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

Objective: To 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. Design: Retrospective cohort study. Setting: Academic 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. (Fertil Steril (R) 2013;100:1673-80. (C)2013 by American Society for Reproductive Medicine.)