Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer

Abstract

Breast cancer is the most common malignancy diagnosed in women in the United States. Many breast cancer survivors are concerned that cancer treatment will compromise their reproductive potential. Despite this concern, most women receive limited information addressing preservation of fertility before initiating adjuvant chemotherapy. Historically, the supraphysiologic levels of estrogens associated with ovarian stimulation have precluded the use of assisted reproductive technologies in the presence of breast cancer. In an effort to mitigate the potential effects of elevated estrogen levels during ovulation induction, we developed a novel ovarian stimulation protocol for women with breast cancer, with the use of aromatase inhibitors. Our studies suggest that in the short term, aromatase inhibitors plus gonadotropins are safe and effective agents for ovarian stimulation in fertility preservation cycles. In this review, we outline the data supporting the use of aromatase inhibitors for ovarian hyperstimulation in women with breast cancer before initiating adjuvant chemotherapy.