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Outcomes of random-start letrozole protocol with PGT-A in women with breast cancer undergoing fertility preservation

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract  

Purpose  

To compare the cycle characteristics and outcomes of random-start-controlled ovarian stimulation (RSCOS) protocols to the outcomes of standard-start-controlled ovarian stimulation (SSCOS) cycles and to report the utility of PGT-A in these cycles.

Methods

One hundred and seventeen who underwent SSCOS and 39 who underwent RSCOS for oocyte and/or embryo cryopreservation before breast cancer chemotherapy were retrospectively evaluated. Mean number of embryos and blastocyst euploidy rates were the main outcome measures.

Results

A majority of RSCOS cycles were initiated in the luteal phase (66.6% luteal vs. 33.3% follicular). While the total dose of gonadotropins was significantly higher in the RSCOS (3720.8 ± 1230.0 vs. 2345.1 ± 803.6 IU; P < 0.001), the mean number of mature oocytes and embryos was similar to SSCOS. However, there was a trend for a higher number of mean embryos with luteal start RSCOS (6.9 ± 2.7 in late follicular start vs. 9.4 ± 4.2 in luteal start, P = 0.08). PGT-A was performed in 48% of the cases that underwent embryo cryopreservation in RSCOS (12 women, mean age = 35.3 ± 4.1; 87 blastocysts), revealing a euploidy rate of 36.2 ± 22.3% per patient. This rate was comparable to a 45% aneuploidy rate from similarly aged published data. Of the 7 RSCOS patients who returned for frozen embryo transfer, 5 delivered and one has an ongoing pregnancy, while in SSCOS, 18 out of 40 cycles resulted in live birth.

Conclusion

Our data suggests that RSCOS fertility preservation cycle outcomes are similar to those with SSCOS and result in age-appropriate euploidy rates.

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Data availability

The data that support the findings of this study are available upon reasonable request.

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Funding

This study was supported, in part, by RO1 HD053112 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Cancer Institute.

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Authors and Affiliations

  1. Innovation Institute for Fertility Preservation, New Haven and NY, CT and NY, USA

    Volkan Turan, Sonia Gayete-Lafuente & KUTLUK H OKTAY

  2. Department of Obstetrics and Gynecology, Istanbul Health and Technology University School of Medicine, Istanbul, Turkey

    Volkan Turan

  3. Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Sonia Gayete-Lafuente & KUTLUK H OKTAY

  4. Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA

    Heejung Bang

Authors
  1. Volkan Turan
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  2. Sonia Gayete-Lafuente
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  3. Heejung Bang
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  4. KUTLUK H OKTAY
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Contributions

KO designed the study, provided the funding, conducted all procedures, and wrote the manuscript. VT collected and tabulated the data, performed the statistical analysis, and participated in manuscript writing. HB performed statistical analysis. SGL collected data.

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Correspondence to KUTLUK H OKTAY.

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The authors declared no competing interests.

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Turan, V., Gayete-Lafuente, S., Bang, H. et al. Outcomes of random-start letrozole protocol with PGT-A in women with breast cancer undergoing fertility preservation. J Assist Reprod Genet 40, 2401–2408 (2023). https://doi.org/10.1007/s10815-023-02882-0

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  • DOI: https://doi.org/10.1007/s10815-023-02882-0

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