Course / Tailoring Treatment for a Cancer Diagnosis
The objective of ovarian stimulation is to recruit multiple follicles for egg retrieval in a short timeframe, while maintaining safe hormone levels.
Key factors influencing the chosen approach include:
Type of cancer and treatment timeline
Hormone receptor status (especially in breast, ovarian, or endometrial cancers)
Blood clotting or thrombotic risk
Baseline ovarian reserve (AMH, antral follicle count)
Availability of time before chemotherapy or radiation
Clinicians must often compress treatment cycles from the traditional 4–6 weeks to as few as 10–14 days without compromising egg yield or patient safety.
Fertility preservation uses controlled ovarian stimulation (COS) to encourage multiple eggs to mature in one cycle. The standard regimen combines:
Gonadotropins (FSH and/or LH analogs) – to stimulate follicular growth
GnRH agonists or antagonists – to prevent premature ovulation
Trigger injections (hCG or GnRH agonist) – to mature eggs for retrieval
Goals of Stimulation
Produce 10–20 mature eggs, depending on patient age and ovarian reserve
Maintain controlled estradiol levels
Allow egg retrieval before cancer therapy starts
Because many cancer patients must begin treatment urgently, protocols are often shortened or initiated at non-traditional cycle times (“random-start stimulation”).
Long Agonist Protocol
This traditional approach uses a GnRH agonist (such as leuprolide acetate) for pituitary suppression before starting gonadotropins.
It provides excellent synchronization and egg yield but requires 2–3 weeks of preparation, which may be unsuitable for urgent oncology cases.
Advantages:
Predictable follicular growth
Reduced risk of premature LH surge
High oocyte yield
Limitations for Cancer Patients:
Time-consuming
Higher estrogen exposure
Often avoided for hormone-sensitive cancers or when treatment urgency is high
PPOS is an increasingly popular alternative that uses oral progestins (e.g., medroxyprogesterone acetate or dydrogesterone) instead of GnRH antagonists to suppress premature ovulation.
Key Advantages:
Eliminates need for daily antagonist injections
Reduces overall cost and patient discomfort
Provides effective ovulation suppression during short or flexible-start protocols
Clinical Application:
PPOS is especially valuable when stimulation must start at any point in the cycle (“random-start”) or when patient tolerance for injections is low.
Since all embryos or oocytes are frozen, the luteal phase effects of progestins are irrelevant to cycle outcome.
Cancer treatment timelines are often urgent. Waiting for a menstrual cycle to begin stimulation is rarely feasible.
Random-start ovarian stimulation allows gonadotropins to begin at any point in the cycle — follicular, luteal, or mid-cycle — with comparable egg yield and maturity to conventional starts.
Benefits:
Enables fertility preservation within 10–14 days total
Reduces delay in initiating cancer therapy
Maintains acceptable oocyte quantity and maturity
How It Works:
Baseline ultrasound and hormone assessment
Immediate start of gonadotropins
Add GnRH antagonist or progestin suppression when follicles reach 12–13mm
Trigger and retrieve eggs once mature
This approach has become standard-of-care for urgent oncofertility cases worldwide.
In estrogen receptor-positive cancers (e.g., breast or endometrial cancers), limiting estrogen exposure during stimulation is crucial.
Modified Natural or Unmedicated Cycles
Minimal or no gonadotropins used
One or two natural follicles are retrieved
Useful when estrogen exposure must be minimized
Lower oocyte yield, but safer for select patients
Tamoxifen and Letrozole Protocols
These selective estrogen receptor modulators (SERMs) and aromatase inhibitors help suppress estrogen levels during stimulation.
Letrozole (2.5–5 mg daily) is the most common option.
It decreases estradiol by inhibiting aromatase, maintaining levels near physiologic baseline.
Tamoxifen may be used similarly, though it has partial estrogenic effects.
Combined Protocol (Letrozole + FSH):
Allows ovarian stimulation with low estrogen rise
Yields similar oocyte numbers as conventional stimulation
Considered standard protocol for ER-positive breast cancer patients
Cancer patients—especially those with solid tumors or receiving hormonal stimulation—are at increased risk of venous thromboembolism (VTE).
Risk Factors Include:
Elevated estrogen levels
Immobility
Chemotherapy-related vascular effects
Use of estrogenic medications or GnRH agonists
Risk Mitigation Strategies:
Use Letrozole-based or Antagonist protocols to minimize estrogen levels
Encourage hydration and ambulation
Use prophylactic low-molecular-weight heparin (LMWH) in high-risk cases
Avoid high-dose estrogen medications or long protocols when unnecessary
Every patient’s thrombotic risk is individually assessed before stimulation begins.
At Surrogacy4All, safety is paramount, and protocols are chosen to minimize all systemic risks while preserving optimal fertility outcomes.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
Secret Guide to Minimizing Surrogacy Costs
All Rights Reserved to Surrogacy4all