Letrozole for ovulation induction and fertility preservation by embryo cryopreservation in young women with endometrial carcinoma

ObjectiveTo reduce estrogen exposure in women with endometrial cancer undergoing in vitro fertilization using an aromatase inhibitor.DesignProspective case series.SettingAcademic center for reproductive medicine.Patient(s)Endometrial carcinoma patients presenting for fertility preservation or fresh embryo transfer to gestational carrier.Intervention(s)Four patients with endometroid carcinoma underwent five IVF cycles for immediate or delayed embryo transfer to gestational carriers before or after staging and definitive surgery. To prevent surge in E2 levels, letrozole was started 2 days before gonadotropin administration and then given concomitantly. Embryos were either cryopreserved for fertility preservation or transfered freshly to a surrogate.Main Outcome Measure(s)Peak E2 level during stimulation, pregnancy in a gestational carrier.Result(s)Peak E2 level during stimulation was 386.67 ± 102.93 pg/mL. A mean of 7 ± 2.85 oocytes were retrieved, resulting in 4.8 ± 1.76 embryos per cycle. In one patient, two embryos were transfered to a surrogate, resulting in a triplet pregnancy. The delivery occurred at 31 weeks and the infants did not show any congenital or developmental abnormalities. Three patients had their embryos cryopreserved for future use.Conclusion(s)The use of letrozole and gonadotropins is associated with lower E2 levels compared with standard stimulation cycles in endometrial carcinoma patients. Combination of this approach with surrogacy may enable these young women to preserve their fertility.