Advertisement

Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase

      Objective

      To analyze if oocytes can be obtained in all patients before cancer treatment within 2 weeks by initiating ovarian stimulation during the follicular or luteal phase.

      Design

      Prospective controlled multicenter trial.

      Setting

      Four university-based centers.

      Patient(s)

      Forty cancer patients before chemotherapy.

      Intervention(s)

      Twenty-eight patients were stimulated with gonadotropins in the follicular phase (group I). In 12 patients (group II), ovarian stimulation was initiated in the luteal phase, and these received GnRH antagonists and recombinant FSH. In 14 patients, 143 oocytes were further processed for fertilization by intracytoplasmic sperm injection (ICSI).

      Main Outcome Measure(s)

      Number of oocytes aspirated after ovarian stimulation, cumulative FSH/hMG dosage, viability and maturity of oocytes, and fertilization rate by ICSI.

      Result(s)

      Patients in group I (age 27.6 ± 4.9 yrs) were stimulated on average for 10.6 days, and patients in group II (age 31.2 ± 5.7 yrs) for 11.4 days. Total amount of FSH was on average 2,255 IU (I) and 2,720 IU (II) per patient. Average and median numbers of aspirated oocytes were, respectively, 13.1 and 11.5 (I) versus 10.0 and 8.5 (II); 83.7% (I) and 80.4% (II) of the oocytes were mature and viable and could be treated by ICSI. Fertilization rate was 61.0% (I) versus 75.6% (II).

      Conclusion(s)

      This pilot study suggests that oocytes can be obtained before cancer treatment efficiently irrespective of the phase of the menstrual cycle.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Schover L.R.
        • Rybicki L.A.
        • Martin B.A.
        • Bringelsen K.A.
        Having children after cancer. A pilot survey of survivors' attitudes and experiences.
        Cancer. 1999; 86: 697-709
        • Schover L.R.
        • Brey K.
        • Lichtin A.
        • Lipshultz L.I.
        • Jeha S.
        Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors.
        J Clin Oncol. 2002; 20: 1880-1889
        • Lee S.J.
        • Schover L.R.
        • Partridge A.H.
        • Patrizio P.
        • Wallace W.H.
        • Hagerty K.
        • et al.
        American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.
        J Clin Oncol. 2006; 24: 2917-2931
        • Madrigrano A.
        • Westphal L.
        • Wapnir I.
        Egg retrieval with cryopreservation does not delay breast cancer treatment.
        Am J Surg. 2007; 194: 477-481
      1. Fertiprotekt. Network for fertility preservation before chemo- and radiotherapy. Available at: http://www.fertiprotekt.eu. Accessed 15 March 2008.

        • Anderson R.A.
        • Kinniburgh D.
        • Baird D.T.
        Preliminary experience of the use of a gonadotrophin-releasing hormone antagonist in ovulation induction/in-vitro fertilization prior to cancer treatment.
        Hum Reprod. 1999; 14: 2665-2668
        • Fridén B.E.
        • Nilsson L.
        Gonadotrophin-releasing hormone-antagonist luteolysis during the preceding mid-luteal phase is a feasible protocol in ovarian hyperstimulation before in vitro fertilization.
        Acta Obstet Gynecol Scand. 2005; 84: 812-816
        • Humaidan P.
        • Bungum L.
        • Bungum M.
        • Hald F.
        • Agerholm I.
        • Blaabjerg J.
        • et al.
        Reproductive outcome using a GnRH antagonist (cetrorelix) for luteolysis and follicular synchronization in poor responder IVF/ICSI patients treated with a flexible GnRH antagonist protocol.
        Reprod Biomed Online. 2005; 11: 679-684
        • Menezo Y.
        Cryopreservation of IVF embryos: which stage?.
        Eur J Obstet Gynecol Reprod Biol. 2004; 113: S28-S32
      2. Deutsches IVF-Register. Available at: http://www.deutsches-ivf-register.de. Accessed 15 March 2008.

        • Niswender G.D.
        • Juengel J.L.
        • Silva P.J.
        • Rollyson M.K.
        • McIntush E.W.
        Mechanisms controlling the function and life span of the corpus luteum.
        Physiol Rev. 2000; 80: 1-29
        • Zeleznik A.J.
        In vivo responses of the primate corpus luteum to luteinizing hormone and chorionic gonadotropin.
        Proc Natl Acad Sci U S A. 1998; 95: 11002-11007
        • Del Canto F.
        • Sierralta W.
        • Kohen P.
        • Muñoz A.
        • Strauss 3rd, J.F.
        • Devoto L.
        Features of natural and gonadotropin-releasing hormone antagonist-induced corpus luteum regression and effects of in vivo human chorionic gonadotropin.
        J Clin Endocrinol Metab. 2007; 92: 4436-4443
        • Azim A.A.
        • 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: 2197-2200