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Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes

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Abstract

Background

Aromatase inhibitors (AI) have been introduced to reduce estrogen exposure in women with estrogen-sensitive cancer undergoing ovarian stimulation for oocyte/embryo cryopreservation. There have been questions regarding whether the addition of AI and the presence of BRCA mutations affect cycle outcomes. We sought to determine the impact of letrozole and BRCA mutations on fertility preservation (FP) cycle outcomes of patients undergoing ovarian stimulation with an antagonist protocol.

Methods

The data were generated by the secondary analysis of a prospective database of all females diagnosed with cancer who underwent embryo or oocyte cryopreservation for FP. The final analysis included 145 patients stimulated with an antagonist protocol either using letrozole combined with recombinant follicle-stimulating hormone (rFSH; LF, n = 118) or rFSH alone (FA, n = 24).

Results

The mean number of total (15.6 [7.9] vs 10.2 [7.8]; P =.004) and mature oocytes (10.4 [5.1] vs 7.8 [3.5]; P =.044) and embryos frozen (7.7 [5.3] vs 5.3 [2.7]; P =.043) were significantly higher after LF stimulation versus FA. In the LF group, women with BRCA mutations produced significantly fewer oocytes (11.0 [8.0] vs 16.4 [7.7], P =.015) and embryos (5.1 [4.4] vs 8.2 [4.7], P =.013), compared to those who were mutation negative. After adjusting for age, body mass index, baseline FSH level, and BRCA status, LF protocol still resulted in higher number of total oocytes (95% confidence interval [CI]: 1.9 to 3.6; P =.002) mature oocyte (95% CI: 0.3 to 1.4; P =.028), and embryo yield (95% CI: 0.7 to 1.4; P =.015).

Conclusion

In women with cancer undergoing FP, letrozole appears to enhance response to ovarian stimulation while the presence of BRCA mutations is associated with lower oocyte and embryo yield.

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Authors and Affiliations

  1. Innovation Institute for Fertility and In Vitro Fertilization, 4 Columbus Circle, New York, NY, USA

    Volkan Turan MD, Giuliano Bedoschi MD, Volkan Emirdar MD, Fred Moy MD & Kutluk Oktay MD, PhD, FACOG

  2. Department of Obstetrics and Gynecology, GOP Hospital, Yeni Yuzyil University School of Medicine, Istanbul, Turkey

    Volkan Turan MD

  3. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil

    Giuliano Bedoschi MD

  4. Laboratory of Molecular Reproduction and Fertility Preservation, Yale University School of Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, New Haven, CT, USA

    Kutluk Oktay MD, PhD, FACOG

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  1. Volkan Turan MD
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  5. Kutluk Oktay MD, PhD, FACOG
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Correspondence to Kutluk Oktay MD, PhD, FACOG.

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Turan, V., Bedoschi, G., Emirdar, V. et al. Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes. Reprod. Sci. 25, 26–32 (2018). https://doi.org/10.1177/1933719117728800

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  • DOI: https://doi.org/10.1177/1933719117728800

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