Abstract
Purpose
To evaluate the ovarian response to controlled ovarian hyperstimulation (COH) in cancer patients according to an age-specific nomogram for the number of retrieved oocytes.
Methods
Retrospective observational study carried out in a University affiliated fertility clinic. Forty-eight patients with cancer underwent ovarian stimulation for oocyte cryopreservation. An age - specific nomogram for the number of retrieved oocytes was built with 1536 IVF cycles due to male factor exclusively, oocyte donation and age related fertility preservation. The number of oocytes retrieved in cancer patients was compared to the expected response according to the nomogram using the Z-score.
Results
The mean number of total retrieved oocytes in patients with cancer was 14.04 ± 8.83. After applying the Z-score to compare the number of retrieved oocytes between women with cancer and the expected response according to the age-specific nomogram, we did not observe a statistically significant difference (Z-score 0.23; 95 % CI [−0.13-0.60]).
Conclusion(s)
According to our results, patients with cancer exhibit an ovarian response as expected by age. Despite the limitation of the sample size, the obtained results should encourage oncologists for early referral of women with cancer to fertility specialists.
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References
Matthews ML, Hurst BS, Marshburn PB, Usadi RS, Papadakis MA, Sarantou T. Cancer, fertility preservation, and future pregnancy: a comprehensive review. Obstet Gynecol Int. 2012;2012:953937.
Noyes N, Knopman JM, Melzer K, Fino ME, Friedman B, Westphal LM. Oocyte cryopreservation as a fertility preservation measure for cancer patients. Reprod Biomed Online. 2011;23:323–33.
Carter J, Chi DS, Brown CL, Abu-Rustum NR, Sonoda Y, Aghajanian C, et al. Cancer-related infertility in survivorship. Int J Gynecol Cancer. 2010;20:2–8.
Martínez F, Devesa M, Coroleu B, Tur R, González C, Boada M, et al. Cancer and fertility preservation: Barcelona consensus meeting. Gynecol Endocrinol. 2013;29:285–91.
González C, Devesa M, Boada M, Coroleu B, Veiga A, Barri PN. Combined strategy for fertility preservation in an oncologic patient: vitrification of in vitro matured oocytes and ovarian tissue freezing. J Assist Reprod Genet. 2011;28:1147–9.
Revelli A, Molinari E, Salvagno F, Delle Piane L, Dolfin E, Ochetti S. Oocyte cryostorage to preserve fertility in oncological patients. Obstet Gynecol Int. 2012;2012:525896.
Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99:37–43.
Friedler S, Koc O, Gidoni Y, Raziel A, Ron-El R. Ovarian response to stimulation for fertility preservation in women with malignant disease: a systematic review and meta-analysis. Fertil Steril. 2012;97:125–33.
van Casteren NJ, Boellaard WP, Romijn JC, Dohle GR. Gonadal dysfunction in male cancer patients before cy- totoxic treatment. Int J Androl. 2010;33:73–9.
Pal L, Leykin L, Schifren JL, Isaacson KB, Chang YC, Nikruil N, et al. Malignancy may adversely influence the quality and behaviour of oocytes. Hum Reprod. 1998;13:1837–40.
Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol. 2010;28:240–4.
Tulandi T, Holzer H. Effects of malignancies on the gonadal function. Fertil Steril. 2012;98:813–5.
Bland JM, Altman DG. Matching. BMJ. 1994;309:1128.
R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2008. ISBN 3-900051-07-0, URL http://www.R-project.org.
Rigby RA, Stasinopoulos DM. Generalized additive models for location, scale and shape (with discussion). Appl Stat. 2005;54:507–54.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.
Fatum M, McVeight E, Child T. The case for aromatase inhibitors use in Oncofertility patients. Should aromatase inhibitors be combined with gonadotropina treatment in Breast Cancer patients undergoing ovarian stimulation for fertiity preservation prior to chemotherapy? A debate. Hum Fertil. 2013;16:235–40.
