Random-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles

doi:10.1016/j.fertnstert.2011.01.030

Fertility and Sterility

Volume 95, Issue 6, May 2011, Pages 2125.e9-2125.e11

https://doi.org/10.1016/j.fertnstert.2011.01.030 Get rights and content

Objective

To report an emergency approach of random-start controlled ovarian hyperstimulation (COH) in the late follicular or luteal phase of the menstrual cycle for embryo cryopreservation in patients with cancer.

Design

Case series.

Setting

Academic tertiary referral centers.

Patient(s)

Three patients with a diagnosis of breast cancer requiring emergency fertility preservation in the late follicular or luteal phase of the menstrual cycle.

Intervention(s)

After baseline pelvic ultrasound and hormonal evaluation, random-start COH was commenced immediately on menstrual cycle days 11, 14, or 17 with use of letrozole 2.5 mg/d and recombinant FSH 150 to 300 IU/d. Gonadotropin-releasing hormone antagonist was administered to prevent ovulation in all cases. Ovulation was triggered with either 250 μg of recombinant hCG or 10,000 IU of urinary hCG.

Main Outcome Measure(s)

Number of oocytes harvested, maturity and fertilization rates, number of embryos frozen.

Result(s)

Nine to 17 oocytes were harvested, resulting in the freezing of seven to 10 embryos with the mean maturity and fertilization rates of 58.8% to 77.7% and 69.2% to 87.5%, respectively.

Conclusion(s)

In an emergent setting, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising fertilization rates in letrozole cycles.

Section snippets

Case reports

Three patients aged 26, 26, and 29 years with breast cancer were referred for fertility preservation. The diagnosis was invasive ductal cancer in two patients and mixed invasive lobular and ductal cancer in the other. All patients were scheduled to undergo four to six cycles of cyclophosphamide-based cytotoxic therapy, and because of a late referral in the process patients did not have sufficient time to wait for the onset of the next menstrual period. The details of initial ultrasound

Discussion

In the present case series, we demonstrated that COH can be started at any time during the menstrual cycle in the setting of urgent fertility preservation. In three cases, seven to 10 embryos were frozen with favorable fertilization rates. Moreover, we were able to generate additional embryos by IVM in all cases. Notably, presence of a dominant follicle measuring 20 mm in one patient and very recent ovulation with a serum P level of 2.5 ng/mL in another patient did not affect the outcomes of

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: M.S. has nothing to disclose. I.T. has nothing to disclose. U.C. has nothing to disclose. K.O. has nothing to disclose.

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Case reportRandom-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles

Objective

Design

Setting

Patient(s)

Intervention(s)

Main Outcome Measure(s)

Result(s)

Conclusion(s)

Section snippets

Case reports

Discussion

Best Pract Res Clin Obstet Gynaecol

Fertil Steril

Reprod Biomed Online

Reprod Biomed Online

Fertil Steril

Fertil Steril

Case report
Random-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles