Fertility Preservation: Convergence of Newly Diagnosed Breast Cancer, Desired Fertility, and Polycystic Ovary Syndrome

  • Michael S. Mersol-BargEmail author
  • Jeffrey H. Margolis


A 34-year-old nulliparous female presented with a self-discovered 4 cm, firm, mobile mass in the upper, outer quadrant of her right breast. Her mother is a breast cancer survivor, diagnosed at age 45, and was BRCA negative. The patient also had polycystic ovary syndrome based on a long history of irregular menstrual cycles, mild facial and lower abdominal hair, acne, and mild acanthosis nigricans on the nape of the neck. She last used hormonal contraception 4 years prior to initial presentation. Menstrual cycles were more regular in the past year. Current medications to treat anxiety and depression included sertraline, lamotrigine, and oxcarbazepine. She had no other medical illness in the past or at presentation. The patient and her husband were just beginning efforts to become pregnant at the time she discovered her breast mass.


Onco-fertility Fertility preservation Breast cancer Polycystic ovary syndrome 


  1. 1.
    von Wolff M, Thaler CJ, Frambach T, Zeeb C, Lawrenz B, Popovici RM, Strowitzki T. Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril. 2009;92(4):1360–5.CrossRefGoogle Scholar
  2. 2.
    Nayak SR, Wakim AN. Random-start gonadotropin-releasing hormone (GnRH) antagonist–treated cycles with GnRH agonist trigger for fertility preservation. Fertil Steril. 2011;96(1):e51–4.CrossRefGoogle Scholar
  3. 3.
    Reddy J, Oktay K. Ovarian stimulation and fertility preservation with the use of aromatase inhibitors in women with breast cancer. Fertil Steril. 2012;98(6):1363–9.CrossRefGoogle Scholar
  4. 4.
    Green DM, Whitton JA, Stovall M, et al. Pregnancy outcome of female survivors of childhood cancer: a report from the childhood cancer survivor study. Am J Obstet Gynecol. 2002;187(4):1070–80.CrossRefGoogle Scholar
  5. 5.
    Deemeestere I, Brice P, Peccatori FA, Kentos A, Dupuis J, Zachee P, Casasnovas O, Van Den Neste E, Dechene J, De Maertelaer V, Bron D, Englert Y. No evidence for the benefit of gonadotropin-releasing hormone agonist in preserving ovarian function and fertility in lymphoma survivors treated with chemotherapy: final long-term report of a prospective randomized trial. J Clin Oncol. 2016;34(22):2568–74. Epub 2016 May 23.
  6. 6.
    von Wolff M, Stute P. Judging the fertility protective effect of GnRH agonists in chemotherapy – it is a matter of perspective. Front Endocrinol. 2017;8:69.Google Scholar
  7. 7.
    Halle CF, Moor MD, Unger JM, Phillips KA. Goserelin for ovarian protection during breast cancer adjuvant chemotherapy. N Engl J Med. 2015;372:923–32.CrossRefGoogle Scholar
  8. 8.
    Donnez J, Dolmans M-M. Fertility preservation in women. N Engl J Med. 2017;377:1657–65.CrossRefGoogle Scholar
  9. 9.
    Francis PA, Regan MM, Fleming GF, Láng I, SOFT Investigators, International Breast Cancer Study Group, et al. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl Med. 2015;372(5):436–46.CrossRefGoogle Scholar
  10. 10.
    Pagani O, Regan MM, Walley BA, Fleming GF, Colleoni M, Láng I, Gomez HL, TEXT and SOFT Investigators, International Breast Cancer Study Group, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014;37(2):107–18. PA%5BAuthor%5D&cauthor=true&cauthor_uid=24881463.CrossRefGoogle Scholar
  11. 11.
    Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10.CrossRefGoogle Scholar
  12. 12.
    McLaughlin M, Albertini DF, Wallace WHB, Anderson RA, Telfer EE. Metaphase II oocytes from human unilaminar follicles grown in a multi-step culture system. MHR: Basic Sci Reprod Med.
  13. 13.
    Cardozo ER, Huber WJ, Stuckey AR, Alvera RJ. Mandating coverage for fertility preservation – a step in the right direction. N Engl J Med. 2017;z377(17):1607–9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Michigan Reproductive MedicineBloomfield HillsUSA
  2. 2.Division of Clinical Hematology and Medical OncologyRose Cancer Treatment Center, William Beaumont HospitalRoyal OakUSA

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