title: Value of early referral to fertility preservation in young women with breast cancer.
abstract: OBJECTIVE
  To determine whether early referral to reproductive specialists improves fertility preservation (FP) outcomes and reduces delay in adjuvant treatment in young women with breast cancer.
  
  
  METHODS
  A secondary analysis of a prospective database of patients with breast cancer undergoing ovarian stimulation (OS) for FP by oocyte or embryo cryopreservation was performed.
  
  
  RESULTS
  Of the 154 patients, 93 met the inclusion criteria (mean age, 35.2 ± 4.4 years). Thirty-five of the 93 patients were referred before breast surgery (PreS), and 58 patients were referred after surgery (PostS). The time periods from initial diagnosis (ID) to initiation of OS (42.6 ± 27.7 days for PreS v 71.9 ± 30.7 days for PostS; P < .001) and from ID to initiation of chemotherapy (83.9 ± 24.3 days for PreS v 107.8 ± 42.9 days for PostS; P = .045) were significantly shorter for the PreS group versus the PostS group. Nine (25.7%) of 35 patients in the PreS group versus one (1.7%) of 58 patients in the PostS group were able to undergo two FP cycles (P < .001), resulting in an increased yield of oocytes in the PreS group (18.2% [93 of 511 oocytes] v 0.6% [five of 800 oocytes], respectively; P < .001) and embryos (17.2% [40 of 233 embryos] v 0.6% [two of 357 embryos], respectively; P < .001). Patients who had an oocyte retrieval within 5 weeks of the surgery were able to complete a second cycle within 9 weeks of the surgery.
  
  
  CONCLUSIONS
  FP referral before breast surgery enables earlier initiation of cryopreservation cycles and chemotherapy and, when appropriate, multiple FP cycles. Women who can undergo multiple cycles may be at advantage for FP because of a larger number of oocytes or embryos cryopreserved. This is the first study demonstrating the benefit of early FP referral in patients with cancer.
authors.affiliation: Institute for Fertility Preservation, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Lee
authors.forename: Sinan
authors.initials: S
authors.lastname: Ozkavukcu
authors.forename: Elke
authors.initials: E
authors.lastname: Heytens
authors.forename: Fred
authors.initials: F
authors.lastname: Moy
authors.forename: Kutluk
authors.initials: K
authors.lastname: Oktay
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D015925:Cryopreservation; D004622:Embryo, Mammalian; D005260:Female; D005298:Fertility / Q000187:drug effects* / Q000528:radiation effects*; D006801:Humans; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000379:methods; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D012017:Referral and Consultation; D012107:Research Design; D013997:Time Factors; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor