eISSN: 1897-4309
ISSN: 1428-2526
Contemporary Oncology/Współczesna Onkologia
Current issue Archive Manuscripts accepted About the journal Supplements Addendum Special Issues Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
4/2017
vol. 21
 
Share:
Share:
more
 
 
abstract:
Original paper

A specific controlled ovarian stimulation (COS) protocol for fertility preservation in women with breast cancer undergoing neoadjuvant chemotherapy

Felipe Cavagna, Anagloria Pontes, Mario Cavagna, Artur Dzik, Nilka F. Donadio, Rafael Portela, Michelle T. Nagai, Luiz H. Gebrim

Contemp Oncol (Pozn) 2017; 21 (4): 290-294
Online publish date: 2017/12/30
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Aim of the study: The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen.

Material and methods: Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35–36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger.

Results: The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10.

Conclusions: The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.
keywords:

breast cancer, fertility pre­servation, ovarian stimulation, letro­zole, tamoxifen

references:
Kim SS, Klem J, Fabian C. Breast cancer and fertility preservation. Fertil Steril 2011; 95: 1535-43.
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67: 7-30.
Morgan S, Anderson RA, Gourley C, Wallace WH, Spears N. How do chemotherapeutic agents damage the ovary? Hum Reprod Update 2012; 18: 525-35.
Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31: 2500-10.
Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G; ESMO Guidelines Working Group. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl 6): vi160-70.
Paluch-Shimon S, Pagani O, Partridge AH, et al. Second international consensus guidelines for breast cancer in young women (BCY2). Breast 2016; 26: 87-99.
Sonmezer M, Oktay K. Fertility preservation in young women undergoing breast cancer therapy. Oncologist 2006; 11: 422-34.
De Pedro M, Otero B, Martin B. Fertility preservation and breast cancer: a review. Ecancermedicalscience 2015; 9: 1-20.
Lambertini M, Cinquini M, Moschetti I, Peccatori FA, Anserini P, Valenzano-Menada M, Tomirotti M, Del Mastro L. Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. Eur J Cancer 2017; 71: 25-33.
Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 2008; 26: 2630-5.
Reddy J, Oktay K. Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer. Fertil Steril 2012; 98: 1363-9.
Checa-Vizcaíno MA, Corchado AR, Cuadri ME, Comadran MG, Brassesco M, Carreras R. The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women. Reprod Biomed Online 2012; 24: 606-10.
Brand JS, Hedayati E, Bhoo-Pathy N, Bergh J, Hall P, Humphreys K, Ludvigsson JF, Czene K. Time-dependent risk and predictors of venous thromboembolism in breast cancer patients: A population-based cohort study. Cancer 2016; 123: 468-75.
Anderson JA, Weitz JI. Hypercoagulable states. Clin Chest Med 2010; 31: 659-73.
Rienzi L, Ubaldi FM. Oocyte versus embryo cryopreservation for fertility preservation in cancer patients: guaranteeing a women’s autonomy. J Assist Reprod Genet 2015; 32: 1195-6.
Martinez M, Rabadan S, Domingo J, Cobo A, Pellicer A, Garcia-Velasco JA. Obstetric outcome after oocyte vitrification and warming for fertility preservation in women with cancer. Reprod. Biomed. Online 2014; 29: 722-8.
Cakmak H, Rosen MP. Random-start ovarian stimulation in patients with cancer. Curr Opin Obstet Gynecol 2015; 27: 215-21.
Mangili G, Papaleo E, Sigismondi C, et al. Timing should no longer be an obstacle to oocyte cryopreservation in patients with cancer. Tumori 2016; doi: 10.5301/tj.5000586.
Rashidi BH, Tehrani ES, Ghaffari F. Ovarian stimulation for emergency fertility preservation in cancer patients: A case series study. Gynecol Oncol Rep 2014; 10: 19-21.
Kim JH, Kim SK, Lee HJ, Lee JR, Jee BC, Suh CS, Kim SH. Efficacy of random-start controlled ovarian stimulation in cancer patients. J Korean Med Sci 2015; 30: 290-5.
Robertson DM, Gilchrist RB, Ledger WL, Baerwald A. Random start or emergency IVF/in vitro maturation: a new rapid approach to fertility preservation. Womens Health (Lond) 2016; 12: 339-49.
von Wolff M, Capp E, Jauckus J, Strowitzki T, Germeyer A; FertiPROTEKT study group. Timing of ovarian stimulation in patients prior to gonadotoxic therapy: an analysis of 684 stimulations. Eur J Obstet Gynecol Reprod Biol 2016; 199: 146-9.
Ubaldi FM, Capalbo A, Vaiarelli A, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril 2016; 105: 1488-95.
Domingo J, Garcia-Velasco JA. Oocyte cryopreservation for fertility preservation in women with cancer. Curr Opin Endocrinol Diabetes Obes 2016; 23: 465-9.
Kim J, Turan V, Oktay K. Long-term safety of letrozole and gonadotropin stimulation for fertility preservation in women with breast cancer. J Clin Endocrinol Metab 2016; 101: 1364-71.
Pereira N, Hancock K, Cordeiro CN, Lekovich JP, Schattman GL, Rosenwaks Z. Comparison of ovarian stimulation response in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins to patients undergoing ovarian stimulation with gonadotropins alone for elective cryopreservation of oocytes. Gynecol Endocrinol 2016; 32: 823-6
Azim AA, Costantini-Ferrando M, Lostritto K, Oktay K. Relative Potencies of Anastrozole and Letrozole to Suppress Estradiol in Breast Cancer Patients Undergoing Ovarian Stimulation before in Vitro Fertilization. J Clin Endocrinol Metab 2007; 92: 2197-200.
Adda-Herzog E, Gallot V, Le Bras A, Hesters L, Fanchin R. Natural ovarian stimulation (NATOS): an innovative estradiol-sparing, multiple follicle protocol suitable for fertility preservation in women with breast cancer. Hum Reprod 2014; 29 (suppl 1): i241.
Oktay K, Buyuk E, Davis O, Yermakova I, Veeck L, Rosenwaks Z. Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen. Hum Reprod 2003; 18: 90-5.
Meirow D, Raanani H, Maman E, et al. Tamoxifen co-administration during controlled ovarian hyperstimulation for in vitro fertilization in breast cancer patients increases the safety of fertility-preservation treatment strategies. Fertil Steril 2014; 102: 488-95.
Parikh RP, Odom EB, Yu L, Colditz GA, Myckatyn TM. Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis. Breast Cancer Res Treat 2017; 163: 1-10.
Thomsen L, Humaidan P. Ovarian hyperstimulation syndrome in the 21st century: the role of gonadotropin-releasing hormone agonist trigger and kisspeptin. Curr Opin Obstet Gynecol 2015; 27: 210-4.
Joo BS, Park SH, An BM, Kim KS, Moon SE, Moon HS. Serum estradiol levels during controlled ovarian hyperstimulation influence the pregnancy outcome of in vitro fertilization in a concentration-dependent manner. Fertil Steril 2010; 93: 442-6.
Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol 2010; 28: 240-4.
Alvarez M, Ramanathan P. Fertility preservation in female oncology patients: the influence of the type of cancer on ovarian stimulation response. Hum Reprod 2016; doi: 10.1093/humrep/dew158.
Shapira M, Raanani H, Feldman B, et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fertil Steril 2015; 104: 1162-7.
The Ethics Committee of the American Society for Reproductive Medicine. Fertility preservation and reproduction in cancer patients. Fertil Steril 2005; 83: 1622-8.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe