Management of ovarian reserve in breast cancer patients seeking pregnancies (MORE BREAKS): A Delphi consensus

Abstract

Breast cancer is one of the most common tumors among women with 10 % of cases diagnosed in reproductive age. Estrogen positive forms are characterized by an excellent long-term prognosis with the 5-year survival rate of approximately 90 %. Recently, the temporary interruption of adjuvant endocrine therapy to attempt pregnancy in women good prognosis have been introduced. At present, there are no indications or protocols on the optimal management of conception during discontinuation of endocrine therapy for these patients. A Delphi consensus was carried out to obtain expert opinion from a global perspective to identify the optimal pathways to pursue childbearing with particular focus in strategies aimed at reducing time to live birth. The Delphi consensus was carried out involving one Scientific Coordinator and 6 additional experts. Each member of the Scientific Board suggested additional experts, resulting in a panel of 31 experts. The Scientific Board proposed 20 statements covering the following area of interest: 1) Resumption of menstrual cycle after the suspension of endocrine therapy; 2) Management of the washout period; 3) Fertility assessment; 4) Decision-making of reproductive planning; 5) Ovarian reserve evaluation; 6) Expectant management vs immediate fertility treatment; 6) Controlled ovarian stimulation protocols; 7) In vitro fertilization protocols. Eighteen statements reached the consensus This Delphi consensus provides strategies to reduce the time to live birth in breast cancer patients' candidates for discontinuation of endocrine therapy.

Keywords: ART; Breast cancer; Delphi consensus; IVF; POSITIVE trial; Time-to-pregnancy.