed: 11/12/2022] Open
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Solmaz U, Mat E, Dereli M, Turan V, Gungorduk K, Hasdemir P, Tosun G, Dogan A, Ozdemir A, Adiyeke M, Sanci M. Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol 2015; 55:81-6. [PMID: 25688821 DOI: 10.1111/ajo.12321] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC). MATERIALS AND METHODS Women who underwent surgery for endometrioid EC between 1995 and 2012 were retrospectively reviewed. Those who underwent prior neoadjuvant chemotherapy or radiotherapy and inadequate lymphadenectomy as well as those with nonendometrioid histology, synchronous cancers, International Federation of Gynecology and Obstetrics stage IV disease, gross uterine serosal and/or gross adnexal involvement were excluded. Lymph node dissemination was defined as occurring in the following circumstances: (i) when nodal metastasis with pelvic and/or para-aortic (P/PA) lymph node dissection (LND) was performed or (ii) when there was recurrence in the P/PA lymph nodes after a negative LND or when LND was not performed. Univariate and multivariate logistic regression models were used to identify the pathological predictors of lymphatic dissemination. RESULTS A total of 827 women with endometrioid EC were assessed; 516 (62.4%) of whom underwent P/PA LND and 205 (24.8%) underwent P LND. Sixty-seven (13%) women in the P/PA LND group and 5 (2.4%) in the P LND group had positive lymph nodes. Multivariate analysis confirmed cervical stromal invasion (OR 4.04, 95% CI 2.02-8.07 (P < 0.001)) and lymphovascular space invasion (LVSI) (OR 110.18, 95% CI 38.43-315.87 (P < 0.001)) as independent predictors of lymphatic dissemination. CONCLUSION Cervical stromal invasion and LVSI are highly associated with LN metastasis. These markers may serve as a surrogate for nodal metastasis.
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Affiliation(s)
- Ulas Solmaz
- Department of Gynaecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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Rodriguez-Wallberg K, Turan V, Munster P, Oktay K. Can ovarian suppression with gonadotropin-releasing hormone analogs (GnRHa) preserve fertility in cancer patients? Ann Oncol 2015; 27:357. [PMID: 26609009 DOI: 10.1093/annonc/mdv554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - V Turan
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla Innovation Institute for Fertility Preservation and IVF, New York
| | - P Munster
- Helen Diller Cancer Center, University of California, San Francisco
| | - K Oktay
- Innovation Institute for Fertility Preservation and IVF, New York Laboratory of Molecular Reproduction and Fertility Preservation, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, USA
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Solmaz U, Mat E, Dereli ML, Turan V, Ekin A, Tosun G, Dogan A, Ozdemir IA, Oztekin O, Sanci M. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases. J OBSTET GYNAECOL 2015; 36:81-6. [PMID: 26467294 DOI: 10.3109/01443615.2015.1041890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.
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Affiliation(s)
- U Solmaz
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - E Mat
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - M L Dereli
- b Department of Obstetrics and Gynecology , Tavas State Hospital , Denizli , Turkey
| | - V Turan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Ekin
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - G Tosun
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Dogan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - I A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - O Oztekin
- c Department of Obstetrics and Gynecology , Medical School of Pamukkale University , Denizli , Turkey
| | - M Sanci
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
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Kim J, Turan V, Oktay K. Safety of controlled ovarian stimulation with gonadotropins and letrozole in women with BRCA mutations. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Emirdar V, Turan V, Moy F, Bedoschi G, Oktay K. Value of Antimullerian hormone and antral follicle count in predicting fertility preservation cycle outcomes. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bedoschi G, Turan V, Emirdar V, Sonmezer M, Oktay K. Comparison of random start controlled ovarian stimulation with standard start in letrozole gonadotropin cycles for fertility preservation in women with breast cancer. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Oocyte aging has a significant impact on reproductive outcomes both quantitatively and qualitatively. However, the molecular mechanisms underlying the age-related decline in reproductive success have not been fully addressed. BRCA is known to be involved in homologous DNA recombination and plays an essential role in double-strand DNA break repair. Given the growing body of laboratory and clinical evidence, we performed a systematic review on the current understanding of the role of DNA repair in human reproduction. We find that BRCA mutations negatively affect ovarian reserve based on convincing evidence from in vitro and in vivo results and prospective studies. Because decline in the function of the intact gene occurs at an earlier age, women with BRCA1 mutations exhibit accelerated ovarian aging, unlike those with BRCA2 mutations. However, because of the still robust function of the intact allele in younger women and because of the masking of most severe cases by prophylactic oophorectomy or cancer, it is less likely one would see an effect of BRCA mutations on fertility until later in reproductive age. The impact of BRCA2 mutations on reproductive function may be less visible because of the delayed decline in the function of normal BRCA2 allele. BRCA1 function and ataxia-telangiectasia-mutated (ATM)-mediated DNA repair may also be important in the pathogenesis of age-induced increase in aneuploidy. BRCA1 is required for meiotic spindle assembly, and cohesion function between sister chromatids is also regulated by ATM family member proteins. Taken together, these findings strongly suggest the implication of BRCA and DNA repair malfunction in ovarian aging.
