Impact of breast cancer prognostic factors on the response to controlled ovarian stimulation patients undergoing fertility preservation

Abstract

The objective is to know if breast cancer (BC) prognostic factors influence ovarian function and response to controlled ovarian stimulation (COS) in patients seeking fertility preservation (FP)? A total of 151 BC patients undergoing COS for FP were prospectively included between November 2013 and December 2016. COS was initiated regardless of the phase of the cycle, with or without letrozole supplementation. Matured oocytes and/or embryos obtained were vitrified. COS characteristics and outcomes were analyzed in all women BC prognostic factors considered in the present study were Scarff-Bloom-Richardson (SBR) SBRIII grade, Ki 67> 20%, HER2 overexpression and "triple negative” tumor. Univariate and multivariate analysis were performed to determine their impact on ovarian reserve markers (serum Anti-Müllerian Hormone (AMH) and antral follicle count (AFC)) as well as on ovarian response to exogenous FSH. Less than 8 mature oocytes vitrified, maturation rate under 70% or Follicle Output RaTe (FORT) under 35% were considered as poor COS outcomes A total of 154 COS cycles were performed and analyzed in BC patients 33.4±4.1 years of age were analyzed. Mean AMH and AFC were 3.2±4.5 ng/mL and 20.2±14.3 follicles, respectively. HER2 overexpression was observed in 18.9% and 34.7% of tumors expressed estrogen or progesterone receptors. Triple negative status characterized 25% of tumors. BRCA1/2 mutation was found in 22.4% of patients. A mean of 9.2 ± 7.4 mature oocytes were cryopreserved per cycle. After multivariate analysis, only serum AMH levels, AFC and smoking status were significantly associated with the number of mature oocytes obtained following COS. BC prognostic factors did not appear to have a significant influence on ovarian reserve markers, number of retrieved oocytes, maturity rate or on ovarian response to exogenous FSH assessed by FORT index, defined as the ratio of the number of pre-ovulatory follicle (16-22 mm) count on the triggering day X100 to the antral follicle (3-8 mm) count at baseline BC prognostic factors probably have no or low impact on ovarian function in terms of ovarian reserve and response to COS. Further analysis, in particular after oocyte thawing will be needed to clarify a possible impact egg quality.