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Risk of thrombosis in women with cancer undergoing controlled ovarian hyperstimulation for fertility preservation

  • Fertility Preservation
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Abstract

Purpose

The study aims to evaluate the risk factors and incidence of thromboembolic events among adult women with cancer who underwent controlled ovarian hyperstimulation (COH) for fertility preservation.

Methods

Retrospective, descriptive cohort analysis of patient demographics, medical history, cancer type/treatment, laboratory values, thrombosis within 6 months of COH.

Results

4 of 127 study participants experienced a venous thromboembolic event within 6 months of COH. The median time between oocyte aspiration and the event was 0.25 years (range = 0.10–0.50). The average age at time of event was 25.3 years (SD = 5.3). Three of four thrombotic patients had ovarian cancer, one had breast cancer. All had received surgery and chemotherapy for treatment. All underwent an antagonist cycle ovarian stimulation protocol — none developed ovarian hyperstimulation syndrome. The average anti-mullerian hormone level at the time of hyperstimulation in the thrombosis group was 1.6 (SD = 1.3), compared to 3.6 in the non-thrombosis group. The average max estradiol level reached during ovarian stimulation was 1281.3 (SD = 665.3) in the thrombosis group and 1839.1 (SD = 1513.9) in the non-thrombosis group. Thromboembolic events were not directly associated with mortality.

Conclusions

Within this small descriptive study, the incidence of thromboembolic events in women with cancer undergoing COH for fertility preservation is high. Cancer may play a greater role than COH in thrombosis risk. Ovarian cancer patients who undergo ovarian stimulation may have an increased risk compared to other cancer types. These findings may inform future, prospective studies to determine the role of thromboprophylaxis.

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Acknowledgements

The authors thank Kathrynne M. Barud, Anthony G. Krenik, and Ellen J. Emrich for their help with data collection.

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Authors and Affiliations

  1. Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Valeria D. Melo, Olivia Y. Liseth & Walker M. Schmidt

  2. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Rajiv K. Pruthi

  3. Division of Hematology, University of Pennsylvania, Philadelphia, PA, USA

    Ariela L. Marshall

  4. Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Chandra C. Shenoy

Authors
  1. Valeria D. Melo
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  2. Olivia Y. Liseth
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  3. Walker M. Schmidt
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  6. Chandra C. Shenoy
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Contributions

All authors and team members have approved the manuscript and agree with its submission to Journal of Assisted Reproduction and Genetics. V. D. M., O. Y. L., and W. M. S. contributed to study design, data abstraction, data analysis, and writing of the manuscript. A. L. M., R. K. P., and C. C. S. served as subject-matter experts and provided critical input to study design and manuscript edits. C. C. S. developed the research question and served as the principal investigator.

Corresponding author

Correspondence to Chandra C. Shenoy.

Ethics declarations

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Mayo Clinic who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of Mayo Clinic.

Competing interests

The authors declare no competing interests.

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Attestation statement

All authors attest that data regarding any of the subjects in the study has not been previously published and that data will be made available to the editors of the journal for review or query upon request.

Valeria D. Melo, Olivia Y. Liseth, and Walker M. Schmidt contributed equally to this work and share co-first authorship.

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Melo, V.D., Liseth, O.Y., Schmidt, W.M. et al. Risk of thrombosis in women with cancer undergoing controlled ovarian hyperstimulation for fertility preservation. J Assist Reprod Genet 39, 2847–2856 (2022). https://doi.org/10.1007/s10815-022-02661-3

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  • DOI: https://doi.org/10.1007/s10815-022-02661-3

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