Influence of breast cancer prognostic factors on ovarian reserve and response to ovarian stimulation in fertility preservation

Abstract

Research questionDo breast cancer (BC) prognostic factors influence ovarian reserve and response to controlled ovarian hyperstimulation (COH) in the context of fertility preservation (FP)? DesignObservational, bicentric retrospective study including all BC patients who had vitrified oocytes after COH using a random start GnRH antagonist protocol after measurement of serum AMH levels and antral follicle count (AFC) between November 2015 and August 2022. Three-hundred-fifty-two BC patients having undergone one cycle of COH were analyzed. Number of oocytes recovered (OOR), maturation rate (number of mature oocytes/number of oocytes recovered), and Follicular Output Rate (FORT) were studied according to the patients’ general characteristics, ovarian reserve markers, as well as BC diagnostic and prognostic factors: histological type, uni/multifocal character, TNM or UICC stage, hormonal receptors expression, HER2 status, Ki67, Grade, presence of vascular emboli, lymph node. ResultsOverall, mean patients’ age was 33.6 ± 4.1 years. Mean AFC and serum AMH level were 20.5 ± 13.0 follicles and 2.7 ± 4.6 ng/mL, respectively. After ovarian stimulation, 12.5 ± 8.5 oocytes were recovered and 9.3 ± 6.9 were mature and further vitrified. Mean oocyte maturation rate was 74 ± 23%. Patient's age was significantly related to the number of mature oocytes recovered: the risk of yielding less than 8 oocytes increased significantly after the age of 35 years. Follicular responsiveness to FSH, assessed by the follicular output rate (FORT index) as well as OOR were 30 ± 24% and 12.5 ± 8.5%, respectively. FORT index was not influenced by tumor characteristics and COH outcome was not influenced by breast cancer prognostic factors. ConclusionOur findings indicate that BC prognostic factors do not influence ovarian reserve markers nor the response to ovarian stimulation in the context of FP. Therefore, tumor grade, triple-negative status, overexpression of HER2, and high Ki67 should not modify the FP strategy when COH for oocyte vitrification is considered.