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Affiliation(s)
- Kutluk Oktay
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Volkan Turan
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Shiny Titus
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Robert Stobezki
- Division of Reproductive Medicine and Laboratory of Molecular Reproduction & Fertility Preservation, Obstetrics and Gynecology, New York Medical College, Valhalla, New York Innovation Institute for Fertility Preservation and IVF, New York, New York
| | - Lin Liu
- Department of Cell Biology and Genetics, College of Life Sciences, Nankai University, Tianjin, China
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Turan V, Mutlu EK, Solmaz U, Ekin A, Tosun O, Tosun G, Mat E, Gezer C, Malkoc M. Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. J Phys Ther Sci 2015; 27:2293-7. [PMID: 26311969 PMCID: PMC4540866 DOI: 10.1589/jpts.27.2293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The short-term effects of structured exercise on the anthropometric,
cardiovascular, and metabolic parameters of non-overweight women diagnosed with polycystic
ovary syndrome were evaluated. [Subjects and Methods] Thirty women with a diagnosis of
polycystic ovary syndrome were prospectively randomized to either a control group (n=16)
or a training group (n=14) for a period of 8 weeks. Anthropometric, cardiovascular, and
metabolic parameters and hormone levels were measured and compared before and after the
intervention. [Results] Waist and hip measurements (anthropometric parameters); diastolic
blood pressure; respiratory rate (cardiovascular parameters); levels of low-density
lipoprotein cholesterol, total cholesterol, fasting glucose, and fasting insulin; and the
homeostasis model assessment of insulin resistance index (metabolic parameters) were
significantly lower in the training group after 8 weeks of exercise compared to the
baseline values. After exercise, the training group had significantly higher oxygen
consumption and high-density lipoprotein levels and significantly shorter menstrual cycle
intervals. The corresponding values for controls did not significantly differ between the
start and end of the 8-week experiment. [Conclusion] Short-term regular exercise programs
can lead to improvements in anthropometric, cardiovascular, and metabolic parameters of
non-overweight women with polycystic ovary syndrome.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Ebru Kaya Mutlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - Ulas Solmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Ozge Tosun
- Department of Physiotherapy, Dokuz Eylul University, Turkey
| | - Gokhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Emre Mat
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Cenk Gezer
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Mehtap Malkoc
- Department of Physiotherapy, Dokuz Eylul University, Turkey
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Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer. J Clin Oncol 2015; 33:2424-9. [PMID: 26101247 DOI: 10.1200/jco.2014.59.3723] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We have previously reported an approach to ovarian stimulation for the purpose of fertility preservation (FP) in women with breast cancer via embryo freezing with the concurrent use of letrozole. The aim of this study was to provide the pregnancy and FP outcomes when embryos generated with the same protocol are used. PATIENTS AND METHODS In all, 131 women with stage ≤ 3 breast cancer underwent ovarian stimulation and received concurrent letrozole 5 mg per day before receiving adjuvant chemotherapy and cryopreserving embryos. RESULTS Thirty-three of the 131 women underwent 40 attempts to transfer embryos to their own uterus (n = 18) or via the use of a gestational carrier (n = 22) at a mean age of 41.5 ± 4.3 years with a median 5.25 years after embryo cryopreservation. The overall live birth rate per embryo transfer was similar to the US national mean among infertile women of a similar age undergoing in vitro fertilization-embryo transfer (45.0 v 38.2; P = .2). Seven (38.8%) of the 18 pregnancies were twins with no higher-order pregnancies being encountered. No fetal anomalies or malformations were reported in 25 children after a mean follow-up of 40.4 ± 26.4 months. Seventeen of the 33 women attempting pregnancy had at least one child, translating into an FP rate of 51.5% per attempting woman. CONCLUSION Embryo cryopreservation after ovarian stimulation with the letrozole and follicle-stimulating hormone protocol preserves fertility in women with breast cancer and results in pregnancy rates comparable to those expected in a noncancer population undergoing in vitro fertilization.
