Different stimulation protocols for oocyte cryropreservation in oncological patients: a retrospective analysis of single university centre

Abstract

Objective: To analyze the results obtain in cancer patients who receive the same controlled ovarian stimulation protocol, started in two different moments of the menstrual cycle, follicular or luteal phase. The stimulation is performed before cancer treatment in order to preserve fertility through oocytes cryopreservation.

Study design: The study is a retrospective analysis about 25 cancer patients at our centre, Department of Reproductive Medicine of University of Pisa, in order to preserve their fertility before cancer treatment. Patients are divided into two groups depending on the menstrual cycle phase, follicular or luteal phase, at the moment of first examination. Standard stimulation protocol with gonadotropins is administered in the follicular group, whereas in the second group we use GnRH (gonadotropin-releasing hormone) antagonist before gonadotropins administration in order to have a rapid luteolysis. The outcome measures are the number of days needed before starting procedure, duration of stimulation, cumulative dosage of gonadotropins number of oocyte retrieved and percentage of mature oocytes.

Results: Any difference showed between two groups based on days of stimulation, total amount of gonadotropins administered and the number of good mature quality oocytes was retrieved. The real difference is the number of days needed to start the procedure, lesser in the luteal group.

Conclusions: This study suggests that oocytes can be obtained before cancer treatment, irrespective of menstrual cycle phase without compromising the efficacy of procedure. Moreover, starting ovarian stimulation anytime during menstrual cycle allows the patients to not postpone the beginning of cancer treatment. Different stimulation protocols, according to different kinds of disease, are available in order to obtain the maximum results without any complication for patients.

Chinese abstract

目的：分析在接受相同控制性卵巢刺激方案的癌症患者，在癌症治疗前，于月经周期的卵泡期或黄体期两个不同时期进行刺激，通过卵母细胞冻存，进行保护生殖力的结果。

研究设计：这个研究是对比萨大学生殖医学科25名癌症患者进行的回顾性分析，为了在癌症治疗前保护患者生殖力。患者在第一次检查时根据月经周期，卵泡或黄体期被分为2组。标准促性腺激素刺激方案在卵泡期组执行，而在第二组在执行促性腺激素前应用GnRH（促性腺激素释放激素）拮抗方案以达到快速的黄体溶解。评估的结果为在方案启动前需要的天数、刺激时间、促性腺激素积累剂量、获卵母细胞数量、成熟卵母细胞百分比。

结果：两组间显示出刺激天数，用促性腺激素的总量、获取的优质成熟卵母细胞数量的差异。真正的差异在于启动程序所需的天数，黄体期组更少。

结论：这个研究表明可在癌症治疗前获得卵母细胞，无论在月经周期的任何时期，不能被方案所限。而且，在月经周期的任何时候都可以开始刺激，以免延迟患者的癌症治疗。根据不同的疾病，选择不同的刺激方案以使患者得到最好的结果而没有并发症。

Keywords:

• Cancer patients
• controlled ovarian stimulation
• fertility preservation
• follicular and luteal phase
• oocyte cryopreservation

Declaration of interest

The authors declare that this research is conducted in the absence of any commercial or financial relationship that can be a potential conflict of interest.