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Random-start ovarian stimulation in patients with cancer

Cakmak, Hakan; Rosen, Mitchell P.

Current Opinion in Obstetrics and Gynecology: June 2015 - Volume 27 - Issue 3 - p 215–221
doi: 10.1097/GCO.0000000000000180
FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan Antonio García Velasco
Editor's Choice

Purpose of review Awaiting menses to start ovarian stimulation for oocyte/embryo cryopreservation in patients with cancer may result in a significant delay of cancer treatment that may lead to patients forgoing fertility preservation. The purpose of this review is to describe the new protocols to facilitate the start of ovarian stimulation, including random-start ovarian stimulation.

Recent findings In random-start protocols, the number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield and fertilization rates are similar to those in conventional (early follicular phase start) protocols. Starting ovarian stimulation in the late follicular or luteal phase did not show any superiority against the other. The presence of corpus luteum or luteal phase progesterone levels did not adversely affect synchronized follicular development, number of mature oocytes retrieved, and/or fertilization rates.

Summary Random-start ovarian stimulation provides a significant advantage by decreasing total time for the IVF cycle, and in emergent settings, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising oocyte yield and maturity.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA

Correspondence to Mitchell P. Rosen, MD, HCLD, Department of Obstetrics, Gynecology and Reproductive Sciences, 499 Illinois Street, 6th Floor, San Francisco, CA 94158, USA. Tel: +1 415 353 3040; fax: +1 415 353 7744; e-mail:

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