title: Effective method for emergency fertility preservation: random-start controlled ovarian stimulation.
abstract: OBJECTIVE
  To determine whether random-start controlled ovarian stimulation (COS), in which a patient is stimulated on presentation regardless of her menstrual-cycle phase, has outcomes similar to conventional early follicular phase-start COS for fertility preservation in cancer patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Women recently diagnosed with cancer and in preparation for gonadotoxic therapy.
  
  
  METHODS
  Random- versus conventional-start COS.
  
  
  METHODS
  
  
  
  METHODS
  number of mature oocytes retrieved; secondary outcomes: pattern of follicular development, oocyte yield, and fertilization rate.
  
  
  RESULTS
  The number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield, and fertilization rates were similar in random- (n = 35) and conventional-start (n = 93) COS cycles. No superiority was noted when comparing COS started in the late follicular (n = 13) or luteal phase (n = 22). The addition of letrozole, in the case of estrogen-sensitive cancers, did not adversely affect COS outcomes or oocyte maturity and competence in either random- or conventional-start protocols.
  
  
  CONCLUSIONS
  Random-start COS is as effective as conventional-start COS in fertility preservation. This protocol would minimize delays and allow more patients to undergo fertility preservation and still proceed with cancer treatment within 2-3 weeks.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: Hakan
authors.initials: H
authors.lastname: Cakmak
authors.forename: Audra
authors.initials: A
authors.lastname: Katz
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Rosen
mesh_terms: D000328:Adult; D015897:Comorbidity; D015925:Cryopreservation / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D059247:Fertility Preservation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D009369:Neoplasms / Q000453:epidemiology* / Q000451:nursing / Q000473:pathology; D054315:Oocyte Retrieval / Q000379:methods / Q000706:statistics & numerical data*; D009865:Oocytes / Q000473:pathology*; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data*; D011897:Random Allocation; D018570:Risk Assessment; D012495:San Francisco / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Random start; controlled ovarian stimulation; fertility preservation