Das M, Shehata F, Moria A, Holzer H, Son WY, Tulandi T. Ovarian reserve, response to gonadotropins, and oocyte maturity in women with malignancy. Fertil Steril. 2011;96:122–5.
Moria A, Das M, Shehata F, Holzer H, Son W-Y, Tulandi T. Ovarian reserve and oocyte maturity in women with malignancy undergoing in vitro maturation treatment. Fertil Steril. 2011;95:1621–3.
Johnson LNC, Dillon KE, Sammel MD, Efymow BL, Mainigi MA, Dokras A, et al. Response to ovarian stimulation in patients facing gonadotoxic therapy. Reprod Biomed Online. 2013;26:337–44.
Levin I, Almog B. Effect of cancer on ovarian function in patients undergoing in vitro fertilization for fertility preservation: a reappraisal. Curr Oncol. 2013;20:e1–3.
Lawrenz B, Fehm T, von Wolff M, Soekler M, Huebner S, Henes J, et al. Reduced pretreatment ovarian reserve in premenopausal female patients with Hodgkin lymphoma or non-Hodgkin-lymphoma—evaluation by using antimüllerian hormone and retrieved oocytes. Fertil Steril. 2012;98:141–4.
Ebbel E, Katz A, Kao CN, Cedars MI, Rosen MP. Reproductive aged women with cancer have a lower antral follicle count than expected. Fertil Steril. 2011;96:S199–200.
Knopman JM, Noyes N, Talebian S, Krey LC, Grifo JA, Licciardi F. Women with cancer undergoing ART for fertility preservation: a cohort study of their response to exogenous gonadotropins. Fertil Steril. 2009;91(4):1476–8.
Quintero RB, Helmer A, Huang JQ, Westphal LM. Ovarian stimulation for fertility preservation in patients with cancer. Fertil Steril. 2010;93:865–8.
Noyes N, Labella PA, Grifo J, Knopman JM. Oocyte cryopreservation: a feasible fertility preservation option for reproductive age cancer survivors. J Assist Reprod Genet. 2010;27:495–9.
Almog B, Azem F, Gordon D, Pauzner D, Amit A, Barkan G, et al. Effects of cancer on ovarian response in controlled ovarian stimulation for fertility preservation. Fertil Steril. 2012;98:957–60.
Domingo J, Guillén V, Ayllón Y, Martínez M, Muñoz E, Pellicer A, et al. Ovarian response to controlled ovarian hyperstimulation in cancer patients is diminished even before oncological treatment. Fertil Steril. 2012;97:930–4.
García-Velasco JA, Domingo J, Cobo A, Martínez M, Carmona L, Pellicer A. Five years’ experience using oocyte vitrification to preserve fertility for medical and nonmedical indications. Fertil Steril. 2013;99:1994–9.
Fauser BC, de Jong D, Olivennes F, Wramsby H, Tay C, Itskovitz-Eldor J, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after Cotreatment with the GnRH antagonist Ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab. 2002;87:709–15.
Cakmak H, Rosen MP. Ovarian stimulation in cancer patients. Fertil Steril. 2013;99:1476–84.
Oktay K, Hourvitz A, Sahin G, Oktem O, Safro B, Cil A, et al. Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy. J Clin Endocrinol Metab. 2006;91:3885–90.
Acknowledgments
This work was performed under the auspices of “Catedra d’Investigació en Obstetricia i Ginecología” of Department of Obstetrics, Gynaecology and Reproductive Medicine; Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona.
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Women with malignancy respond de COH as expected by age.
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Devesa, M., Martínez, F., Coroleu, B. et al. Ovarian response to controlled ovarian hyperstimulation in women with cancer is as expected according to an age-specific nomogram. J Assist Reprod Genet 31, 583–588 (2014). https://doi.org/10.1007/s10815-014-0183-6
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DOI: https://doi.org/10.1007/s10815-014-0183-6