Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase (original) (raw)
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JBRA assisted reproduction, 2018
To evaluate COS and oocyte retrieval results in ART treatment cycles initiated at any stage of the menstrual cycle (random start) in cancer patients, who could not postpone the onset of cancer treatment. Prospective observational study of 26 women with cancer, with an indication to start cancer treatment within the next 20 days and wishing to preserve their fertility. Ovarian stimulation started immediately with FSH followed by GnRH antagonist for pituitary suppression and GnRH agonist for oocyte maturation. Treatment started from day 1 to day 14 of the menstrual cycle was considered to be in the follicular phase, and that started from day 15 to day 28 was considered to be in the luteal phase. Oocyte retrieval was performed 34 h after GnRH agonist administration. After identification and maturity classification, metaphase II oocytes were cryopreserved using vitrification. A total of 13 women had breast cancer, 4 ovarian cancer, 3 Central Nervous System cancer, 3 endometrial cancer, ...
Oocyte Cryostorage to Preserve Fertility in Oncological Patients
Obstetrics and Gynecology International, 2012
Thanks to the progress in oncostatic treatments, young women affected by cancer have a fairly good chance of surviving the disease and leading a normal post-cancer life. Quite often, however, polychemiotherapy and/or radiotherapy can induce ovarian damage and significantly reduce the content of follicles and oocytes inside the ovary, thus predisposing the patient to menstrual disorders, infertility, and precocious menopause. Several techniques have been proposed to preserve fertility in these patients; among them oocyte collection and cryopreservation prior to the oncostatic treatment has been widely applied in the last decade. The proper indications, the permitting conditions, the available hormonal stimulation protocols, as well as the effectiveness and limits of this option will be discussed herein, with a comprehensive and up-to-date review of the two techniques commonly used to cryostore oocytes, the slow-freezing technique and the vitrification technique.
JBRA Assisted Reproduction, 2019
Objective: This study aimed to assess whether a diagnosis of cancer interferes with ovarian function prior to the treatment of the disease. Methods: This observational retrospective study used data from medical records of ovarian stimulation cycles performed for purposes of oocyte cryopreservation. Results: The included patients had a mean age of 35.13±3.72 years and 51.6% of them were aged between 36 and 40 years. More than half of the patients (57.6%) were single and 82.1% had a normal body mass index (BMI). Most women had not become pregnant (85.5%) or had babies (95.1%) or miscarriages (89.6%) prior to cryopreservation. The mean number of oocytes obtained from non-cancer patients was 11.4±8, while for cancer patients the number was 13.8±9. The mean number of frozen mature oocytes was 9.7±7 for the non-cancer group and 11.2±7.2 for the cancer group. The majority (63.1%) of the patients had up to 10 oocytes frozen per cycle. Breast cancer had the highest incidence among the included patients. There was no significant difference in ovarian response between patients with different types of cancer. Conclusion: The number of harvested and frozen oocytes from cancer and non-cancer patients indicated that in the two groups response to ovarian stimulation was similar.
Fertility and Sterility, 2010
Objective: To explore the use of oocyte cryopreservation as a fertility-conserving option. Cancer treatments administered during the reproductive and adolescent years can result in sterility. Previous fertility preservation efforts focused on embryo rather than oocyte storage because the latter was deemed inefficient. Recently, several large reports of healthy births resulting from the transfer of embryos derived from frozen/thawed oocytes have been published. We sought to establish an oocyte cryopreservation program at our center. Design: Twenty-three oocyte cryopreservation cycles were performed. Collected oocytes were cryopreserved by either the slow or the vitrification method. Approximately 1-4 months later, a programmed cycle of thawing/warming, fertilization with intracytoplasmic sperm injection, and ET was performed; cycle and pregnancy outcomes were assessed. Setting: University-based fertility center. Patient(s): Twenty-two infertile women. Intervention(s): Oocyte cryopreservation. Main Outcome Measure(s): Oocyte survival, embryo development, pregnancy outcomes. Result(s): Oocyte survival, 2-pronuclei fertilization, and blastocyst formation rates were 92%, 79%, and 43%, respectively. Fourteen women became pregnant; one miscarried; 10 have delivered 13 viable infants, and three pregnancies are ongoing for an ongoing/delivered pregnancy rate of 57%. This result was not statistically different from cycles performed consecutively in age-matched controls using fresh, nonfrozen autologous or donor oocytes during a similar time period. Conclusion(s): Oocyte cryopreservation appears to be a viable option for fertility preservation in some centers.
Journal of Assisted Reproduction and Genetics, 2010
Purpose To report the case of a patient with a diagnosis of infiltrative ductal carcinoma of the breast (case 1) and of a patient with Hodgkin's lymphoma (case 2), both submitted to ovarian stimulation during the luteal phase of the menstrual cycle in order to cryopreserve embryos and oocytes, respectively, in view of the need to start chemotherapy within a maximum of three weeks. Methods Case reports Results Both patients were submitted to ovarian stimulation with recombinant follicle stimulating hormone together with pituitary blockade with a GnRH antagonist during the luteal phase of the cycle. Oocyte retrieval was performed nine days after the beginning of ovarian stimulation, with 12 mature oocytes being obtained in both cases. In case 1, all mature oocytes were submitted to ICSI, with fertilization and cleavage rates of 83.3% and 70%, respectively, and with the formation of seven good quality embryos. In case 2, all of mature oocytes were cryopreserved. Conclusions These cases demonstrate that it is possible to obtain mature oocytes when ovarian stimulation is started in the luteal phase in situations in which there is not sufficient time for conventional stimulation.
