Abstract
ABSTRACTObjective To compare the effectiveness of oral progestins and injectable gonadotropin-releasing hormone antagonist medication in cancer fertility preservation in patients with breast cancer.Methods A cross-sectional study with 40 breast cancer patients submitted to cancer fertility preservation, who were divided into two groups according to histochemical analysis of progesterone receptors to define luteinizing hormone block: if positive, use of gonadotropin-releasing hormone antagonist, if negative, use of oral progestins. The mean age, medication days, antral follicle count, number of oocytes in metaphase II and the occurrence of ovarian hyperstimulation syndrome were compared.Results A total of 20 patients both in the group using gonadotropin-releasing hormone antagonist, and in the group with oral progestins, respectively, had a mean age of 33.9 (32-35.8) and 33.8 (32-35.6) years; days of medications of 11 (9.7-12.3) and 12.8 (11.6-13.9), p=0.037; antral follicle count of 9 (7.11-12) and 8.5 (6-11.9), p=0.370; metaphase II oocyte number of 4 (2.1-9.8) and 7.5 (3.1-10), p=0.348; and ovarian hyperstimulation syndrome of 2 (10%) and 5 (25%) cases, p=0.212.Conclusion The use of oral progestins, in spite of requiring longer treatment time, is effective in relation to the protocol with gonadotropin-releasing hormone antagonist, and offers greater comfort at a lower cost in breast cancer patients with negative progesterone receptors, submitted to cancer fertility preservation.
Highlights
In Brazil, neoplasms are the second leading cause of death among women, with an incidence of 420 thousand cases per year in 2018-2019, excluding non-melanoma skin cancer.[1]
Despite the increasing survival rates in this population provided by the development of cancer treatments, the greatest concern are the late effects on quality of life.[2,3] Among these, the deleterious effect on the patients’ reproductive potential stands out.[4] the professionals involved in the treatment are encouraged to offer guidance to female patients with cancer, as early as possible, on cancer fertility preservation (FP) options, especially if gonadotoxic treatments are indicated.[5]. The high prevalence of premature ovarian failure and infertility after chemotherapy treatments justifies cryopreservation of oocytes and embryos as a reproductive alternative.[6,7,8]
It maintains positive feedback on the endogenous release of follicle stimulating hormone (FSH).(11). Another effect of controlled ovarian stimulation (COS) is the prevention of luteinizing hormone (LH) peak, avoiding premature ovulation, which is one of the major causes of cycle cancellations.[12,13,14,15] Traditionally, both gonadotropin-releasing hormone agonist and gonadotrophin-releasing hormone antagonist have been used as injectable medications.[13]. In cases of preservation of fertility, especially in cancer patients, the ant-GnRH protocol is generally used
Summary
In Brazil, neoplasms are the second leading cause of death among women, with an incidence of 420 thousand cases per year in 2018-2019, excluding non-melanoma skin cancer.[1]. Despite the increasing survival rates in this population provided by the development of cancer treatments, the greatest concern are the late effects on quality of life.[2,3] Among these, the deleterious effect on the patients’ reproductive potential stands out.[4] the professionals involved in the treatment are encouraged to offer guidance to female patients with cancer, as early as possible, on cancer fertility preservation (FP) options, especially if gonadotoxic treatments are indicated.[5] The high prevalence of premature ovarian failure and infertility after chemotherapy treatments justifies cryopreservation of oocytes and embryos as a reproductive alternative.[6,7,8] In this context, during controlled ovarian stimulation (COS), it is common to observe a supraphysiological estrogen level — which is inadvisable in estrogendependent cancers. Considering an average of 4 days of ant-GnRH use, this reduction could be as great as eight-fold lower, which means savings of approximately US$300.00.(18)
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