IVM

Dept of OB-Gyn
Université Paris-Descartes
Hôpital Cochin
Surgery
Charles Chapron
Hervé Foulot
Bruno Borghese
Pietro Santlli
Guillaume Pierre
Marie Christine Lafay
Fouzia Decuypere
François X. Aubriot
RE, Infertility
Dominique de Ziegler
Vanessa Gayet
Isabelle Streuli
Blandine Boquet
Ann Marszalek
Juliane Berdah
Alessandra Fubini
Caterina Feretti
Jacques de Mouzon
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
Emotional intelligence
Hodgkin 90%
What can you say about a twentyfive-year-old girl who died? That she
was beautiful. And brilliant. That she
loved Mozart and Bach. And the
Beatles. And me.
age
20
40
de Ziegler et al. Université Paris FIVE
Emotional intelligence
Hodgkin 90%
What can you say about a twentyfive-year-old girl who died? That she
was beautiful. And brilliant. That she
loved Mozart and Bach. And the
Beatles. And me.
13%
Breast cancer
age
20
40
de Ziegler et al. Université Paris FIVE
Pregnancy after breast ca: Risk
www.grsgo.ch
Pregnancy after breast ca: Risk
www.grsgo.ch
www.grsgo.ch
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
Pregnancy after breast ca: Chances
Age-related decline in oocyte quality
37
Fecundity
25
35
45
age
Pregnancy after breast ca: Chances
Pregnancy after breast ca: Chances
PR
cycles
1-5
>11
n oocytes
Pregnancy after breast ca: Chances
40
40
40
40
Pregnancy after breast ca: Chances
Age-related decline in oocyte quality
cancer
Chemotherapy
Immidiate impact
Recovery
Late conseuences
37
Fecundity
25
35
45
age
Pregnancy after breast ca: Chances
Pregnancy after breast ca: Chances
6 months
Light chemo
(no ABVD)
Pregnancy after breast ca: Chances
Fertil Steril 2012 in press
Pregnancy after breast ca: Chances
Recovery
No alkylating
AMH >2
AMH <2
Alkylating agent
Fertil Steril 2012 in press
Pregnancy after breast ca: Chances
Age-related decline in oocyte quality
cancer
Chemotherapy
Immidiate impact
Recovery
Late conseuences
Cancer patients
Lower ov reserve?
37
Fecundity
25
35
45
age
Is it going to work?
Is it truly necessary?
Pregnancy after breast ca: Chances
Natural pregnancy chances
37
Fecundity
25
35
45
age
Pregnancy after breast ca: Chances
Fert preservation
Age limits?
Functional limits?
Natural pregnancy chances
ART pregnancy chances
37
Fecundity
25
35
45
age
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Indicated when nothing to
lose and no other options.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Indicated when nothing to
lose and no other options.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Indicated when nothing to
lose and no other options.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Indicated when nothing to
lose and no other options.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Offers assessable and
predictable pregnancy
chances (20 oocyte/BB).
No known risk.
Can be conducted during
the 3-6 weeks time interval
between Sx and Chemo.
Associated in principle with
oocyte vitrification.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
Standard reference
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Offers assessable and
predictable pregnancy
chances (20 oocyte/BB).
No known risk.
Can be conducted during
the 3-6 weeks time interval
between Sx and Chemo.
Associated in principle with
oocyte vitrification.
IVM exists for >20 years
Dedicated for PCOS
Results: PCOS >> Normal
In PCOS : IVM << regART
IVM is not indicated in
breast ca (except neoadjuvent) because of poor
results, whereas OHSS can
be prevented w/ antagonist.
Ovarian freezing
Fertil Steril 2012
Experimental
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Standard reference
Experimental
In PCOS, IVM offers results markedly inferior to regART
In principle, not indicated in
Offers assessable and
In cycling
women,
IVM
results
are
inferior
to pregnancy
PCOS
breast cancer for the fear
predictable
Oocyte
in IVM is more traumatic
in ART,
that retrieval
it offers sporadic
chances than
(20 oocyte/BB).
andbenefit
may cause
pelvic
adhesion
and may
harm
the
No known risk.
chances of natural
pregnancy.
Can be conducted during
the 3-6 weeks time interval
between Sx and Chemo.
Associated in principle with
oocyte vitrification.
IVM exists for >20 years
Dedicated for PCOS
Results: PCOS >> Normal
In PCOS : IVM << regART
IVM is not indicated in
breast ca (except neoadjuvent) because of poor
results, whereas OHSS can
be prevented w/ antagonist.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
pregnancy.
