Emergency COS in oncofertility preservation

Abstract

There is often an urgent need to start cancer treatment.Therefore, protocols with alternative timing to start COS have been proposed in fertility preservation. Is random start COS as effective as conventional start COS in fertility preservation? We conducted a retrospective study. The study included 104 patients recently diagnosed with cancer and in preparation for gonadotoxic therapy, from January 2017 to January 2019. Patients were evaluated within 24-48h after the referral, clinically, by ultrasound (antral follicular count) and by an AMH dosage.The underlying conditions were mainly: Hodgkin’s Lymphoma (46% patients), Breast cancer (30%), Rectal cancer (3%), and various other pathologies (Ovarian, Gastric cancer, T Lymphoma, etc.). AMH levels ranged from 0,2ng/ml to a maximum of 10,5ng/ml. All 104 patients underwent IVF cycles using GnRH antagonist protocol. 65 patients underwent an early-follicular start COS (Group 1), whereas 49 had a random (late follicular or luteal) start (Group2). The addition of Letrozole was compulsory in case of estrogen-sensitive tumors and E2 levels , closely monitored. Oocyte retrieval was done transvaginally in 65% of cases and was trans-urethral in 35%. Oocyte or embryo vitrification were proposed to the patients based on marital status and preference. Our aim was to compare the outcome of random-start versus conventional start COS Our patients’ age ranged from 14 to 41 years, with a mean of 26 in both groups. As for status, 73% were single, and 27% married. Mean AMH levels were similar in both groups (2.34+/- 0.7 in Group 1; 2.29+/- 0.9 in Group 2). All patients followed an antagonist protocol. There was no significant difference in the duration of stimulation (10.6+/-2 days in case of early follicular start COS versus 10.13+/- 2 days in random-start COS; p=0.5). Furthermore, the total number of oocytes retrieved upon pick-up was similar in both groups (8.06+/-3 in Group 1 versus 7.37+/-2 in Group 2; NS). As for the maturity rate, no significant difference was noted (76% oocyte maturity rate in early follicular start COS and 73% in random-start COS). Random start COS seems as effective as conventional start COS in fertility preservation. The main advantage is that Random-start can minimize delays and allow more patients to undergo fertility preservation, and yet still proceed with cancer treatment within 2 weeks.