Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclère Hospital, 92140 Clamart, France; Department of Reproductive Medicine and Fertility Preservation, Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, 93143 Bondy, France; INSERM, U1133, Université Paris Diderot, France.
Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris, Antoine Beclère Hospital, 92140 Clamart, France.
Reprod Biomed Online. 2024 Nov;49(5):104109. doi: 10.1016/j.rbmo.2024.104109. Epub 2024 May 17.
Do breast cancer prognostic factors influence ovarian reserve and response to ovarian stimulation in the context of fertility preservation?
Observational, bicentric retrospective study of 352 women with breast cancer who underwent ovarian stimulation using a random start gonadotrophin releasing hormone antagonist protocol and vitrified oocytes between November 2015 and August 2022. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were measured. The number of oocytes recovered, maturation rate and follicular output rate (FORT) were analysed according to patients' characteristics and breast cancer prognostic factors.
Median age was 34 years (31.1-37.1). Median AFC and serum AMH level were 17 (12-26) follicles and 2 (1.2-3.4) ng/ml, respectively. After ovarian stimulation, 10.5 (6.0-16.0) oocytes were recovered, with eight (4-13) being mature. Mean oocyte maturation rate was 79% (62-92). Antral follicle count (>12) significantly affected the risk of recovering fewer than eight mature oocytes (P < 0.0001, multivariate analysis). Follicular responsiveness to FSH, assessed by the follicular output rate (FORT index) and number of oocytes recovered, were 31% (21-50) and 10.5% (6.0-16.0), respectively. FORT index and ovarian stimulation outcomes were not influenced by breast cancer prognostic factors.
Breast cancer prognostic factors do not influence ovarian reserve markers or response to ovarian stimulation in fertility preservation. Therefore, tumour grade, triple-negative status, HER2 overexpression and high Ki67 should not alter the fertility-preservation strategy when considering ovarian stimulation for oocyte vitrification.
乳腺癌预后因素是否会影响生育保存过程中卵巢储备和对卵巢刺激的反应？
对 2015 年 11 月至 2022 年 8 月期间接受随机起始促性腺激素释放激素拮抗剂方案和玻璃化卵母细胞的 352 例乳腺癌女性进行了观察性、双中心回顾性研究。测量血清抗苗勒管激素（AMH）水平和窦卵泡计数（AFC）。根据患者特征和乳腺癌预后因素分析了获得的卵母细胞数量、成熟率和卵泡输出率（FORT）。
中位年龄为 34 岁（31.1-37.1）。中位 AFC 和血清 AMH 水平分别为 17（12-26）个卵泡和 2（1.2-3.4）ng/ml。卵巢刺激后，获得 10.5（6.0-16.0）个卵母细胞，其中 8 个（4-13 个）成熟。平均卵母细胞成熟率为 79%（62-92）。AFC（>12）显著影响获得少于 8 个成熟卵母细胞的风险（P < 0.0001，多变量分析）。通过卵泡输出率（FORT 指数）和获得的卵母细胞数量评估卵泡对 FSH 的反应性，分别为 31%（21-50）和 10.5%（6.0-16.0）。FORT 指数和卵巢刺激结果不受乳腺癌预后因素的影响。
乳腺癌预后因素不会影响生育保存过程中的卵巢储备标志物或对卵巢刺激的反应。因此，在考虑对卵母细胞进行玻璃化以进行生育保存时，肿瘤分级、三阴性状态、HER2 过表达和高 Ki67 不应改变生育保存策略。