Offers assessable and
predictable pregnancy
chances (20 oocyte/BB).
No known risk.
Can be conducted during
the 3-6 weeks time interval
between Sx and Chemo.
Associated in principle with
oocyte vitrification.
IVM exists for >20 years
Dedicated for PCOS
Results: PCOS >> Normal
In PCOS : IVM << regART
IVM is not indicated in
breast ca (except neoadjuvent) because of poor
results, whereas OHSS can
be prevented w/ antagonist.
Ovarian freezing
Stat ART (IVF/ICSI) &
oocyte/emb freezing
In vitro maturation (IVM)
Experimental
In principle, not indicated in
breast cancer for the fear
that it offers sporadic
benefit and may harm the
chances of natural
60 pregnancy.
40
20
0
ART
IVM
Offers assessable and
predictable pregnancy
chances (20 oocyte/BB).
No known risk.
Can be conducted during
the 3-6 weeks time interval
between Sx and Chemo.
Associated in principle with
oocyte vitrification.
IVM exists for >20 years
Dedicated for PCOS
Results: PCOS >> Normal
In PCOS : IVM << regART
IVM is not indicated in
breast ca (except neoadjuvent) because of poor
results, whereas OHSS can
be prevented w/ antagonist.
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
Therapeutic options
Therapeutic options
Therapeutic options
Pregnancy after breast ca
Risk
Chances
Therapeutic options
Actual data
Dos & don’ts
GnRH-a
GnRH-antag./ AI
Cetrotide/Orgalutran
0.25mg/J
Random Start Protocol
Cetrotide/
Orgalutran
*
Jours de traitement
TAM (20mg/day)
FSH/hMG
0 1 2 3 4 5 6 7 8 9 10 11
Dosage: E2
x
Echographie
* Jours de la semaine
Ve
Ma
13 14
x
x
x
x
x
x
x
x
Je
Sa
Lu
Me
GnRH-a
GnRH-antag./ TAM
Cetrotide/Orgalutran
0.25mg/J
Random Start Protocol
Cetrotide/
Orgalutran
*
Jours de traitement
TAM (20mg/day)
FSH/hMG
0 1 2 3 4 5 6 7 8 9 10 11
Dosage: E2
x
Echographie
* Jours de la semaine
Ve
Ma
13 14
x
x
x
x
x
x
x
x
Je
Sa
Lu
Me
GnRH-a
GnRH-antag.
Cetrotide/Orgalutran
0.25mg/J
Random Start Protocol
Cetrotide/
Orgalutran
*
Jours de traitement
TAM (20mg/day)
FSH/hMG
0 1 2 3 4 5 6 7 8 9 10 11
Dosage: E2
x
Echographie
* Jours de la semaine
Ve
Ma
13 14
x
x
x
x
x
x
x
x
Je
Sa
Lu
Me
Cancer sein
AMP d’urgence
Séquence
conventionnelle
Séquence
néo-adjuvente
Stimulation ovarienne
Protocole antag. GnRH-a,
random start, ponction M II
Maturation in vitro
Mais tt hCG
Impact sur g spontanée?
Cryopréservation
ovarienne
Cancer sein
AMP d’urgence
Séquence
conventionnelle
Cryopréservation
ovarienne
Stimulation ovarienne
Protocole antag. GnRH-a,
random start, ponction M II
MIV n’est pas le ‘standard of care’.
Procédure expérimentale avec
résultats largement inférieur à AMP
Séquence
néo-adjuvente
Maturation in vitro
Mais tt hCG
Impact sur g spontanée?
Cancer sein
AMP d’urgence
Séquence
conventionnelle
Cryopréservation
ovarienne
Stimulation ovarienne
Protocole antag. GnRH-a,
random start, ponction M II
MIV n’est pas le ‘standard of care’.
Procédure expérimentale avec
résultats largement inférieur à AMP
Séquence
néo-adjuvente
Maturation in vitro
Mais tt hCG
Impact sur g spontanée?
En principe:
n’est pas indiqué
dans cancer sein
Dept of OB-Gyn
Université Paris-Descartes
Hôpital Cochin
Surgery
Charles Chapron
Hervé Foulot
Bruno Borghese
Pietro Santlli
Guillaume Pierre
Marie Christine Lafay
Fouzia Decuypere
François X. Aubriot
RE, Infertility
Dominique de Ziegler
Vanessa Gayet
Isabelle Streuli
Blandine Boquet
Ann Marszalek
Juliane Berdah
Alessandra Fubini
Caterina Feretti
Jacques de Mouzon