title: Does higher starting dose of FSH stimulation with letrozole improve fertility preservation outcomes in women with breast cancer?
abstract: OBJECTIVE
  To evaluate the efficacy of ovarian stimulation with higher doses of gonadotropins in fertility preservation (FP) cycles with the intention to maximize the likelihood of future pregnancies.
  
  
  METHODS
  Retrospective (secondary analysis).
  
  
  METHODS
  Academic medical centers.
  
  
  METHODS
  Low-dose (LD, 150 IU; n = 34) versus high-dose (HD, >150 IU; n = 117) FSH start in 151 patients with breast cancer (BCa) undergoing ovarian stimulation for embryo cryopreservation with letrozole (LE) before cancer treatment.
  
  
  METHODS
  None.
  
  
  METHODS
  FP cycle outcomes.
  
  
  RESULTS
  Mean total FSH dose (2,037 ± 679 IU vs. 1,128 ± 381 IU) and FSH level on trigger day (21.1 ± 8.9 vs. 10.6 ± 4.5 mIU/mL) were higher in the HD group, confirming the receipt of higher-dose FSH. There was no difference in other patient characteristics. Despite the larger number of follicles >17 mm in diameter in the HD group (5.0 ± 2.0 vs. 3.4 ± 1.4), neither peak E(2) (498.0 ± 377.5 vs. 397.9 ± 320.3), number of oocytes (13.3 ± 8.7 vs. 12.3 ± 8.0), nor number of embryos (6.3 ± 4.7 vs. 5.4 ± 3.8) were significantly different from the LD group. Of those undergoing frozen embryo transfer (ET), live birth rate (LBR)/ET trended higher in the LD (9/15) compared with HD (2/11) group, with 2.1 ± 0.8 vs. 1.9 ± 0.3 embryos transferred, respectively.
  
  
  CONCLUSIONS
  Higher-dose FSH stimulation in LE cycles does not improve outcomes and may be associated with lower LBR. Our findings may support minimal stimulation in young noninfertile women with BCa.
authors: Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation, New York Medical College, Valhalla, New York 10595, USA.
authors: Sanghoon
authors: S
authors: Lee
authors: Kutluk
authors: K
authors: Oktay
mesh_terms: D000328:Adult; D047072:Aromatase Inhibitors / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage*; D006801:Humans; D000077289:Letrozole; D009570:Nitriles / Q000008:administration & dosage*; D054315:Oocyte Retrieval / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D047072:Aromatase Inhibitors; D043373:Follicle Stimulating Hormone, Human; D009570:Nitriles; D014230:Triazoles; D000077289:Letrozole