title: Timing of ovarian stimulation in patients prior to gonadotoxic therapy: an analysis of 684 stimulations.
abstract: OBJECTIVE
  Time to therapy initiation in patients requiring gonadotoxic therapy is crucial. This article evaluates the efficiency of random start ovarian stimulation in affected women.
  
  
  METHODS
  Retrospective anonymous registry data analysis from 85 university and non-university fertility centres participating in the international network FertiPROTEKT. The study comprised 684 women undergoing ovarian stimulation for fertility preservation from 2007 to 2013. According to the time of stimulation initiation, days of ovarian stimulation, total dose of gonadotropins used, gonadotropin dose used per day, number of oocytes retrieved and incidence of ovarian hyperstimulation syndrome were analysed. Statistical analysis was performed using analysis of variance in case of continuous outcome variables and chi-square tests in case of categorical variables.
  
  
  RESULTS
  Among 684 women who underwent ovarian stimulation prior to gonadotoxic therapy 472 (69.0%) started ovarian stimulation between menstrual cycle day 1-5 (group A), 109 (15.9%) between day 6-14 (group B) and 103 (15.1%) after day 14 (group C). The days of stimulation (A: 10.8±2.4, B: 10.6±2.7, C: 11.5±2.2) and total dose of gonadotropins (A: 2496IU±980, B: 2529IU±940, C: 2970IU±1145) were significantly increased in group C. Numbers of obtained oocytes (Group A: 11.6±7.7, B: 13.9±9.1, C: 13.6±7.9) were significantly increased in group B and C, while the overall incidence of ovarian hyperstimulation syndrome III° was 0.15%.
  
  
  CONCLUSIONS
  The outcome of ovarian stimulation is similar after stimulation initiation during any phase of the menstrual cycles, supporting the concept of random-start ovarian stimulation before gonadotoxic therapy without disadvantage for the patient concerning later fertility preservation.
authors.affiliation: University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Bern, Effingerstrasse 102, 3010 Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: von Wolff
authors.affiliation: Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350/4 andar, 90035-003 Porto Alegre, RS, Brazil; University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
authors.forename: Edison
authors.initials: E
authors.lastname: Capp
authors.affiliation: University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Jauckus
authors.affiliation: University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Strowitzki
authors.affiliation: University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany. Electronic address: Ariane.Germeyer@med.uni-heidelberg.de.
authors.forename: Ariane
authors.initials: A
authors.lastname: Germeyer
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005307:Fertilization in Vitro; D006801:Humans; D015994:Incidence; D054315:Oocyte Retrieval; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors
keywords: Assisted reproduction; Cancer; Fertility preservation; Timing of ovarian stimulation