Random Start Ovarian Stimulation for Fertility Preservation Allows Minimal Treatment Delays with Neo-adjuvant Breast Cancer Treatments

Introduction: Chemotherapy for breast cancer has been associated with infertility and early menopause. Oocyte and embryo cryopreservation are effective practices for fertility preservation. Neo-adjuvant chemotherapy is becoming a popular treatment for breast cancer patients. In this setting, fertility preservation procedures are presumed to delay starting cancer treatment.

Aim: To determine whether random start ovarian stimulation for fertility preservation is associated with delays in the initiation of neo-adjuvant chemotherapy in breast cancer patients.

Materials & Methods: A retrospective cohort study. Women who were diagnosed with breast cancer with a treatment plan for neo-adjuvant chemotherapy and who were seen for fertility preservation consultation through September 2016 were included in the study. Referrals for fertility preservation evaluation came from breast cancer diagnostic centers, often prior to medical oncology consultation. Women chose to undergo random start ovarian stimulation and oocyte retrieval for fertility preservation (FP) or not (No FP). The time from diagnosis to FP, time from diagnosis to chemotherapy treatment, and time from FP consult to chemotherapy treatment were measured. Results were analyzed with t-tests or Wilcoxon rank-sum tests accordingly.

Results: Out of 490 breast cancer patients that were referred for fertility preservation consult, 52 patients (11%) received neo-adjuvant chemotherapy. Their average age was 34 +/- 5 years. Thirty-four women chose to undergo FP (65%) and 18 (35%) chose not to do the procedure. The median time from cancer diagnosis to fertility preservation consult was slightly less than two weeks in the FP and NO FP groups (13 days vs. 11 days, p=0.42). In the FP group, the median time from the fertility preservation consult to the beginning of ovarian stimulation was 2 days and the median time from fertility preservation consult to oocyte retrieval procedure was 14 days. The median time from oocyte retrieval procedure to start of neoadjuvant chemotherapy was 12 days. The total time from cancer diagnosis to start of chemotherapy was similar in the FP and NO FP groups (41 vs. 48, p=0.97).

Conclusion: Our findings suggest that random start ovarian stimulation does not cause significant delays in the neo-adjuvant chemotherapy setting. Patients undergoing neo-adjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern about speculative delays of their oncology treatment due to the procedure for fertility preservation.