Abstract
ObjectiveTo evaluate COS and oocyte retrieval results in ART treatment cycles initiated at any stage of the menstrual cycle (random start) in cancer patients, who could not postpone the onset of cancer treatment.MethodsProspective observational study of 26 women with cancer, with an indication to start cancer treatment within the next 20 days and wishing to preserve their fertility. Ovarian stimulation started immediately with FSH followed by GnRH antagonist for pituitary suppression and GnRH agonist for oocyte maturation. Treatment started from day 1 to day 14 of the menstrual cycle was considered to be in the follicular phase, and that started from day 15 to day 28 was considered to be in the luteal phase. Oocyte retrieval was performed 34 h after GnRH agonist administration. After identification and maturity classification, metaphase II oocytes were cryopreserved using vitrification.ResultsA total of 13 women had breast cancer, 4 ovarian cancer, 3 Central Nervous System cancer, 3 endometrial cancer, 2 cervical cancer and one bowel cancer. Thirteen patients started treatment during follicular phase and 13 during luteal phase. We found similar results for the duration of treatment, total dose of follicle stimulating hormone, number of ampoules of gonadotropin releasing hormone antagonist, mean number of follicles identified at ultrasound on the day of trigger and retrieval, number of aspirated oocytes and Metaphase II oocytes.ConclusionRandom-start controlled ovarian stimulation for emergency fertility preservation for minimizing delay in oncologic treatment for cancer patients does not interfere with the number of metaphase II oocytes, and therefore can be routinely used for stimulation followed by cryopreservation.
Highlights
Life expectancy after cancer treatment is increasing continuously, due to improved prognosis and higher survival rates
When we compared treatment outcome from both groups, we found similar results for the duration of treatment, total dose of recombinant follicle stimulating hormone (FSH), number of gonadotropin releasing hormone (GnRH) antagonist ampoules, mean number of follicles identified upon ultrasound on the day of trigger and retrieval, number of aspirated oocytes and Metaphase II (Table 1)
Our study demonstrated that random-start controlled ovarian stimulation for emergency fertility preservation is a valid strategy for minimizing delay in oncologic treatment for cancer patients
Summary
Life expectancy after cancer treatment is increasing continuously, due to improved prognosis and higher survival rates Some treatments such as surgery (oophorectomy), radio and chemotherapy can adversely affect female reproductive and endocrine functions, and one third of cancer patients will develop premature ovarian failure (Chung et al, 2013). The use of oocyte or embryo cryopreservation is the preferred method for fertility preservation, with clinically acceptable results (ASRM Practice Committee, 2013) Both alternatives require controlled ovarian stimulation (COS) to increase the number of embryos/oocytes for cryopreservation. For women submitted to Assisted Reproductive Technology (ART) treatment, COS starts at early follicular or mid luteal phases, in order to optimize pregnancy rates This treatment might require 14 to 30 days, depending on the patient’s menstrual cycle phase at the presentation day
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