Cavagna Felipe, Pontes Anagloria, Cavagna Mario, Dzik Artur, Donadio Nilka F, Portela Rafael, Nagai Michelle T, Gebrim Luiz H
Women's Health Reference Center, Hospital Perola Byington, São Paulo, Brazil.
Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil.
Contemp Oncol (Pozn). 2017;21(4):290-294. doi: 10.5114/wo.2017.72395. Epub 2017 Dec 30.
The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen.
Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35-36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger.
The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10.
The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.
作者提出了一种新颖且特定的控制性卵巢刺激方案，用于雌激素受体阳性乳腺癌女性在接受新辅助化疗时的生育力保存。该方案预计随机开始卵巢刺激，并使用来曲唑联合他莫昔芬。
40例乳腺癌患者纳入本研究。采用重组促卵泡激素（FSH）或人绝经期促性腺激素（hMG）进行控制性卵巢刺激（COS）。在COS同时，每天口服5mg来曲唑和20mg他莫昔芬。当卵泡≥19mm时，使用0.2mg曲普瑞林进行扳机。在曲普瑞林注射后35 - 36小时安排取卵。我们的主要观察指标为收集的卵母细胞数量、玻璃化冷冻的卵母细胞数量、卵巢刺激的时长、给予促性腺激素的总剂量以及扳机日的雌二醇水平。
患者的平均年龄为30.43±4.25岁。19名女性在黄体期开始COS，11名在卵泡早期，10名在卵泡晚期。收集的卵母细胞平均数量为11.78±9.12，玻璃化冷冻的卵母细胞平均数量为9.72±7.36。COS的平均时长为10.03±1.33天。扳机日的平均雌二醇浓度为623.10±441.27，给予促性腺激素的平均剂量为2540±713.10。
作者认为该方案是有效的，可能是这些患者进行卵母细胞玻璃化冷冻的安全选择。
