Puerperal Fertility Preservation with Controlled Ovarian Stimulation and Embryo Cryopreservation for Pregnancy-Associated Breast Cancer

Abstract

Abstract

Background: Pregnancy-associated breast cancer is the most common one diagnosed in pregnancy. At least two-thirds of all women <40 years of age at diagnosis will present with a stage II or higher breast cancer, and almost all of these women are advised to undergo gonadotoxic chemotherapy. However, these gonadotoxic chemotherapeutic agents can markedly increase ovarian follicular loss, leading to premature menopause. This article reports a case of puerperal fertility preservation via embryo cryopreservation in a patient with pregnancy-associated breast cancer. Case: A 35-year-old woman, gravida 3, para 1, aborta 2, was diagnosed with stage II estrogen-receptor negative, progesterone-receptor negative, and human epidermal growth factor receptor–2 negative breast cancer during her 34th week of pregnancy. The patient delivered a healthy female infant at term and presented within 72 hours of delivery for fertility preservation prior to starting urgent neoadjuvant chemotherapy. Controlled ovarian stimulation was started on postpartum day 4. Results: Ten oocytes were retrieved after 12 days of ovarian stimulation with gonadotropins. Following conventional in vitro fertilization, seven embryos were cryopreserved. The patient subsequently initiated neoadjuvant chemotherapy. Conclusions: Immediate puerperal embryo cryopreservation can be a feasible option for fertility preservation in patients diagnosed with breast cancer during the third trimester of pregnancy requiring urgent neoadjuvant chemotherapy. (J GYNECOL SURG 31:173)