Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140, Bondy, France.
Department of Cytogenetic and Reproductive Biology, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140, Bondy, France.
Reprod Biol Endocrinol. 2022 Jun 11;20(1):87. doi: 10.1186/s12958-022-00958-7.
In absence of contraindication, breast cancer patients of reproductive age can undergo fertility preservation with controlled ovarian stimulation for oocyte/embryo cryopreservation before the administration of potentially gonadotoxic treatments. High hormonal levels induced by ovarian stimulation might have an adverse impact on hormone-positive breast cancer. Whether letrozole supplementation during ovarian stimulation (COSTLES) reduces serum progesterone levels after GnRHa trigger remains unknown. We aimed to determine whether COSTLES might be useful for breast cancer patients undergoing fertility preservation to reduce early luteal progesterone levels following GnRH-agonist (GnRHa)trigger.
All women who underwent COS with GnRH antagonist protocol with GnRHa trigger were included. Serum progesterone level measured 12 h after GnRHa trigger was compared between patients undergoing COS with letrozole supplementation (COSTLES group) and patients undergoing COS without letrozole (Control group) for fertility preservation purposes.
A total of 246 patients were included, of which 84 patients (34.1%) in the COSTLES group and 162 patients (65.6%) in the Control group. All patients in the COSTLES group were BC patients (n = 84, 100%), while the Control group included 77 BC patients (47.5%). Patients in the two groups were comparable. The mean number of oocytes recovered and vitrified at metaphase 2 stage did not significantly differ between the two groups. Serum progesterone levels on the day after GnRHa trigger were significantly lower in the COSTLES group (8.6 ± 0.7 vs. 10.5 ± 0.5 ng/mL, respectively, p < 0.03), as well as serum E2 levels (650.3 ± 57.7 vs. 2451.4.0 ± 144.0 pg/mL, respectively, p < 0.01). However, the GnRHa-induced LH surge was significantly higher in in the COSTLES group (71.9 ± 4.6 vs. 51.2 ± 2.6 UI/L, respectively, p < 0.01).
Our results show that COSTLES for fertility preservation in breast cancer patients using GnRHa trigger reduces serum progesterone levels compared to ovarian stimulation without letrozole. These findings encourage the use of COSTLES in this context to decrease the potential deleterious effect of elevated hormonal levels on hormone-positive breast cancer.
在没有禁忌症的情况下，有生育需求的育龄期乳腺癌患者可在接受潜在性腺毒性治疗前进行控制性卵巢刺激，以获取卵母细胞/胚胎并进行冷冻保存。卵巢刺激产生的高激素水平可能对激素阳性乳腺癌产生不良影响。然而，GnRH 激动剂（GnRHa）扳机后，卵巢刺激中添加来曲唑（COSTLES）是否能降低血清孕激素水平仍不清楚。我们旨在确定 COSTLES 是否可用于接受生育力保存的乳腺癌患者，以降低 GnRH 激动剂（GnRHa）扳机后黄体中期孕激素水平。
纳入接受 GnRH 拮抗剂方案加 GnRHa 扳机的控制性卵巢刺激患者。比较接受 GnRHa 扳机后 12 小时的血清孕激素水平，以评估接受来曲唑补充（COSTLES 组）与未接受来曲唑补充（对照组）的患者的卵巢刺激对生育力保存的影响。
共纳入 246 例患者，其中 84 例（34.1%）患者在 COSTLES 组，162 例（65.6%）患者在对照组。COSTLES 组所有患者均为乳腺癌患者（n=84，100%），而对照组包括 77 例乳腺癌患者（47.5%）。两组患者具有可比性。两组间获卵数和中期 II 期冷冻卵母细胞数无显著差异。COSTLES 组 GnRHa 扳机后第 1 天的血清孕激素水平明显较低（分别为 8.6±0.7 vs. 10.5±0.5 ng/mL，p<0.03），E2 水平也明显较低（分别为 650.3±57.7 vs. 2451.4.0±144.0 pg/mL，p<0.01）。然而，COSTLES 组 GnRHa 诱导的 LH 峰更高（分别为 71.9±4.6 vs. 51.2±2.6 UI/L，p<0.01）。
我们的结果表明，与未使用来曲唑的卵巢刺激相比，乳腺癌患者使用 GnRHa 扳机进行生育力保存时添加来曲唑（COSTLES）可降低血清孕激素水平。这些发现鼓励在这种情况下使用 COSTLES，以降低升高的激素水平对激素阳性乳腺癌的潜在有害影响。
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