Effective method for emergency fertility preservation: random-start controlled ovarian stimulation

Area of Science:

• Reproductive Endocrinology
• Oncology
• Fertility Preservation

Background:

• Cancer patients undergoing gonadotoxic therapy require timely fertility preservation.
• Conventional controlled ovarian stimulation (COS) starts in the early follicular phase, potentially causing delays.
• Random-start COS offers an alternative by initiating stimulation regardless of the menstrual cycle phase.

Purpose of the Study:

• To compare the effectiveness of random-start COS versus conventional early follicular phase-start COS for fertility preservation in cancer patients.
• To evaluate if random-start COS yields similar oocyte retrieval and fertilization outcomes.

Main Methods:

• Retrospective cohort study conducted at an academic medical center.
• Inclusion of women recently diagnosed with cancer preparing for gonadotoxic therapy.
• Comparison of outcomes between random-start and conventional-start COS protocols.

Main Results:

• Similar numbers of total and mature oocytes retrieved between random-start (n=35) and conventional-start (n=93) COS cycles.
• Oocyte maturity rates, mature oocyte yield, and fertilization rates were comparable across groups.
• No significant differences were observed when COS was initiated in the late follicular or luteal phases.
• Addition of letrozole for estrogen-sensitive cancers did not negatively impact COS outcomes or oocyte competence.

Conclusions:

• Random-start COS is a viable and effective alternative for fertility preservation in cancer patients.
• This protocol can significantly reduce treatment delays, enabling more patients to undergo fertility preservation.
• Patients can commence cancer treatment within 2-3 weeks after random-start COS, optimizing their care.