Young Shih-Hung Richard, Chang Yi-En, Yang Wei-Chung Vivian, Lu Buo-Jia, Chou Szu-Yuan, Chen Chi-Huang
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Hung-Chi Women & Children's Hospital, Taoyuan, Taiwan.
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2023 Mar;62(2):330-333. doi: 10.1016/j.tjog.2022.08.017.
What is the more efficient and safer protocol during controlled ovarian hyperstimulation (COH) for early-stage breast cancer patients seeking emergency fertility preservation before adjuvant chemo/radiotherapy?
This retrospective, case-series study involved two early-stage (Ia) breast cancer patients that requested for fertility preservation within 3 weeks. Random start/dual stimulation protocols with aromatase inhibitor (AI) were used to maximize oocyte yield and suppress serum estradiol (E2) level.
E2 levels on trigger day during dual COH were between 112.0 and 407.0 pg/mL. Duration of COH could be shortened to only 17 days, and up to 41 oocytes were successfully retrieved with two retrievals.
This remarkable efficient and safe protocol involves the combination of random start/dual stimulation with step-up AI dosage beforehand which not only maximize oocyte yield within the shortest possible timeframe, but also to maintain the low level of E2 to avoid over-stimulating estrogen-sensitive cancer cells and to decrease the risk of developing ovarian hyperstimulation syndrome (OHSS).
对于在辅助化疗/放疗前寻求紧急生育力保存的早期乳腺癌患者，在控制性卵巢过度刺激（COH）期间，哪种方案更高效且更安全？
这项回顾性病例系列研究纳入了两名在3周内要求保留生育力的早期（Ia期）乳腺癌患者。采用随机起始/双重刺激方案联合芳香化酶抑制剂（AI），以最大化卵母细胞产量并抑制血清雌二醇（E2）水平。
双重COH期间扳机日的E2水平在112.0至407.0 pg/mL之间。COH的持续时间可缩短至仅17天，通过两次取卵成功获取了多达41个卵母细胞。
这种显著高效且安全的方案包括随机起始/双重刺激与预先逐步增加AI剂量的组合，这不仅能在最短时间内最大化卵母细胞产量，还能维持E2的低水平，以避免过度刺激雌激素敏感的癌细胞，并降低发生卵巢过度刺激综合征（OHSS）的风险。
