Does Higher Starting Dose of FSH Stimulation with Letrozole Improve Fertility Preservation Outcomes in Women with Breast Cancer

Capsule:
Higher FSH start dose does not improve cycle outcomes in women with breast cancer undergoing fertility preservation with letrozole for embryo cryopreservation.

Authors:
Sanghoon Lee, M.D. and Kutluk Oktay, M.D.

Volume 98, Issue 4, Pages 961-964.e1, October 2012

Abstract:

Objective:
To evaluate the efficacy of ovarian stimulation with higher doses of gonadotropins in fertility preservation (FP) cycles with the intention to maximize the likelihood of future pregnancies.

Design:
Retrospective (secondary analysis).

Setting:
Academic medical centers.

Patients:
Low (LD, = 150 IU, n=34) versus high dose (HD, > 150 IU, n=117) FSH start in 151 patients with breast cancer (BCa) undergoing ovarian stimulation for embryo cryopreservation with letrozole (LE) before cancer treatment.

Intervention:
None.

Main outcome measures:
FP cycle outcomes.

Results:
Mean total FSH dose (2037±679 IU vs 1128±381 IU, p<0.001) and FSH level on trigger day (21.1±8.9 vs 10.6±4.5 mIU/ml, p<0.001) were higher in the HD group confirming the receipt of higher dose FSH. There was no difference in other patient characteristics. Despite the larger number of follicles >17mm in diameter in the HD group (5.0±2.0 vs 3.4±1.4), neither the peak E2 (498.0±377.5 vs 397.9±320.3), number of oocytes (13.3±8.7 vs 12.3±8.0) nor embryos (6.3±4.7 vs 5.4±3.8) were significantly different from the LD. Of those undergoing frozen embryo transfer (FET), live birth rate/ET (LBR) trended higher in the LD (9/15) compared to HD (2/11) (p=0.051) with 2.1 ±0.8 vs 1.9±0.3 (p=0.496) embryos transferred.

Conclusions:
Higher dose FSH stimulation in LE cycles does not improve outcomes and maybe associated with lower LBR. Our findings may support minimal stimulation in young non-infertile women with BCa.

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