Random start versus conventional start controlled ovarian stimulation in women with cancer: comparing oocyte yield among fertility preservation cycles

Abstract

To determine if random start controlled ovarian stimulation provides similar oocyte yields compared to conventional ovarian stimulation in women with cancer. Retrospective cohort study. All stimulation cycles for patients undergoing oocyte cryopreservation for fertility preservation due to recent cancer diagnoses and upcoming chemotherapy or radiation were reviewed from 2012-2018. Of the 180 oocyte cryopreservation cycles, 42 cycles (40 unique patients) met inclusion criteria. Patients were grouped into either random start or non-random cycle start. Conventional start was defined as scheduled early follicular phase (prior to cycle day six) initiation of gonadotropins. A two-sample t test was used to compare the primary outcome (number of mature oocytes cryopreserved) between the random and conventional starts. The mean number of mature oocytes cryopreserved were similar in random (n=22) and conventional start controlled ovarian stimulation cycles (n=20) (12.3 versus 10.8, p=0.58). There were no differences in cancellation rate, patient age, patient body mass index (BMI), days of stimulation, peak estradiol, or total cycle gonadotropin use. Mean BMI was 27.4. The addition of letrozole to the stimulation cycles in women with breast cancer (18 cycles) did not change the mean number of oocytes retrieved (17.5 vs 15.2, p = 0.52) or the mean number of mature oocytes cryopreserved (12.8 vs 9.7, p =0.25) compared to non-letrozole stimulation cycles. Fertility preservation is of great interest for women with cancer preparing to undergo potentially gonadotoxic cancer treatments. Random cycle start controlled ovarian stimulation reduces the time delay for initiation of cancer treatment and provides similar oocyte yields in comparison to conventional cycle start. Minimizing cancer treatment delays will expand fertility preservation options for women with cancer.Table 1Oocyte yield comparing random start versus conventional start ovarian stimulation cyclesRandom-start (n=20)Conventional Start (n=22)p-valueAge (years)28.2 (23.9-32.5)30.6 (27.1-34.2)0.37Baseline E2 (pg/mL)151 (21-280) n=16 (some data missing)66.56 (39.9-80.4) n=19 (some data missing)0.12Days of Stimulation10.5 (9.5-11.5)11.0 (10.2-11.8)0.40Peak E2 (pg/mL)1910 (1204-2617)1658 (1080-2237)0.56Total gonadotropin dose (IU)3758 (2813-4703)4643 (3833-5453)0.14Total number of oocytes aspirated (Mean and 95% CI)18.3 (13.0-23.5)14.9 (10.1-19.7)0.33Number of mature oocytes cryopreserved (Mean and 95% CI)12.3 (8.8-15.7)10.8 (6.6-15.0)0.58DiagnosisAML-2 Breast- 8 Cervix-2 Hodgkins Lymphoma-3 Neuroendocrine-1 Polycythemia-1 Sarcoma-2ALL- 1 Breast- 10 Brain- 4 Hodgkins Lymphoma-3 MDS-1 Sarcoma- 1 Open table in a new tab