Credit: Timeline for referral to a fertility preservation specialist. Original courtesy of K. Oktay.

ASCO guidelines recommend that young patients with cancer should be referred to specialists for fertility preservation as soon as possible after the initial diagnosis. Now, Sanghoon Lee and colleagues report data to support this recommendation.

Effective ovarian stimulation must be initiated within 4 days of the menstrual cycle starting, and takes around 2 weeks to complete. Delaying this process can lead to a longer wait before chemotherapy is started and a lower chance of completing multiple cycles. “We wanted to prove and quantify the benefit of early referral for fertility preservation,” explains lead investigator Kutluk Oktay.

The researchers analyzed data prospectively collected from 93 patients with breast cancer undergoing ovarian stimulation for fertility preservation (by embryo or oocyte cryopreservation). 35 were referred for fertility preservation before surgery and 58 were referred after surgery.

Women who were referred to a fertility preservation specialist before breast surgery started chemotherapy, on average, 24 days earlier than women referred after surgery. Moreover, “...they were able to freeze a larger number of eggs and embryos because a larger proportion could undergo a second embryo or egg freezing cycle,” Oktay reports. Indeed, nine patients in the pre-sugery group (25.7%) versus one patient in the post-surgery group (1.7%) were able to have a second cycle of freezing. This outcome resulted in an increased yield of oocytes of 18.2% in the pre-surgery group versus 0.6% in the post-surgery group.

The researchers plan to use these data to advocate early referral by various medical professionals involved in the early steps of cancer diagnosis. “To improve the likelihood of success and feasibility of fertility preservation and not to compromise cancer treatment, referrals should be made as soon after the diagnosis as possible,” Oktay concludes.