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Affiliation(s)
- Kutluk Oktay
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY.
| | - Volkan Turan
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Giuliano Bedoschi
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Fernanda S Pacheco
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
| | - Fred Moy
- Kutluk Oktay, Volkan Turan, Giuliano Bedoschi, and Fernanda S. Pacheco, New York Medical College, Valhalla, and Innovation Institute for Fertility Preservation and In Vitro Fertilization, New York; and Fred Moy, New York Medical College, Valhalla, NY
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Ozcan A, Töz E, Turan V, Sahin C, Kopuz A, Ata C, Sancı M. Should we remove the normal-looking appendix during operations for borderline mucinous ovarian neoplasms?: A retrospective study of 129 cases. Int J Surg 2015; 18:99-103. [DOI: 10.1016/j.ijsu.2015.04.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/31/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022]
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Oktay K, Turan V, Kim J. Long-term safety of fertility preservation by ovarian stimulation and concurrent aromatase inhibitor treatment in women with breast cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kutluk Oktay
- Institute for Fertility Preservation and New York Medical College, New York, NY
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Solmaz U, Mat E, Levent Dereli M, Turan V, Peker N, Tosun G, Dogan A, Adiyeke M, Ozdemir A, Gungorduk K, Sanci M, Yildirim Y. Does neoadjuvant chemotherapy plus cytoreductive surgery improve survival rates in patients with advanced epithelial ovarian cancer compared with cytoreductive surgery alone? J BUON 2015; 20:580-587. [PMID: 26011353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare the outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC/IDS) with primary debulking surgery (PDS) in patients diagnosed with advanced epithelial ovarian cancer (EOC). METHODS A total of 292 patients with stages IIIC and IV disease who were treated with either NAC/IDS or PDS between 1995 and 2012 were retrospectively reviewed. The study population was divided into two groups: the NAC/IDS group (N=84) and the PDS group (N=208). Progression-free survival (PFS), overall survival (OS), and optimal cytoreduction were compared. RESULTS The mean age was significantly higher in the NAC/IDS group (61.5±11.5 vs 57.8±11.1 years, p=0.01). Optimal cytoreduction was achieved in 34.5% (29/84) of the patients in the NAC/IDS group and in 32.2% (69/208) in the PDS group (p=0.825). The survival rates were comparable. The mean survival rate of patients who achieved optimal cytoreductive surgery in either the PDS or the NAC/IDS arm was significantly higher than that of patients who achieved suboptimal cytoreductive surgery (p<0.001 and p<0.001, respectively). Multivariate analysis confirmed the treatment method, amount of ascitic fluid, and optimal cytoreduction as independent factors for OS. CONCLUSIONS No definitive evidence was noticed regarding whether NAC/IDS increases survival compared with PDS. NAC should be reserved for patients who cannot tolerate PDS or when optimal cytoreduction is not feasible.
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Affiliation(s)
- Ulas Solmaz
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey
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