Skip to main content

Advertisement

SpringerLink
Log in

Back-to-back random-start ovarian stimulation prior to chemotherapy to maximize oocyte yield

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the feasibility of utilizing back-to-back random-start ovarian stimulation to increase oocyte yield for fertility preservation prior to cancer treatment.

Methods

A case series of 15 patients who underwent back-to-back random-start stimulation cycles prior to chemotherapy.

Results

Of the 15 back-to-back random-start stimulation cases, 13 had breast cancer and 2 had other cancers. The average age was 38 years (range 30–43) and average AFC was 8 (range 3–14). Fourteen of the 15 women (93%) who underwent two ovarian stimulation cycles completed both of them. The average time to complete back-to-back random-start ovarian stimulation was 33 days (range 13–43 days). The average time between the first cycle completion and the second cycle start in our back-to-back random-start stimulations was 9 days (range 0–14 days). Two of the women underwent back-to-back random-start ovarian stimulation prior to starting neoadjuvant chemotherapy for breast cancer. Eleven of our 15 women at least doubled their oocyte or embryo yield relative to their first cycle. Only 1 of the 15 second cycles was canceled. The mature oocyte rate, fertilization rate, and embryo yield were similar among the first and second cycles.

Conclusions

Back-to-back random-start ovarian stimulation may be an effective way to maximize fertility preservation, even in time-limited settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, et al. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2012;118(6):1710–7.

    Article  PubMed  Google Scholar 

  2. Levine JM, Kelvin JF, Quinn GP, Gracia CR. Infertility in reproductive-age female cancer survivors. Cancer. 2015;121(10):1532–9.

    Article  PubMed  Google Scholar 

  3. Cobo A, García-Velasco JA, Coello A, Domingo J, Pellicer A, Remohí J. Oocyte vitrification as an efficient option for elective fertility preservation. Fertil Steril. 2016;105(3):755–764 e8.

    Article  PubMed  Google Scholar 

  4. Druckenmiller S, Goldman KN, Labella PA, Fino ME, Bazzocchi A, Noyes N. Successful oocyte cryopreservation in reproductive-aged cancer survivors. Obstet Gynecol. 2016;127(3):474–80.

    Article  CAS  PubMed  Google Scholar 

  5. Goldman RH, Racowsky C, Farland LV, Munné S, Ribustello L, Fox JH. Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients. Hum Reprod. 2017;32(4):853–9.

    Article  CAS  PubMed  Google Scholar 

  6. Rebar RW. Social and ethical implications of fertility preservation. Fertil Steril. 2016;105(6):1449–51.

    Article  PubMed  Google Scholar 

  7. Oktay K, Buyuk E, Libertella N, Akar M, Rosenwaks Z. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol. 2005;23(19):4347–53.

    Article  CAS  PubMed  Google Scholar 

  8. Cakmak H, Katz A, Cedars MI, Rosen MP. Effective method for emergency fertility preservation: random-start controlled ovarian stimulation. Fertil Steril. 2013;100(6):1673–80.

    Article  PubMed  Google Scholar 

  9. Kuang Y, Chen Q, Hong Q, Lyu Q, Ai A, Fu Y, et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol). Reprod BioMed Online. 2014;29(6):684–91.

    Article  PubMed  Google Scholar 

  10. Ubaldi FM, Capalbo A, Vaiarelli A, Cimadomo D, Colamaria S, Alviggi C, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril. 2016;105(6):1488–1495 e1.

    Article  PubMed  Google Scholar 

  11. 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):1681–5 e1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Graham PJ, Brar MS, Foster T, McCall M, Bouchard-Fortier A, Temple W, et al. Neoadjuvant chemotherapy for breast cancer, is practice changing? A population-based review of current surgical trends. Ann Surg Oncol. 2015;22(10):3376–82.

    Article  PubMed  Google Scholar 

  13. Letourneau JM, Sinha N, Wald K, Harris E, Quinn M, Imbar T, et al. Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer. Hum Reprod. 2017;32(10):2123–9.

    Article  PubMed  Google Scholar 

  14. diZerega GS, Hodgen GD. Folliculogenesis in the primate ovarian cycle. Endocr Rev. 1981;2(1):27–49.

    Article  CAS  PubMed  Google Scholar 

  15. diZerega GS, Hodgen GD. The interovarian progesterone gradient: a spatial and temporal regulator of folliculogenesis in the primate ovarian cycle. J Clin Endocrinol Metab. 1982;54(3):495–9.

    Article  CAS  PubMed  Google Scholar 

  16. Lambertini, M., et al., Cancer and fertility preservation: international recommendations from an expert meeting. BMC Med, 2016. 14: p. 1.

  17. Rosen MP, et al. A quantitative assessment of follicle size on oocyte developmental competence. Fertil Steril. 2008;90(3):684–90.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Abbara A, Clarke SA, Dhillo WS. Novel concepts for inducing final oocyte maturation in in vitro fertilization treatment. Endocr Rev. 2018;39(5):593–628.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: antral follicle count versus anti-Mullerian hormone. Reprod BioMed Online. 2015;31(4):486–96.

    Article  CAS  PubMed  Google Scholar 

  20. Kotanidis L, Nikolettos K, Petousis S, Asimakopoulos B, Chatzimitrou E, Kolios G, et al. The use of serum anti-Mullerian hormone (AMH) levels and antral follicle count (AFC) to predict the number of oocytes collected and availability of embryos for cryopreservation in IVF. J Endocrinol Investig. 2016;39(12):1459–64.

    Article  CAS  Google Scholar 

  21. Moon KY, Kim H, Lee JY, Lee JR, Jee BC, Suh CS, et al. Nomogram to predict the number of oocytes retrieved in controlled ovarian stimulation. Clin Exp Reprod Med. 2016;43(2):112–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to extend a special thank you the UCSF nurses, who provided patient education and ovarian stimulation cycle coordination. We also thank the UCSF Department of OB/GYN for their support of this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA

    Kaitlyn Wald, Hakan Cakmak, Evelyn Mok-Lin, Marcelle Cedars, Mitchell Rosen & Joseph Letourneau

  2. University of Utah Center for Reproductive Medicine, Salt Lake City, UT, USA

    Joseph Letourneau

Authors
  1. Kaitlyn Wald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hakan Cakmak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evelyn Mok-Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcelle Cedars
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitchell Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Letourneau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaitlyn Wald.

Ethics declarations

All study procedures were approved by University of California, San Francisco (UCSF) Committee on Human Research and the Institutional Review Board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wald, K., Cakmak, H., Mok-Lin, E. et al. Back-to-back random-start ovarian stimulation prior to chemotherapy to maximize oocyte yield. J Assist Reprod Genet 36, 1161–1168 (2019). https://doi.org/10.1007/s10815-019-01462-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-019-01462-5

Keywords

Search

Navigation