Luteal phase GnRHa trigger in random start fertility preservation cycles

Excerpt

Depending on the type of cancer and how early the patient is referred before chemotherapy, there may nor may not be sufficient time to wait for the menstrual period to initiate ovarian stimulation for embryo or oocyte freezing. We have previously reported a “Random Start Controlled Ovarian Stimulation”(RSCOH) protocol where females with breast cancer were initiated on letrozole and gonadotropins followed by human chorionic gonadotropin (hCG) trigger, regardless of where they were in their menstrual cycle, even postovulation [5]. This approach resulted in a considerable number of oocytes and embryos. We have also reported previously that use of GnRHa trigger instead of hCG reduces ovarian hyperstimulation syndrome (OHSS) risks and estrogen exposure in letrozole-gonadotropin cycles [4]. OHSS may carry additional risks, as cancer patients are already prone to thromboembolic events. In addition, development of severe OHSS as well as hCG trigger-induced false positive pregnancy tests prior to initiation of chemotherapy may result in further delay of chemotherapy. Here we report an index case where the use of GnRHa trigger was tested in a luteal start COH (RSCOH)ovarian stimulation cycle which was initiated immediately after an LH surge. …