Two cases of polycystic ovary syndrome with onset of severe ovarian hyperstimulation syndrome following controlled ovarian stimulation with aromatase inhibitors for fertility preservation before breast cancer treatment

Sugiko Oishi; Keiko Mekaru; Rie Nakamura; Maho Miyagi; Kozue Akamine; Chiaki Heshiki; Yoichi Aoki

doi:10.1016/j.tjog.2021.07.028

Two cases of polycystic ovary syndrome with onset of severe ovarian hyperstimulation syndrome following controlled ovarian stimulation with aromatase inhibitors for fertility preservation before breast cancer treatment

Taiwan J Obstet Gynecol. 2021 Sep;60(5):931-934. doi: 10.1016/j.tjog.2021.07.028.

Authors

Sugiko Oishi¹, Keiko Mekaru², Rie Nakamura², Maho Miyagi², Kozue Akamine², Chiaki Heshiki², Yoichi Aoki²

Affiliations

¹ Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan. Electronic address: [email protected].
² Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.

PMID: 34507678
DOI: 10.1016/j.tjog.2021.07.028

Abstract

Objective: The risks of ovarian hyperstimulation syndrome (OHSS) involve high estrogen (E₂) levels. We report two breast cancer patients with polycystic ovarian syndrome who underwent fertility preservation and had severe OHSS; their E₂ levels were lowered using aromatase inhibitors (AI).

Case reports: A 36-year-old woman underwent controlled ovarian stimulation (COS) with AI and cryopreserved 10 blastocysts. She was hospitalized with OHSS (E₂ = 139.1 pg/mL). She improved with infusion alone. A 31-year-old woman underwent COS with AI and cryopreserved 8 blastocysts. She was hospitalized for OHSS (E₂: 429 pg/mL). Her vascular endothelial growth factor (VEGF) levels were high (62 pg/mL) at 8 days after the procedure. She needed hospitalization for 9 days. The planned adjuvant therapy was delayed for a week in both cases.

Conclusion: Elevated VEGF levels should be considered as a risk factor of OHSS even if E₂ levels are low with AI treatment.

Keywords: Aromatase inhibitors; Estrogens; Fertility preservation; Ovarian hyperstimulation syndrome; Polycystic ovary syndrome.

Publication types

Case Reports

MeSH terms

Adult
Aromatase Inhibitors / adverse effects
Aromatase Inhibitors / therapeutic use*
Breast Neoplasms / drug therapy
Female
Fertility Agents, Female / therapeutic use*
Fertility Preservation / methods*
Fertilization in Vitro
Humans
Infertility, Female / drug therapy*
Infertility, Female / etiology
Ovarian Hyperstimulation Syndrome / chemically induced*
Ovarian Hyperstimulation Syndrome / etiology
Ovulation Induction / adverse effects*
Ovulation Induction / methods
Polycystic Ovary Syndrome / complications*
Polycystic Ovary Syndrome / drug therapy
Vascular Endothelial Growth Factor A

Substances

Aromatase Inhibitors
Fertility Agents, Female
Vascular Endothelial Growth Factor A