Oocyte Quality Assessment in Breast Cancer: Implications for Fertility Preservation

SIMPLE SUMMARY: Fertility preservation programs in patients with cancer are one of the most interesting current topics in reproductive medicine. Breast cancer is the most common malignancy in women of reproductive age. Young women with breast cancer are at risk of future infertility, as cancer treatment can be lifesaving, but negatively impacts ovarian function. The clinical risk is related to the age of the patient, the chemotherapy drugs used, and the duration of treatment. Mature oocyte cryopreservation is no longer considered an experimental technique, and many improvements have been made in oocyte cryopreservation. Considering the paucity of research on the effect of breast cancer on the ovarian response in this specific group of cancer patients, we aimed to design a study to investigate the outcome of ovarian stimulation in terms of the oocyte number, maturity, and quality in women with breast cancer. ABSTRACT: Background: The aim of this study was to evaluate the effects of breast cancer on the ovarian response and on oocyte quality following controlled ovarian hyperstimulation (COH). Methods: This retrospective case-control study evaluated the effects of breast cancer on the ovarian response and on the oocyte quality. Oncological patients with breast cancer undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male or tubal factor infertility were included in the study. Two hundred and ninety-four women were enrolled: 105 affected by breast cancer and 189 healthy women in the control group. Both groups were comparable in terms of age, BMI, and AMH value. Maximal estradiol levels on the triggering day, duration of stimulation, total amount of gonadotropins administered, number of oocytes retrieved, rate of metaphase 2 oocyte production, and numbers of immature and dysmorphic oocytes were analyzed. Results: Considering factors influencing the oocyte quality, such as age, BMI, AMH, duration of stimulation, E2 level on the triggering day, total FSH cumulative dose, stage, histotype, BRCA status, and hormone receptors, the univariate and multivariate analyses identified breast cancer as a risk factor for the presence of dysmorphic oocytes. Conclusions: The diagnosis of breast cancer does not seem to be associated with the impairment of the ovarian reserve, but is linked to a worsening oocyte quality.