P-389 Ovarian stimulation for fertility preservation in adolescents and young women with cancer
Notice bibliographique
Résumé
Abstract Study question Is controlled ovarian stimulation (COS) for fertility preservation (FP) for oncologic reasons different in adolescents when compared to young women of reproductive age? Summary answer Adolescents produce more mature oocytes (metaphase II) than women 18-25 and 26-35, require lower FSH doses than women aged 26–35, with similar stimulation durations. What is known already Each year, thousands of children and adolescents around the world develop cancer, with leukemia, brain tumors, lymphomas, and solid tumors (e.g. neuroblastomas) being most common. Advances in cancer treatments have increased 10-year survival rates. However, cancer treatments can impair ovarian function, causing infertility and even premature ovarian insufficiency. It is imperative to offer FP to pediatric cancer patients, such as oocyte or ovarian tissue cryopreservation. Random-start ovarian stimulation protocols help minimize oncologic treatment delays. Pediatric cancer patients may require adjusted protocols due to altered gonadotropin responses and hypothalamic-pituitary immaturity. Data on efficacy, feasibility and complications in adolescent FP remains limited. Study design, size, duration This retrospective cohort study compares adolescents (menarche–17 years) to women aged 18-25 and 26-35 undergoing FP before cancer treatments, from 2013 to 2022, in the same assisted reproduction technology center. The study includes 42 teenagers and 132 young women, with data obtained from archived digital medical records. The primary outcome was the number of mature oocytes retrieved after COS. Secondary outcomes included: total retrieved oocyte count, FSH dose, stimulation duration, follicle count, and complications. Participants/materials, setting, methods Participants must have undergone COS for FP due to oncological reasons. Exclusion criteria include patients with advanced reproductive age (>35 years) and those undergoing social elective FP or COS for infertility. The study analyzed dependent variables (mature metaphase II oocytes retrieved) and independent variables (age, AMH, BMI, prior treatments, fertility treatment timing, stimulation phase, FSH dose, stimulation duration, complications, cryopreservation method, reimplantation timing). Confounding factors included demographics, ovarian reserve, PCOS, obstetric history, and oncological treatment. Main results and the role of chance 42 adolescents (menarche-17), 42 women aged 18-25, and 90 women aged 26-35 met our inclusion criteria. The most common oncological diagnosis in adolescents and women <25 years of age was lymphoma (52%), while breast cancer was the most prevalent among women >25 years (72%). GnRH antagonist stimulation protocols were used across all groups. On average, the total number of oocytes retrieved per individual was 19, 16, and 13 for the three age groups, respectively (p = 0.003). The number of mature oocytes retrieved was 13, 12, and 9, respectively (p = 0.003). The FSH dose required for stimulation was 2795, 2672, and 3355 IU per group (p = 0.086). There were no significant differences in the duration of stimulation or in the number of follicles on ultrasound. Complications associated with ovarian stimulation were rare across all groups. However, moderate ovarian hyperstimulation syndrome occurred more frequently in adolescents (12%) compared to those aged 26-35 years (2%). COS resulted in a higher number of mature in adolescents compared to young women. Adolescents required a lower FSH dose than women aged 26-35. There were no differences in stimulation days or follicle count between groups. Ovarian hyperstimulation syndrome was more common in adolescents than in adults. Limitations, reasons for caution This is a retrospective investigation, thus prone to missing data and selection bias. More well-designed prospective trials are urgently warranted to clarify further the role of COS for oocytes freezing in adolescents with cancers. Wider implications of the findings This is one of the largest studies on COS in adolescents undergoing FP and confirms its feasibility and short-term safety. However, longer follow-up is warranted; reproductive outcomes of vitrified oocytes from adolescents are needed to confirm the efficacy and safety of FP in this population. Trial registration number No
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».