Effective method for emergency fertility preservation: random-start controlled ovarian stimulation

ObjectiveTo 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.DesignRetrospective cohort study.SettingAcademic medical center.Patient(s)Women recently diagnosed with cancer and in preparation for gonadotoxic therapy.Intervention(s)Random- versus conventional-start COS.Main Outcome Measure(s)Primary outcome: number of mature oocytes retrieved; secondary outcomes: pattern of follicular development, oocyte yield, and fertilization rate.Result(s)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.Conclusion(s)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.