Outcomes of ovarian stimulation and fertility preservation in breast cancer patients with different hormonal receptor profiles

• Published in: Journal of assisted reproduction and genetics 2020-04, Vol.37 (4), p.913-921
• Main Authors: Balayla, Jacques, Tulandi, Togas, Buckett, William, Holzer, Hananel, Steiner, Naama, Shrem, Guy, Volodarsky-Perel, Alexander
• Format: Article
• Language: English
• Subjects: 17β-Estradiol; Adult; Breast cancer; Cryopreservation; Estrogen receptors; Estrogens - genetics; Female; Fertility; Fertility Preservation; Follicles; Gynecology; Human Genetics; Humans; Maturation; Medicine; Medicine & Public Health; Oocyte Retrieval - methods; Oocytes; Oocytes - growth & development; Oocytes - transplantation; Ovulation Induction; Population studies; Preservation; Progesterone; Receptors, Estrogen - genetics; Receptors, Progesterone - genetics; Reproductive Medicine; Triple Negative Breast Neoplasms - complications; Triple Negative Breast Neoplasms - genetics; Triple Negative Breast Neoplasms - pathology
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-020-01730-9

Purpose To evaluate fertility preservation outcomes in breast cancer women with different hormonal receptor profiles before oncological treatment. Methods The study population included women with a diagnosis of breast cancer who underwent fertility preservation from 2009 until 2018 at a university-affiliated tertiary hospital. Stimulation parameters and fertility preservation outcomes were compared among the following receptor-specific profile groups: (1) estrogen receptor positive (ER+) versus estrogen receptor negative (ER−), (2) triple-negative breast cancer (TNBC) versus estrogen and progesterone receptor positive (ER+/PR+), and (3) TNBC versus non-TNBC. Primary outcome was the total number of mature oocytes. Secondary outcomes included the number of retrieved oocytes, the peak estradiol level, and the number of follicles > 14 mm on the final oocyte maturation trigger day. Results A total of 155 cycles were included in the final analysis. These were divided into the exposure groups of ER+ ( n  = 97), ER− ( n  = 58), ER+/PR+ ( n  = 85), TNBC ( n  = 57), and non-TNBC ( n  = 98). Cycle outcomes revealed similar number of retrieved oocytes and follicles > 14 mm on the trigger day. Women with TNBC had significantly lower number of mature oocytes compared with those with ER + PR+ (7 (5–11) versus 9 (7–15); p  = 0.02) and non-TNBC (7 (5–11) versus 9 (7–16); p  = 0.01) status. Triple-negative breast cancer profile was associated with a significant reduction in the chance of developing over 10 mature oocytes (OR 0.41; 95% CI 0.19–0.92). Conclusion Among the different hormonal receptor profiles in breast cancer, the TNBC subtype has a negative effect on fertility preservation outcomes.