Random-Start Protocols Allow Fertility Preservation Without Delaying Treatment

Melody Rasouli, MD, MBA, FACOG, a reproductive endocrinology and infertility specialist at HRC Fertility in Newport Beach, California, spoke with CancerNetwork® about how cancer centers can better inform oncologists and patients about rapid-start fertility preservation protocols when cancer treatment cannot be delayed. Rasouli explained that egg freezing or in vitro fertilization (IVF) can now begin regardless of where a patient is in her menstrual cycle, with random-start ovarian stimulation completed in about 10 to 14 days rather than the month or more patients and clinicians often expect.

She noted that letrozole (Femara) is added for patients with hormone-sensitive cancers, such as breast cancer, and that sperm banking for men can be completed within days. Rasouli also shared her practice of giving oncologists a 1-page reference outlining these timelines and how to reach the fertility team, helping them make a patient-specific decision about whether there is time to proceed before starting treatment.

Transcript:

Rasouli: This is a great area of our medicine. Right now, we’re able to start a woman on IVF or egg freezing right away, regardless of where she is in her menstrual cycle. That can take away some of the fear of delaying treatment, which is a barrier that has been previously described in the literature. Instead of thinking you need at least a month, maybe 6 weeks, we can do a random-start ovarian stimulation, and it can be done in about 10 to 14 days. In terms of protocols, we also add letrozole (Femara) for hormone-sensitive cancers; I often use that in my patients with breast cancer. For men, we can do sperm banking within days.

The way I’ve liked to do this in the past is to give oncologists a 1-page reference that lays out these timelines and how to reach our team, so they can refer with confidence that this is going to be an appropriate plan for the patient. Do they have this number of days to spare before starting treatment, or do they make the clinical decision with the patient that they don’t have those 2 weeks? Sometimes that is the case. It’s patient dependent, but there are things we can do to streamline that process.