October 18th, 2018

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Combined Use of a GnRH Agonist and Antagonist for Luteolysis in a Breast Cancer Patient Presenting in the Late Follicular Phase for Oocyte Cryopreservaton: A Case Report
Authors:  Lily Proctor, M.D., and Jeffrey E. Roberts, M.D., FRCSC
BACKGROUND: As screening and treatment for women with breast cancer improve, fertility preservation is becoming a major survivorship issue. The concern, however, with ovarian stimulation using gonadotropins is the supraphysiologic levels of serum estrogens generated with multifollicular recruitment and the inadvertent activation of metastatic disease. Another concern is the delay of oncology treatments as 3–4 weeks is typically required from the time of presentation to the generation of mature oocytes. The optimal fertility preservation technique is one that minimizes delay with little or no elevation in serum sex steroids.

CASE: A 38-year-old woman with newly diagnosed breast cancer presented in the late follicular phase of her menstrual cycle for emergency fertility preservation prior to the initiation of gonadotoxic chemotherapy. Using a combination of a GnRH agonist induction of ovulation in the natural cycle with the addition of a GnRH antagonist to accelerate luteolysis, we were able to truncate the active menstrual cycle and minimize the delay to gonadotropin start.

CONCLUSION: This case demonstrates an effective stimulation protocol for patients who present in the follicular phase of their menstrual cycle and require emergency fertility preservation.
Keywords:  assisted reproductive techniques, breast cancer, controlled ovarian stimulation, cryopreservation, fertility preservation, luteolysis, ovarian stimulation, ovulation induction
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