Fertility Preservation in Young Early Breast Cancer: Strategies and Patient Preferences

ABSTRACT Background In Italy, approximately 1800 women younger than 39 years of age are diagnosed with breast cancer (BC) every year. Chemotherapy (CT)-induced loss of fertility is a major concern for these patients. Different strategies are available to attempt to preserve ovarian function and they should be considered as early as possible during treatment planning. We evaluated feasibility and patient preferences of two different strategies: oocyte cryopreservation (OC) and temporary ovarian suppression with the administration of LHRH analogue (LHRHa) during CT. Materials and methods From March 2010 to April 2012 28 BC patients younger than 41 years (median age: 38 [range 33-41]) candidates for CT, referred to our institution. They were offered the possibility to reduce the gonadotoxic effects of such treatments by two different strategies. The oncologist proposed both the administration of LHRHa before and during CT, and a reproductive counselling performed by the gynecologist, where OC was discussed. Results The majority of patients (25 [89.3%]) accepted to undergo a treatment with LHRHa, started at least 1 week before CT. Nineteen patients (67.9%) refused the reproductive counselling; the reasons for refusal were: previous pregnancies (13 patients [46.4%]) and no desire for children (6 patients [21.4%]). Out of 9 patients (32.1%) that accepted the reproductive counselling, only 3 (10.7%) accepted to undergo OC. The reasons for refusal were: fear of delaying cancer treatment (2 patients [7.1%]), fear of the ovarian stimulation required (1 patients [3.6%]), not eligible for comorbidities (1 patients [3.6%]), low successful rate of the technique (1 patients [3.6%]) and unknown in 1 cases (3.6%). The 3 patients underwent a controlled ovarian stimulation with the use of daily injections of recombinant FSH: median length of stimulation was 9 days (range, 8 to 9 days); peak estradiol levels ranged from 280 to 521 pg/ml. An average of 13.3 ± 5.7 oocytes was retrieved, and 8.3 ± 3.1 oocytes cryopreserved per patient. Conclusions This analysis suggests that the majority of patients (89%) accept the administration of LHRHa during CT and approximately 11% of patients undergoes OC. Disclosure All authors have declared no conflicts of interest.