Further Evidence on the Safety and Success of Ovarian Stimulation With Letrozole and Tamoxifen in Breast Cancer Patients Undergoing In Vitro Fertilization to Cryopreserve Their Embryos for Fertility Preservation

ArticleinJournal of Clinical Oncology 23(16):3858-9 · July 2005with116 Reads
DOI: 10.1200/JCO.2005.04.011 · Source: PubMed
    • "In current practice a proportion of young cervical cancer patients undergo cryo-conservation of unfertilized oocytes after appropriate ovarian stimulation [11] . Another established option which however requires a partner is in vitro fertilization (IVF) and cryo-preservation of embryos, which is not regulated by legislation in several countries [9] . Alternatively ovarian tissue might be cryo-preserved and later be re-implanted, preferably by an orthotopic approach, a procedure which requires no partner and no hormonal stimula- tion [12]. "
    [Show abstract] [Hide abstract] ABSTRACT: Young patients with cervical cancer who undergo chemoradiation might be interested in fertility preservation, not only dependent upon the use of a gestational carrier as maybe achieved by the use of ovarian transposition and cryo-conservation of oocytes or ovarian tissue, but may prefer to carry pregnancy to term after cancer treatment. The latter approach is a non-established concept needing both modern radiation therapy approaches as well as modifications -if at all possible- in current recommendations for target volume delineation to spare dose to the unaffected uterus. Future strategies to serve selected patients in this respect should only be conducted in prospective clinical evaluations and are critically discussed in this article.
    Full-text · Article · Dec 2015
    • "One study monitored participants for varying lengths of time (between 272 and 600 days) post COS. No differences were found in the recurrence of breast cancer when compared with those patients who did not undergo COS [31]. Breast cancer patients are usually referred for chemotherapy 6–8 weeks after surgery. "
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer is the most prevalent malignancy among women under 50. Improvements in diagnosis and treatment have yielded an important decrease in mortality in the last 20 years. In many cases, chemotherapy and radiotherapy develop side effects on the reproductive function. Therefore, before the anti-cancer treatment impairs fertility, clinicians should offer some techniques for fertility preservation for women planning motherhood in the future. In order to obtain more available oocytes for IVF, the ovary must be stimulated. New protocols which prevent exposure to increased estrogen during gonadotropin stimulation, measurements to avoid the delay in starting anti-cancer treatment or the outcome of ovarian stimulation have been addressed in this review. There is no evidence of association between ovarian stimulation and breast cancer. It seems that there are more relevant other confluent factors than ovarian stimulation. Factors that can modify the risk of breast cancer include: parity, age at full-term birth, age of menarche, and family history. There is an association between breast cancer and exogenous estrogen. Therefore, specific protocols to stimulate patients with breast cancer include anti-estrogen agents such as letrozole. By using letrozole plus recombinant follicular stimulating hormone, patients develop a multifollicular growth with only a mild increase in estradiol serum levels. Controlled ovarian stimulation (COS) takes around 10 days, and we discuss new strategies to start COS as soon as possible. Protocols starting during the luteal phase or after inducing the menses currently prevent a delay in starting ovarian stimulation. Patients with breast cancer have a poorer response to COS compared with patients without cancer who are stimulated with conventional protocols of gonadotropins. Although many centres offer fertility preservation and many patients undergo ovarian stimulation, there are not enough studies to evaluate the recurrence, breast cancer-free interval or mortality rates in these women.
    Full-text · Article · Feb 2015
    • "For hormone-dependent cancers, aromatase inhibitor letrozole has been documented as an alternative to traditional hormonal stimulation, without evolution of malignancies on a short-term basis. Perspectives are centered on the reduction of ovarian estrogen production when the use of letrozole is started before and maintained during stimulation with gonadotropins (Oktay K, 2005; Azim & Oktay, 2007 ). Similarly, good results have been demonstrated with tamoxifen stimulation, generating positive expectations for breast cancer patients (Oktay et al., 2003). "
    [Show abstract] [Hide abstract] ABSTRACT: Malignant and cardiovascular diseases are the main causes of death in Brazil. Estimates for 2013 predict the occur-rence of 189,150 new cases of cancer in Brazilian women. With advanced detection tools, patients are diagnosed and treated for cancer at a younger age and are more likely to survive. The cytotoxic action of chemotherapeutic agents and radiotherapy very frequently implies serious damage to the gonads, and consequences due to the hypoestro-genism, such as osteoporosis, infertility and premature ovarian failure, are expected. Oncofertility, then, appears as a new area of reproductive medicine, which is dedicated to the development of strategies for the reduction of ther-apeutic sequels in cancer survivals, ultimately aiming the maintenance of their quality of life and the possibility of bi-ological maternity. This article aims to present an overview of possible options for female fertility preservation after cancer and future perspectives in oncofertility.
    Full-text · Dataset · Apr 2014 · ecancermedicalscience
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