Étude de non-infériorité du protocole « Random Start » en cryoconservation ovocytaire dans le cancer de la femme jeune

Abstract : Objective: the initiation of anti-cancer treatment, often gonadotoxic, is urgent in women with cancer. The objective of this study was to show the non-inferiority of the Random Start protocol, an ovarian stimulation protocol that allows stimulation to begin at any time during the cycle, compared to the conventional protocol. The application of this new technique would save precious time in the context of urgent fertility preservation in young women with cancer. Materials and Methods: this was a descriptive, retrospective, unicentric, unicentric study at the Bordeaux University Hospital. 52 patients were included from September 2013 to June 2018, to whom 58 cycles of ovarian stimulation will have been administered. Depending on the day of the cycle on which the patient presented at the first consultation, a protocol was chosen. The main endpoint was the number of mature oocytes (in metaphase II) cryopreserved, the secondary endpoints were: The total dose of gonadotropins used, the duration of ovarian stimulation, and the time required to treat oncofertility. Results : of the 58 ovarian stimulation cycles, 30 according to the classical protocol corresponded to group 1, and 28 according to the Random Start protocol to group 2. The number of mature oocytes obtained (Group 1: 6.20 ± 5.24, Group 2: 9.43 ± 5.90) was significantly higher in the Random Start group with a p < 0.01. The duration of ovarian stimulation (Group 1: 10.3 ± 1.67, Group 2: 11.2 ± 1.96), as well as the total dose of gonadotropins used (Group 1: 3054 IU ± 927, Group 2: 3073 IU ± 1107) did not show a significant difference with p = 0.085 and p = 0.83 respectively. Finally, the oncofertility management time (Group 1: 9.81 ± 9.79, Group 2: 1.64 ± 2.28) was significantly shorter in the Random Start group with a p < 0.001. Conclusion: this study showed that ovarian stimulation according to the Random Start protocol provided a yield at least equivalent to the Gold Standard, and saved a significant amount of time in this emergency fertility preservation context.
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Master Thesis
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Clotilde Lacour. Étude de non-infériorité du protocole « Random Start » en cryoconservation ovocytaire dans le cancer de la femme jeune. Médecine humaine et pathologie. 2018. ⟨dumas-01975415⟩

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