Charles Muteshi1, Tim Child2, Eric Ohuma3, Muhammad Fatum2. 1. Oxford Fertility, Institute of Reproductive Sciences, Oxford OX4 2HW, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; Endometriosis CaRe Centre, Oxford OX3 9DU, UK. Electronic address: charles.muteshi@obs-gyn.ox.ac.uk. 2. Oxford Fertility, Institute of Reproductive Sciences, Oxford OX4 2HW, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK. 3. Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Abstract
OBJECTIVES: To determine response to controlled ovarian stimulation in a random start cycle and utilisation of cryopreserved oocytes and embryos in cancer patients. STUDY DESIGN: A retrospective cohort study was carried out in an assisted reproductive treatment centre. Participants included 137 cancer patients who underwent controlled ovarian stimulation for fertility preservation between 1 Feb 2003 and 30 June 2016. The primary outcome variable was number of oocytes retrieved. Multivariable logistic regression analysis was performed, and differences compared using Chi squared test and student t-test as appropriate. P < 0.05 was considered statistically significant. RESULTS: Using the antagonist protocol, there was no difference in number of oocytes retrieved between the early follicular phase or at random start stimulation; 11.9 (95% CI 10.3-13.5) and 12.9 (95% CI 9.6-16.2), P = 0.602, respectively. Similarly, the number of embryos frozen was comparable between those starting stimulation in early follicular and random phase, 6.7 (95% CI 5.7-7.7) and 5.1 (95% CI 3.6-6.5), P= 0.1508 respectively. Among patients undergoing fertility preservation, those who returned to attempt a pregnancy had an ongoing pregnancy rate of 24.3%. Overall, 65% of oocytes and embryos were still in storage, however, 16 (11.7%) had elected to have their oocytes or embryos disposed of. CONCLUSION(S): For women faced with potential gonadotoxic treatment and requiring urgent fertility preservation, ovarian stimulation with the antagonist protocol can be started at random without compromising ovarian response. Pregnancy rates following utilisation of frozen-thawed oocytes and embryos are promising, however, more research is needed to understand reasons underlying disposition of oocytes and embryos especially when survival following cancer treatment has improved significantly.
OBJECTIVES: To determine response to controlled ovarian stimulation in a random start cycle and utilisation of cryopreserved oocytes and embryos in cancerpatients. STUDY DESIGN: A retrospective cohort study was carried out in an assisted reproductive treatment centre. Participants included 137 cancerpatients who underwent controlled ovarian stimulation for fertility preservation between 1 Feb 2003 and 30 June 2016. The primary outcome variable was number of oocytes retrieved. Multivariable logistic regression analysis was performed, and differences compared using Chi squared test and student t-test as appropriate. P < 0.05 was considered statistically significant. RESULTS: Using the antagonist protocol, there was no difference in number of oocytes retrieved between the early follicular phase or at random start stimulation; 11.9 (95% CI 10.3-13.5) and 12.9 (95% CI 9.6-16.2), P = 0.602, respectively. Similarly, the number of embryos frozen was comparable between those starting stimulation in early follicular and random phase, 6.7 (95% CI 5.7-7.7) and 5.1 (95% CI 3.6-6.5), P= 0.1508 respectively. Among patients undergoing fertility preservation, those who returned to attempt a pregnancy had an ongoing pregnancy rate of 24.3%. Overall, 65% of oocytes and embryos were still in storage, however, 16 (11.7%) had elected to have their oocytes or embryos disposed of. CONCLUSION(S): For women faced with potential gonadotoxic treatment and requiring urgent fertility preservation, ovarian stimulation with the antagonist protocol can be started at random without compromising ovarian response. Pregnancy rates following utilisation of frozen-thawed oocytes and embryos are promising, however, more research is needed to understand reasons underlying disposition of oocytes and embryos especially when survival following cancer treatment has improved significantly.
Authors: Maren Goeckenjan; A Freis; K Glaß; J Schaar; I Trinkaus; S Torka; P Wimberger; A Germeyer Journal: Arch Gynecol Obstet Date: 2020-05-06 Impact factor: 2.344