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    Oocyte cryopreservation with in vitro maturation for fertility preservation in girls at risk for ovarian insufficiency
    (Springer/Plenum Publishers, 2023) Gayete-Lafuente, Sonia; Turan, Volkan; Oktay, Kutluk H.
    Purpose To assess the feasibility and outcomes of oocyte cryopreservation with in vitro maturation (IVM) in post-pubertal girls undergoing fertility preservation (FP) for primary ovarian insufciency (POI) risk. Methods Ovarian stimulation was performed with an antagonist protocol or progesterone priming. Ultrasound monitoring was performed transabdominally. Oocytes were retrieved transvaginally under IV sedation. Immature oocytes were subjected to IVM for up to 36 h. All MII oocytes were vitrifed. The main outcome measure was the total number of mature oocytes cryopreserved. The secondary outcome was the increase in the mature oocyte yield after IVM. Results Indications for FP included mosaic Turner syndrome (mTS; n=10), malignancy (n=3), and POI risk (n=2). The mean±SD age, antral follicle count (AFC), and AMH levels were 14.2±1.4 years, 8±5.2 and 1.3±1.3 ng/mL. In girls with mTS, the ovarian reserve was low for age (AFC 7.4±4.7 and AMH 1.4±1.6 ng/mL). Oocyte cryopreservation was possible in all girls with a range of 1–27 mature oocytes obtained, even in those who were previously exposed to chemotherapy or with low ovarian reserve, and no surgical complications were encountered. After IVM, the median mature oocyte yield increased signifcantly from 7.5 to 10.5 (p=0.001). Conclusions Oocyte cryopreservation appears to be feasible and safe in girls as young as 12 years of age at risk for POI The utility of IVM increases the yield of cryopreserved mature oocytes. Prior exposure to chemotherapy or low ovarian reserve should not be an automatic reason to exclude these girls from FP consideration.
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    Outcomes of random-start letrozole protocol with PGT-A in women with breast cancer undergoing fertility preservation
    (Springer/Plenum Press, 2023) Turan, Volkan; Gayete-Lafuente, Sonia; Bang, Heejung; Oktay, Kutluk H.
    PURPOSE : To compare the cycle characteristics and outcomes of random-start-controlled ovarian stimulation (RSCOS) protocols to the outcomes of standard-start-controlled ovarian stimulation (SSCOS) cycles and to report the utility of PGT-A in these cycles. Methods: One hundred and seventeen who underwent SSCOS and 39 who underwent RSCOS for oocyte and/or embryo cryopreservation before breast cancer chemotherapy were retrospectively evaluated. Mean number of embryos and blastocyst euploidy rates were the main outcome measures. Results: A majority of RSCOS cycles were initiated in the luteal phase (66.6% luteal vs. 33.3% follicular). While the total dose of gonadotropins was significantly higher in the RSCOS (3720.8 ± 1230.0 vs. 2345.1 ± 803.6 IU; P < 0.001), the mean number of mature oocytes and embryos was similar to SSCOS. However, there was a trend for a higher number of mean embryos with luteal start RSCOS (6.9 ± 2.7 in late follicular start vs. 9.4 ± 4.2 in luteal start, P = 0.08). PGT-A was performed in 48% of the cases that underwent embryo cryopreservation in RSCOS (12 women, mean age = 35.3 ± 4.1; 87 blastocysts), revealing a euploidy rate of 36.2 ± 22.3% per patient. This rate was comparable to a 45% aneuploidy rate from similarly aged published data. Of the 7 RSCOS patients who returned for frozen embryo transfer, 5 delivered and one has an ongoing pregnancy, while in SSCOS, 18 out of 40 cycles resulted in live birth. Conclusion: Our data suggests that RSCOS fertility preservation cycle outcomes are similar to those with SSCOS and result in age-appropriate euploidy rates.
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    Ovarian stimulation and PGT-A outcomes with random start letrozole protocol for fertility preservation in breast cancer patients
    (Oxford University Press, 2022) Arkfeld, Christopher; Gayete-Lafuente, Sonia; Turan, Volkan; Oktay, Kutluk
    Study question Data on random start letrozole ovarian stimulation (RSL) in breast cancer patients is scant. We studied RSL outcomes from a single-center with fertility preservation expertise. Summary answer RSL appears to result in high oocyte and embryo/blastocyst yield, with an age-appropriate aneuploidy rate.
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    Trends and regional differences for fertil ity preservation procedures in women with breast cancer
    (Elsevier, 2024) Turan, Volkan; Bedoschi, Giuliano; Lee, Dong-Yun; Barbosa, Caio Parente; Oliveira, Renato de; Saçıntı, Koray Görkem; Sönmezer, Murat; Lambertini, Matteo; Massarotti, Claudia; Schaub, Amelia; Wang, Erica; Gayete-Lafuente, Sonia; Dunlop, Cheryl; Anderson, Richard A.; Bang, Heejung; Oktay, Kutluk H.
    Introduction : Breast cancer is the most common malignancy in women of reproductive age and chemotherapy protocols impair fertility, frequently necessitating fertility preservation (FP) referral. Embryo, oocyte, or ovarian tissue cryopreservation are established FP modalities in women with breast cancer but there are few data on their uptake over time. In this study our aim was to determine the regional time trends and utility differences for fertility preservation methods of reproductive tissue cryopreservation. Methods : This multicenter study included 1,623 women diagnosed with breast cancer from seven tertiary centers in six countries (Brazil, Italy, Scotland, South Korea, Turkey, USA). Participant centers provided the details of FP cryopreservation approaches broken down annually from 2012 to 2021. Women with newly diagnosed breast cancer, aged 18-45 years who were referred for FP at participating centers and had normal ovarian function at the time were included. Results : We found a mean increase of 7% per year (p=0.002, adjusting for centers) in the number of women referred for FP. Of those who were referred (n=1623), a mean 38.7% underwent FP (n=629), with a range of 12% in South Korea) to 95% in Brazil. The number of women undergoing ovarian stimulation for FP continually increased until 2021, with oocyte cryopreservation being the most common procedure throughout the study period (p=0.014 for time trend). The proportion of random start ovarian stimulation cycles increased each year from 58.3% in 2012 to 86.8% in 2021, (p=0.005 for time trend, and p=0.04 for 2012 vs. 2021). Conclusions : The utility of FP has steadily increased for young women with breast cancer over the last decade, although regional differences significantly influence FP practices. The findings of our study could have value for policy making in FP care for young women with breast cancer at the local, regional, or global level. Micro abstract Breast cancer is the most common malignancy in women of reproductive age and chemotherapy protocols impair fertility, frequently necessitating fertility preservation referral. The utility of fertility preservation has steadily increased for young women with breast cancer over the last decade, although regional differences significantly influence fertility preservation practices.