Journal of Assisted Reproduction and Genetics, 2020
PurposeThe majority of data regarding oocyte cryopreservation (OC) outcomes focuses on healthy women. We compare trends, cycle characteristics, and outcomes between women freezing oocytes for fertility preservation due to cancer versus elective and other medical or fertility-related diagnoses.MethodsRetrospective cohort using national surveillance data includes all autologous OC cycles between 2012 and 2016. Cycles were divided into 4 distinct groups: cancer, elective, infertility, and medically indicated. We calculated trends and compared cycle and outcome characteristics between the 4 groups. We used multivariable log-binomial models to estimate associations between indication and gonadotropin dose, hyperstimulation, and cancelation and used Poisson regression models to estimate associations between indication and oocyte yield and maturity.ResultsThe study included 29,631 autologous OC cycles. Annual total (2925 to 8828) and cancer-related (177 to 504) cycles increased over the study period; the proportions remained constant. Compared to elective, cancer-related cycles were more likely to be performed among women < 35 years old, with higher BMI, living in the South, using an antagonist protocol. Compared to elective OC cycles, gonadotropin dose (aRR 0.89, 95%CI 0.80–0.99), cancelation (aRR 0.90, 95%CI 0.70–1.14), and hyperstimulation (aRR 1.46, 95%CI 0.77–2.29) were not different for cancer-related cycles. Oocyte yield and percent maturity were comparable in both groups.ConclusionThe number of OC cycles among women with cancer has increased; however, the percentage OC cycles for cancer have remained stable. While patient demographic characteristics were different among those undergoing OC for cancer indication, cycle outcomes were comparable to elective OC. The outcomes of the subsequent oocyte thaw, fertilization, and embryo transfer cycles remain unknown.Electronic supplementary materialThe online version of this article (10.1007/s10815-020-01715-8) contains supplementary material, which is available to authorized users.
Immature oocyte retrieval in the luteal phase to preserve fertility in cancer patients
Reproductive BioMedicine Online, 2008
As cancer treatment outcomes improve, the number of women with cancer seeking fertility preservation increases. Currently, embryo/oocyte cryopreservation appears to provide the best fertility preservation option. However, patients may not have sufficient time to undergo ovarian stimulation prior to chemotherapy and/or the hormones used in ovarian stimulation are contraindicated for certain tumours. In-vitro maturation has been suggested as an effective treatment for these patients. This report presents three women aged 21, 30 and 40 years, without male partners, seeking fertility preservation prior to chemotherapy. They were first seen during the luteal phase of their menstrual cycle and were to undergo gonadotoxic treatment imminently. They underwent immature oocyte retrieval in the luteal phase and seven, five and seven immature oocytes were recovered, respectively. After in-vitro maturation, five, three and five metaphase II (MII) oocytes were vitrified. Two patients later underwent one and two more retrievals, respectively, in the follicular phase of the next cycle(s) and additional oocytes were cryopreserved. These results suggest that immature oocytes recovered in the luteal phase can successfully be matured in vitro; therefore, if there is not sufficient time for conventional follicular-phase oocyte retrieval in a stimulated/unstimulated cycle prior to chemotherapy, a retrieval in the luteal phase could be considered.
Journal of Assisted Reproduction and Genetics, 2010
Purpose To compare oocyte cryopreservation cycles performed in cancer patients to those of infertile women. Methods Cancer patients referred for fertility preservation underwent counseling in compliance with the ASRM; those electing oocyte cryopreservation were included. Ovarian stimulation was achieved with injectable gonadotropins and freezing was performed using slow-cooling and vitrification methods. Results Fifty cancer patients (mean age 31 y) underwent oocyte cryopreservation; adequate ovarian stimulation was achieved in 10±0.3 days. The outcome from these cycles included a mean peak estradiol of 2,376 pg/ml and an average of 19 oocytes retrieved (15 mature oocytes were cryopreserved/cycle). All patients tolerated ovarian hyperstimulation. There were no significant differences noted between cryopreservation cycles performed in cancer patients and in women without malignancy.
Oocyte cryopreservation as a fertility preservation measure for cancer patients
Reproductive BioMedicine Online, 2011
Dr Noyes has worked full-time in infertility since 1990. She received her medical degree from the University of Vermont, then completed residency in obstetrics/gynaecology and fellowship in reproductive endocrinology at the New York Hospital-Cornell Medical Center. She is board-certified in both obstetrics/gynaecology and reproductive endocrinology. Dr Noyes has been involved in the treatment of over 17,000 infertility patients using assisted reproductive technologies. In addition, since 2004, she and Dr Westphal have been actively involved in fertility preservation, including oocyte freezing. Their continued academic collaboration has culminated in this important and informative clinical review.