Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen.
BACKGROUND
Breast cancer chemotherapy commonly causes premature ovarian failure and infertility. Because increased estrogen levels are thought to be potentially risky in breast cancer patients, natural cycle IVF (NCIVF) has been used to preserve fertility and treat infertility in these women.


METHODS
Twelve women with breast cancer received 40-60 mg tamoxifen for 6.9 +/- 0.6 days beginning on days 2-3 of their menstrual cycle (15 cycles), and had IVF (TamIVF) with either fresh embryo transfer (six cycles) or cryopreservation (nine cycles). They were compared to a retrospective control group (n = 5) who had natural cycle IVF (NCIVF, nine cycles).


RESULTS
Cycle cancellation was significantly less frequent in TamIVF, compared with NCIVF (1/15 versus 4/9, P < 0.05). Compared with NCIVF, TamIVF patients had a greater number of mature oocytes (1.6 +/- 0.3 versus 0.7 +/- 0.2, P = 0.03) and embryos (1.6 +/- 0.3 versus 0.6 +/- 0.2, P = 0.02) per initiated cycle. TamIVF resulted in the generation of embryo(s) in every patient (12/12) while only three out of five patients had an embryo following NCIVF. Two out of six patients in TamIVF, and 2/5 in NCIVF conceived. One patient in the TamIVF group delivered a set of twins. After a mean follow up of 15 +/- 3.6 months (range 3-54), none of the patients had a recurrence of cancer.


CONCLUSIONS
Tamoxifen stimulation appears to result in a higher number of embryos and may provide a safe method of IVF and fertility preservation in breast cancer patients.
Oktay
K
K
The Center for Reproductive Medicine and Infertility, Joan and Sanford I Weill Medical College of Cornell University, 505 East 70th Street, HT-340, New York, NY 10021, USA. kuo9001@med.cornell.edu
Buyuk
E
E
Davis
O
O
Yermakova
I
I
Veeck
L
L
Rosenwaks
Z
Z
D000328:Adult; D001943:Breast Neoplasms / Q000503:physiopathology*; D002452:Cell Count; D016922:Cellular Senescence; D015925:Cryopreservation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004624:Embryo Transfer; D004622:Embryo, Mammalian; D004965:Estrogen Antagonists / Q000008:administration & dosage*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D009865:Oocytes / Q000473:pathology / Q000502:physiology; D010062:Ovulation Induction; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D013629:Tamoxifen / Q000008:administration & dosage*; D014427:Twins
D004965:Estrogen Antagonists; D013629:Tamoxifen