Fertility preserving methods in women with breast cancer before gonadotoxic therapy
Authors:
N. Halászová; I. Crha; M. Huser; Vít Weinberger; J. Žáková; M. Ješeta; E. Lousová; E. Filipinská; P. Ventruba
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in:
Ceska Gynekol 2017; 82(4): 287-292
Overview
Objective:
To present current options and own experiences with ovarian stimulation in young women with breast cancer before gonadotoxic therapy.
Design:
Review article with own experiencies.
Methods:
Literary search, analysis of own experiences with complex therapy in women with breast cancer planning pregnancy, definitions of stimulating protocols, using methods of assisted reproduction.
Setting:
Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.
Results:
Embryo and oocyte cryopreservation are important methods of fertility preservation requiring controlled ovarian stimulation before the start of chemotherapy. Current studies demonstrante effectivenes of this special stimulating protocol and did not find negative side effects such a progression of the breast cancer. Since January 2016 to June 2016 we performed controlled ovarian stimulation and oocyte retrieval in three patients with breast cancer before chemotherapy. We used short stimulation protocol with recombinant FSH, GnRH agonists and letrozole and retrieved 13, 12 and 9 oocytes. We cryopreserved 8 and 6 embryos, one woman prefered freezing of 12 oocytes. During the stimulation estradiol level did not exceed 1,6 nmol/l.
Conclusion:
Neither the normal nor the cancerous cells in the breast react to the gonadotropins FSH, LH, nor to hCG. Conversely, there is a cellular proliferation and an increase in cancer cell lines with oestrogen receptors with exposure to oestrogen, and it is dose – dependent. The special stimulation protocol with FSH, GnRH agonists and letrozole is effective in gain of efficient amount of gamets with minimal increase of estradiole level. Current study reviews did not find higher risk of progression of breast cancer in association with ovarian stimulation. It is important to respect the recomendation of oncology committee and to effectively suppress the estradiol level.
Keywords:
breast cancer, cryopreservation, chemotherapy, letrozole, oncofertility, ovarian stimulation
Sources
1. Argyle, CE., Harper, JC., Davies, MC. Oocyte cryopreservation: where are we now? Hum Reprod Update, 2016, 22(4), p. 440–449.
2 Azim, AA., Costantini-Ferrando, M., Oktay, K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol, 2008, 26, p. 2630–2635.
3. Boots, CE., Meister, M., Cooper, AR., et al. Ovarian stimulation in the luteal phase: systematic review and meta-analysis. J Assist Reprod Genet, 2016, 33, 8, p. 971–980.
4. Cooley, A. Effect of infertility and pregnancy-related hormones on breast cell proliferation in vitro. Human Reprod, 2012, 27, p. 146–152.
5. Donnez, J., Dolmans, MM. Ovarian cortex transplantation: 60 reported live births brings the success and worldwide expansion of the technique towards routine clinical practice. J Assist Reprod Genet, 2015, 32, 8, p. 1167–1170.
6. ÚZIS (Národní onkologický registr ČR). Novotvary 2014 ČR. Praha: ÚZIS Zdravotnická statistika, 2014.
7. Huser, M. Onkofertilita – nová oblast reprodukční medicíny. 1. ed. Praha: Mladá fronta, 2014, 109 s.
8 Huser, M., Smardova, L., Janku, P., et al. Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues. J Assist Reprod Genet, 2015, 32, 8, p. 1187–1193.
9. Kroman, N., Jensen, MB., Wohlfahrt, J., et al. Pregnancy after treatment of breast cancer-a population-based study on behalf of Danish Breast Cancer Cooperative Group. Acta Oncol, 2008, 47, 4, p. 545–549.
10. Minář, L., Weinberger, V., Jandáková, E. Histopatologická klasifikace karcinomu prsu a její vztah k využitelným modalitám systémové léčby. Prakt Gyn, 2012, 16, 1, s. 36–41.
11. Minář, L., Hvizdová, M., Weinberger, V., Jandáková, E. Triple negativní karcinom prsu – prognosticky vysoce závažná skupina mamárních malignit. Čes Gynek, 2012, 77, 2, s. 132–138.
12. Oktay, K. Further evidence on the safety and success of ovarian stimulation with letrozole and tamoxifen in breast cancer patients undergoing in vitro fertilization to cryopreserve their embryos for fertility preservation. J Clin Oncol, 2005, 23, p. 3858–3859.
13. Sergentanis, TN., Diamantaras, AA., Perlepe, C., et al. IVF and breast cancer: a systematic review and meta-analysis. Hum Reprod Update, 2014, 20, 1, p. 106–123.
14. Turan, V., Bedoschi, G., Moy, F., Oktay, K. Safety and feasibility of performing two consecutive ovarian stimulation cycles with the use of letrozole-gonadotropin protocol for fertility preservation in breast cancer patients. Fertil Steril, 2013, 100, 6, p. 1681–1685.
15. Van derVen, H., Liebenthron, J., Beckmann, M., et al. Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates. Hum Reprod, 2016, 31, 9, p. 2031–2041.
16. Ventruba, P., Žáková, J., Trávník P., et al. Aktuální otázky asistované reprodukce v České republice. Čes Gynek, 2013, 78, 4, s. 392–398.
17. Weinberger, V., Minář, L., Brančíková, D. Moderní chirurgická a biologická léčba karcinomu prsu. Čes Gynek, 2012, 77, 6, s. 513–520.
18. Weinberger, V., Zikán, M. Karcinom prsu – specifika gynekologické péče a poradenství. Klin Onkol, 2016, 29, (Suppl. 3), s. 7–15.
19. Zikán, M. Gynekologická prevence a gynekologické aspekty péče u nosiček mutací genů BRCA1 a BRCA2. Klin Onkol, 2016, 29, (Suppl. 1), s. 22–30.
Labels
Paediatric gynaecology Paediatric clinical oncology Gynaecology and obstetrics Clinical oncology Reproduction medicineArticle was published in
Czech Gynaecology
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