Department of Maternal and Child Health and Urology, Sapienza University, Viale Regina Elena, 324, 00161, Rome, Italy.
Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Assist Reprod Genet. 2023 Sep;40(9):2149-2156. doi: 10.1007/s10815-023-02883-z. Epub 2023 Jul 13.
Random start protocols are commonly used for oocyte cryopreservation in women with cancer. However, albeit generally reassuring, available evidence is still insufficient to rule out a sub-optimal cycle outcome. This study aimed to compare follicular steroidogenesis between women initiating the random start protocol in the luteal phase and those initiating in the follicular phase.
Consecutive women with cancer scheduled for oocyte cryostorage were prospectively recruited. We excluded those requiring a concomitant letrozole assumption. All women received a standardized protocol with recombinant FSH and GnRH antagonists. At the time of oocyte retrieval, follicular fluids were pooled, and a sample was collected and frozen at -80 °C. All samples were assayed concomitantly after thawing by liquid chromatography-tandem mass spectrometry. The concentration of 15 different steroid hormones was determined.
Seventy-one women were recruited. Thirty-three initiated the ovarian stimulation in the luteal phase, while the remaining 38 initiated in the follicular phase. Baseline characteristics were generally similar. Cycle outcome did also not differ; the median (interquartile range) number of frozen mature oocytes was 9 (5-14) and 10 (5-21), respectively (p = 0.42). None of the 15 tested steroid hormones differed.
The endocrine microenvironment surrounding oocytes is not markedly influenced by the phase of the menstrual cycle at the initiation of ovarian stimulation. This result further supports the validity of random start protocols.
随机起始方案常用于癌症女性的卵母细胞冷冻保存。然而，尽管现有证据通常令人安心，但仍不足以排除周期结局不佳的可能性。本研究旨在比较黄体期和卵泡期开始随机起始方案的女性卵泡类固醇生成情况。
连续招募计划进行卵母细胞冷冻保存的癌症女性。我们排除了需要同时服用来曲唑的患者。所有女性均接受重组 FSH 和 GnRH 拮抗剂的标准化方案治疗。在卵母细胞采集时，将卵泡液汇集，采集并在-80°C 下冷冻一份样本。所有样本解冻后均通过液相色谱-串联质谱法同时进行检测。测定了 15 种不同类固醇激素的浓度。
共招募了 71 名女性。33 名女性在黄体期开始卵巢刺激，其余 38 名女性在卵泡期开始。基线特征通常相似。周期结局也没有差异；冷冻成熟卵母细胞的中位数（四分位距）分别为 9（5-14）和 10（5-21）（p=0.42）。15 种测试的类固醇激素均无差异。
卵巢刺激起始时月经周期阶段对卵母细胞周围的内分泌微环境没有明显影响。这一结果进一步支持了随机起始方案的有效性。
