Prospective observational study on fertility preservation in young early breast cancer patients: The PREFER (Pregnancy and Fertility) trial.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17548-e17548
Author(s):  
Matteo Lambertini ◽  
Paola Anserini ◽  
Valeria Fontana ◽  
Annalisa Abate ◽  
Fausta Sozzi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Ovarian Stimulation ◽  
Ovarian Function ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Ovarian Tissue Cryopreservation ◽  
Breast Cancers ◽  
Breast Cancer Patients

e17548 Background: Approximately 4.5% of breast cancers are diagnosed in women younger than 40 years. Chemotherapy (CT)-induced loss of fertility is a major concern for young patients. Different strategies are available to attempt to preserve ovarian function. We evaluated feasibility and patient preferences of 3 different strategies: oocyte cryopreservation (OC), ovarian tissue cryopreservation (OTC) and temporary ovarian suppression with the administration of LHRH analogue (LHRHa) during CT. Methods: From March 2010 to January 2013 49 breast cancer patients younger than 45 years (median age: 38 [range 25-45]), referred to our institution. They were offered the possibility to reduce the gonadotoxic effects of anticancer treatments: the oncologist proposed both the administration of LHRHa during CT, and a reproductive counselling performed by the gynecologist, where OC and OTC were discussed. The first analysis was planned after 2 years; preliminary data are presented. Results: The majority of patients (42 [85.7%]) accepted the treatment with LHRHa, started at least 1 week before CT. Thirty-eight patients (77.6%) refused the reproductive counselling; the main reason for refusal was previous pregnancies (19 patients [38.8%]). Out of 11 patients (22.4%) who accepted the reproductive counselling, only 3 (6.1%) accepted to undergo OC and 1 (2.0%) OTC. The reasons for refusal were: not eligible for comorbidities 3 patients [6.1%]), fear of delaying cancer treatment (2 patients [4.1%]), fear of the ovarian stimulation required (1 patients [2.0%]) and low successful rate of the technique (1 patients [2.0%]). The 3 patients undergoing OC received a controlled ovarian stimulation with the use of daily injections of recombinant FSH: median length of stimulation was 9 days (range, 8 to 9 days); peak estradiol levels ranged from 280 to 521 pg/ml. An average of 13.3 ± 5.7 oocytes was retrieved, and 8.3 ± 3.1 oocytes cryopreserved per patient. Conclusions: This preliminary analysis suggests that the majority of patients (85.7%) accept the administration of LHRHa during CT and approximately 8.2% of patients undergoes surgical fertility preservation techniques.

O-180 Oocyte vitrification for fertility preservation does not delay the initiation of neoadjuvant chemotherapy for breast cancer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I Sellami ◽  
M Grynberg ◽  
A Benoit ◽  
C Sifer ◽  
A Mayeur ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Diagnosis ◽  
Ovarian Tissue ◽  
Young Patients ◽  
Oocyte Retrieval ◽  
Breast Cancer Patients ◽  
Oocyte Vitrification

Abstract Study question Does oocyte vitrification for fertility preservation (FP) delay the initiation of neoadjuvant chemotherapy for breast cancer? Summary answer The indication of neoadjuvant chemotherapy for breast cancer should not be considered as an impediment to urgent oocyte vitrification for FP. What is known already FP is considered as one of the most important issues to address for young breast cancer patients. Cryopreservation of oocytes or embryos may be considered after controlled ovarian hyperstimulation (COH) or in vitro maturation (IVM). Pregnancies have been reported after reutilization of oocytes frozen following both procedures. Although oocyte competence is better after COH, this strategy requires on average 13 days to be achieved. In addition, the safety of ovarian stimulation before tumor removal is currently not formally established. In case of neoadjuvant chemotherapy, the risk-benefit balance of COH is not well known. Study design, size, duration Retrospective cohort study including all breast cancer patients eligible for oocyte vitrification following COH or IVM before initiation of neoadjuvant chemotherapy between January 2016 and December 2020. Participants/materials, setting, methods Inclusion criteria were: female patients with confirmed non metastatic breast cancer, 18 to 40 years of age, with indication of neoadjuvant chemotherapy, who have had oocyte retrieval for FP after COH or IVM +/- cryopreservation of ovarian tissue. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. Main results and the role of chance A total of 198 patients with confirmed breast cancer who had oocyte retrieval following COH (n = 57) or IVM +/- cryopreservation of ovarian tissue (n = 141) for FP prior to neoadjuvant chemotherapy were included. Although women in IVM group were significantly younger as compared to patients who underwent COH (31.7 ± 4.2 vs. 33.3 ± 4.0 years, p = 0.019), ovarian reserve parameters, BMI and cancer stage did not differ between the two groups. Overall, the average time from cancer diagnosis to chemotherapy start was similar between patients having undergone COH or IVM before oocyte vitrification (37.3 ± 13.8 vs. 36.9 ±13.5 days in COH and IVM groups respectively, p=0.857). Limitations, reasons for caution The time from referral to FP consultation may have influenced the type of FP. In addition, the retrospective nature of the present analysis may constitute a limitation. Moreover, the efficiency and security of the different FP strategies used has not been analysed. Wider implications of the findings Oocyte vitrification following COH or IVM was not associated with delayed breast cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Young patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. Trial registration number Not applicable

scholarly journals Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study

2020 ◽  
Vol 35 (11) ◽  
pp. 2524-2536 ◽  
Author(s):  
S Delattre ◽  
I Segers ◽  
E Van Moer ◽  
P Drakopoulos ◽  
I Mateizel ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Stimulation ◽  
Ovarian Function ◽  
Ex Vivo ◽  
Ovarian Tissue ◽  
Ovarian Tissue Cryopreservation ◽  
Reproductive Outcomes ◽  
Female Patients ◽  
Clinical Scenarios

Abstract STUDY QUESTION What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue ‘ex vivo’ (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

2019 ◽  
Vol 13 ◽  
pp. 117955811982839 ◽  
Author(s):  
Matteo Lambertini ◽  
François Richard ◽  
Bastien Nguyen ◽  
Giulia Viglietti ◽  
Cynthia Villarreal-Garza
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Clinical Evidence ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Ovarian Suppression ◽  
Gonadotropin Releasing Hormone Agonist

Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.

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