Effective method for emergency fertility preservation random start controlled ovarian stimulation

Capsule:
Random-start controlled ovarian stimulation (COS) protocols are as effective as conventional-start COS in fertility preservation and provide a significant advantage by decreasing the total time for embryo/oocyte cryopreservation.

Authors:
Hakan Cakmak, M.D., Katz Audra, R.N., Marcelle I. Cedars, M.D., Mitchell P. Rosen, M.D.

Volume 100, Issue 6, Pages 1673-1680, December 2013

Abstract:

Objective:
To determine whether random-start controlled ovarian stimulation (COS), in which a patient is stimulated on presentation regardless of her menstrual-cycle phase, has outcomes similar to conventional early follicular phase–start COS for fertility preservation in cancer patients.

Design:
Retrospective cohort study.

Setting:
Academic medical center.

Patient(s):
Women recently diagnosed with cancer and in preparation for gonadotoxic therapy.

Intervention(s):
Random- versus conventional-start COS.

Main Outcome Measure(s):
Primary outcome: number of mature oocytes retrieved; secondary outcomes: pattern of follicular development, oocyte yield, and fertilization rate.

Result(s):
The number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield, and fertilization rates were similar in random- (n = 35) and conventional-start (n = 93) COS cycles. No superiority was noted when comparing COS started in the late follicular (n = 13) or luteal phase (n = 22). The addition of letrozole, in the case of estrogen-sensitive cancers, did not adversely affect COS outcomes or oocyte maturity and competence in either random- or conventional-start protocols.

Conclusion(s):
Random-start COS is as effective as conventional-start COS in fertility preservation. This protocol would minimize delays and allow more patients to undergo fertility preservation and still proceed with cancer treatment within 2–3 weeks.

  • Maria Cecilia Erthal

    Hello. I’m a doctor in Brasil.
    It’s a very interesting work.
    In the patients that the ovarian stimulation start in the late follicular phase without GnRH antagonist, I would like to know what level of the LH was considered to make a decision of starting GnRH antagonist.
    Thanks in advance
    Maria Cecília Erthal M.D.

Translate »