Fertility preservation by random-start controlled ovarian stimulation as part of multidisciplinary treatment for medulloblastoma

Abstract

Fertility preservation is a challenge to overcome in order to improve survivorship of adolescent and young adult (AYA) cancer patients. The St. Jude medulloblastoma-96 protocol, which involves radiotherapy followed by chemotherapy with high-dose alkylating agents and autologous peripheral blood stem cell transplantation, is widely used to treat medulloblastoma. Despite the high overall survival rate, loss of fertility is inevitable. We report the case of a 16-year-old girl with cerebellar medulloblastoma. After gross resection of the tumor, peripheral blood stem cell collection was started 14 days after surgery, and radiotherapy consisting of 23.4 Gy craniospinal irradiation and 32.4 Gy tumor bed boost irradiation was started 24 days after surgery. After radiotherapy, the anti-Müllerian hormone level decreased to 1.84 ng/mL. Random-start controlled ovarian stimulation was performed by administering an FSH analog for nine consecutive days followed by hCG injection for the final stage of oocyte maturation. Four oocytes were successfully cryopreserved without any adverse events or a delay in high-dose chemotherapy. Random-start controlled ovarian stimulation is a promising technique to preserve fertility in AYA patients, which does not delay treatment of medulloblastoma.