title: Tamoxifen co-administration during controlled ovarian hyperstimulation for in vitro fertilization in breast cancer patients increases the safety of fertility-preservation treatment strategies.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of tamoxifen co-administration during conventional controlled ovarian hyperstimulation (COH) protocols for a fertility-preservation IVF cycle in breast cancer patients.
  
  
  METHODS
  Two groups: retrospective descriptive cohort study and prospective study.
  
  
  METHODS
  Breast cancer oncology and fertility-preservation centers in a tertiary hospital.
  
  
  METHODS
  Two groups of breast cancer patients: premenopausal patients treated with adjuvant tamoxifen; and patients undergoing in vitro fertilization (IVF) for fertility preservation.
  
  
  METHODS
  Fertility-preservation cycles, tamoxifen co-administration during conventional IVF.
  
  
  METHODS
  Endocrine records, and IVF results.
  
  
  RESULTS
  Estradiol (E2) levels were chronically high (mean 2663 pmol/L, maximum: 10,000 pmol/L) in 38 of 46 breast cancer patients treated with adjuvant tamoxifen. Co-administration of tamoxifen (48 cycles) during conventional IVF or without tamoxifen (26 cycles), using either the long gonadotropin-releasing hormone-agonist or-antagonist protocols, resulted, respectively, in a mean of 12.65 and 10.2 oocytes retrieved, and 8.5 and 6.4 embryos cryopreserved. Average peak E2 levels were 6,924 pmol/L and 5,093 pmol/L, respectively, but long-term recurrence risk (up to 10 years) was not increased.
  
  
  CONCLUSIONS
  In breast cancer patients, co-administration of tamoxifen during conventional COH for fertility preservation does not interfere with IVF results. The high serum E2 levels during COH should be considered safe, as it simulates the high prevalence of persistently high serum E2 levels in premenopausal breast cancer patients safely treated with adjuvant tamoxifen.
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel. Electronic address: meirow@post.tau.ac.il.
authors.forename: Dror
authors.initials: D
authors.lastname: Meirow
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Raanani
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ettie
authors.initials: E
authors.lastname: Maman
authors.affiliation: Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shani
authors.initials: S
authors.lastname: Paluch-Shimon
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Shapira
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Irena
authors.initials: I
authors.lastname: Kuchuk
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Levron
authors.affiliation: Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Mozer-Mendel
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Masha
authors.initials: M
authors.lastname: Brengauz
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Hana
authors.initials: H
authors.lastname: Biderman
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Daphna
authors.initials: D
authors.lastname: Manela
authors.affiliation: Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Rephael
authors.initials: R
authors.lastname: Catane
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Jehoshua
authors.initials: J
authors.lastname: Dor
authors.affiliation: Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Raoul
authors.initials: R
authors.lastname: Orvieto
authors.affiliation: Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Bella
authors.initials: B
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D015925:Cryopreservation; D004334:Drug Administration Schedule; D004958:Estradiol / Q000097:blood; D004965:Estrogen Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D059247:Fertility Preservation / Q000009:adverse effects / Q000379:methods*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D017697:Premenopause; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage* / Q000009:adverse effects; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D013629:Tamoxifen; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol
keywords: IVF; breast cancer; controlled ovarian hyperstimulation; fertility preservation; tamoxifen