Article Data

  • Views 545
  • Dowloads 135

Case Reports

Open Access

Twin delivery after IVF-ET with variable dose letrozole-FSH protocol of lower estradiol in a patient previously treated for breast cancer: a case report

  • Chang-Jun Zhang1
  • Ying Zhang1
  • Guang-Zhu Hu2
  • Honglu Diao1,*,

1Reproductive Medical Center, Renmin Hospital, Shiyan, Hubei, China

2Department of Thoracic and Cardiomacrovascular Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China

DOI: 10.12892/ejgo2837.2016 Vol.37,Issue 2,April 2016 pp.278-281

Published: 10 April 2016

*Corresponding Author(s): Honglu Diao E-mail:


Objective: To present a case of twin pregnancy obtained by in vitro fertilization and embryo transfer (IVF-ET) with variable dose letrozole- FSH protocol of lower peak estradiol level, after treatment of carcinoma of the breast. Materials and Methods: A 34-year-old patient diagnosed with mucinous breast carcinoma undergoing assisted fertilization treatment after breast cancer operation and treatment including controlled ovarian stimulation (COS), oocyte retrieval, IVF, and embryo culture and transfer. Results: Four oocytes were obtained in three COS procedures in the three IVF cycle. All oocytes were fertilized. In the third cycle, two fresh embryos were transferred, and two healthy girls were born at 37 gestational weeks. Conclusion: Variable dose letrozole-FSH protocol can maintain lower peak estradiol levels and reduce estrogen exposure after breast cancer operation and chemotherapy.


Breast cancer; Variable dose letrozole-FSH protocol; IVF-ET; Twin pregnancy.

Cite and Share

Chang-Jun Zhang,Ying Zhang,Guang-Zhu Hu,Honglu Diao. Twin delivery after IVF-ET with variable dose letrozole-FSH protocol of lower estradiol in a patient previously treated for breast cancer: a case report. European Journal of Gynaecological Oncology. 2016. 37(2);278-281.


[1] Knobf M.T.: “The influence of endocrine effects of adjuvant therapy on quality of life outcomes in younger breast cancer survivors”. Oncologist, 2006, 11, 96.

[2] Jemal A., Murray T., Samuels A., Ghafoor A., Ward E., Thun M.J.: “Cancer statistics, 2003”. CA Cancer J. Clin., 2003, 53, 5.

[3] Poniatowski B.C., Grimm P., Cohen G.: “Chemotherapy-induced menopause: a literature review”. Cancer Invest., 2001, 19, 641.

[4] Brinton L.A.: “Breast cancer risk after use of fertility drugs: stimu-lating new controversy”. J. Natl. Cancer Inst., 2012, 104, 962.

[5] Oktay K., Buyuk E., Libertella N., Akar M., Rosenwaks Z.: “Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation”. J. Clin. Oncol., 2005, 23, 4347.

[6] Mouridsen H., Gershanovich M., Sun Y., Perez-Carrion R., Boni C., Monnier A., et al.: “Phase III study of letrozole versus tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: analysis of survival and update of efficacy from the International Letrozole Breast Cancer Group”. J. Clin. Oncol., 2003, 21, 2101.

[7] Mitwally M.F., Casper R.F.: “Aromatase inhibitors in ovulation induction”. Semin. Reprod. Med., 2004, 22, 61.

[8] Nielsen T.O., Parker J.S., Leung S., Voduc D., Ebbert M., Vickery T., et al.: “A comparison of PAM50 intrinsic subtyping with immunohistochemistry and clinical prognostic factors in tamoxifen-treated estrogen receptor-positive breast cancer”. Clin. Cancer Res., 2010, 16, 5222.

[9] Goldhirsch A., Wood W.C., Coates A.S., Gelber R.D., Thurlimann B., Senn H.J., et al.: “Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011”. Ann. Oncol., 2011, 22, 1736.

[10] Meirow D., Schiff E.: “Appraisal of chemotherapy effects on reproductive outcome according to animal studies and clinical data”. J. Natl. Cancer Inst. Monogr., 2005, 34, 21.

[11] Albrektsen G., Heuch I., Hansen S., Kvale G.: “Breast cancer risk by age at birth, time since birth and time intervals between births: exploring interaction effects”. Br. J. Cancer, 2005, 92, 167.

[12] Dupont W.D., Page D.L.: “Breast cancer risk associated with proliferative disease, age at first birth, and a family history of breast cancer”. Am. J. Epidemiol., 1987, 125, 769.

[13] Mueller B.A., Simon M.S., Deapen D., Kamineni A., Malone K.E., Daling J.R.: “Childbearing and survival after breast carcinoma in young women”. Cancer, 2003, 98, 1131.

[14] Trichopoulos D., Hsieh C.C., MacMahon B., Lin T.M., Lowe C.R., Mirra A.P., et al.: “Age at any birth and breast cancer risk”. Int. J. Cancer, 1983, 31, 701.

[15] Goodwin P.J., Ennis M., Pritchard K.I., Trudeau M., Hood N.: “Risk of menopause during the first year after breast cancer diagnosis”. J. Clin. Oncol., 1999, 17, 2365.

[16] Largillier R., Savignoni A., Gligorov J., Chollet P., Guilhaume M.N., Spielmann M., et al.: “Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years: a GET(N)A Working Group analysis”. Cancer, 2009, 115, 5155.

[17] Lee S., Ozkavukcu S., Heytens E., Moy F., Alappat R.M., Oktay K.: “Anti-Mullerian hormone and antral follicle count as predictors for embryo/oocyte cryopreservation cycle outcomes in breast cancer patients stimulated with letrozole and follicle stimulating hormone”. J. Assist. Reprod. Genet., 2011, 28, 651.

[18] Santen R.J., Song R.X., Zhang Z., Kumar R., Jeng M.H., Masamura S., et al.: “Adaptive hypersensitivity to estrogen: mechanisms and clinical relevance to aromatase inhibitor therapy in breast cancer treatment”. J. Steroid Biochem. Mol. Biol., 2005, 95, 155.

[19] Mitwally M.F., Casper R.F.: “Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate”. Fertil. Steril., 2001, 75, 305.

[20] Oktay K., Hourvitz A., Sahin G., Oktem O., Safro B., Cil A., et al.: “Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy”. J. Clin. Endocrinol. Metab., 2006, 91, 3885.

[21] Dennis S.J., Thomas M.A., Williams D.B., Robins J.C.: “Embryo morphology score on day 3 is predictive of implantation and live birth rates”. J. Assist. Reprod. Genet., 2006, 23, 171.

[22] Racowsky C., Stern J.E., Gibbons W.E., Behr B., Pomeroy K.O., Biggers J.D.: “National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate”. Fertil. Steril., 2011, 95, 1985.

[23] Dow K.H.: “Having children after breast cancer”. Cancer Pract., 1994, 2, 407.

[24] Simon B., Lee S.J., Partridge A.H., Runowicz C.D.: “Preserving fertility after cancer”. CA Cancer J. Clin., 2005, 55, 211.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time