OBJECTIVE: the study aims to determine the impact of BRCA1 and BRCA2 germline mutations on fertility preservation outcomes
DESIGN: retrospective study
MATERIALS AND METHODS: 65 breast cancer patients between 18 and 40 years old undergoing a fertility preservation treatment at the University of Bologna IVF Center from 1997 to 2017 were considered. 21 patients had not performed the test, therefore were excluded from the study. Patients were divided in four group: Group A was composed by 9 BRCA 1-positive patients, Group B with 11 BRCA 2-positive patients, Group C with 24 breast cancer BRCA-negative patients and Group D, control group composed by 181 women with a mean age of 32.4±2.8 years who underwent and ovarian stimulation due to male factor. All patients were stimulated with FSH-r and GnRH agonist or antagonist. In breast cancer patients with hormone-sensitive neoplasm, aromatase inhibitor was used. General characteristic and ovarian stimulation aspects were analyzed. T-student test was used to analyze the data.
RESULTS: All the results are shown in Tab. 1. Group A showed significant lower AMH levels compared to Group C and D. Furthermore patients in group A showed significant lower AFC compared to the control group (Group D). Maximal estradiol serum levels were not considered due to the Letrozole use. BRCA 1+ patients showed a significant lower rate of mature oocytes (MII) compared to Group D (4.1±3.43 vs 6.3±3.4 p<0,05). No significant differences were found between the groups considering basal FSH levels, duration of stimulation, number of follicles developed and number of oocytes retrieved.
CONCLUSIONS: The study showed that BRCA 1 patients had a higher risk of premature ovarian failure confirmed by a diminished ovarian reserve (lower AMH and AFC) and a lower number of cryopreserved oocytes. Therefore women should be properly counseled about this risk and oocytes cryopreservation option should be suggested considering the recommendation of a prophylactic bilateral salpingo-oophorectomy at 40 years old for both BRCA 1 and 2 women.
|GROUP A||GROUP B||GROUP C||GROUP D|
|DAYS OF STIMULATION||10.66±2.49||10.18±2.75||10.79±2.65||11.3±3.25|
|TOTAL DOSE OF GONADOTROPINS||2012.5± 1298.22||1670.45± 827.78||2106.25± 1336.14||1597±709|
|N. OOCYTES RETRIEVED||7.3±4.65||9.90±6.50||9.12±6.06||8.8±4.3|
|N. CRYOPRESERVED OOCYTE||4.1±3.43||7.27±5.74||7.15±4.41||6.3±3.4|