Ovarian stimulation and fertility preservation using aromatase inhibitors in women with breast cancer

Capsule:
Studies suggest that in the short term, an aromatase inhibitor plus gonadotropin protocol is effective for safely inducing controlled ovarian hyperstimulation in women with breast cancer for fertility preservation.

Authors:
Jhansi Reddy, M.D. and Kutluk Oktay, M.D.

Volume 98, Issue 6, Pages 1363-1369, December 2012

Abstract:
Breast cancer is the most common malignancy diagnosed in women in the United States. Many breast cancer survivors are concerned that cancer treatment will compromise their reproductive potential. Despite this concern, most women receive limited information addressing preservation of fertility prior to initiating adjuvant chemotherapy. Historically, the supraphysiologic levels of estrogens associated with ovarian stimulation have precluded the utilization of assisted reproductive technologies in the presence of breast cancer. In an effort to mitigate the potential effects of elevated estrogen levels during ovulation induction, we developed a novel ovarian stimulation protocol for women with breast cancer, utilizing aromatase inhibitors. Our studies suggest that in the short term, aromatase inhibitors plus gonadotropins are safe and effective agents for ovarian stimulation in fertility preservation cycles. In this review, we outline the data supporting the use of aromatase inhibitors for ovarian hyperstimulation in women with breast cancer prior to initiating adjuvant chemotherapy.

  • Javier Domingo del Pozo

    Congratulations, excellent review! I think sometimes part of the low or bad responses breast and other cancer patients have after COH may be due to the stimulation itself and influenced by the lack of time: luteolysis prior to stimulation with GnRH antagonists , emergency stimulations, recruited follicles at the beginning of the stimulation,… Or due to the use of letrozole instead of conventional gonadotrophin protocols. But patients with low responses due to the stimulation itself should have normal AFC. When we analyzed hormonal dependent tumors versus non-hormonal, we found that there is a group with special characteristics within the cancer patients group, with low AFC, not related to age and with worse response to COH. But I think we have to stimulate them anyway, even with low available oocytes and limited IVF development, as it may be the only choice to obtain some oocytes and embryos. It´s important to recognize these patients prior to COH and advice them.

Translate »