The following is the summary of “IVF characteristics and the molecular luteal features of random start IVF cycles are not different from conventional cycles in cancer patients” published in the January 2023 issue of Human reproduction by Esmaeilian, et al.

Is there a difference between random-start IVF cycles and traditional cycles in terms of the IVF parameters used and the steroidogenic luteal features seen in cancer patients? However, the expression of enzymes involved in the cholesterol utilization and steroid hormone biosynthesis pathways, gonadotropin receptor expression, and estradiol (E2) and progesterone (P4) production during controlled ovarian stimulation cycles initiated at LFP and LP are completely comparable to those observed during conventional IVF cycles initiated at EFP. Because of time restrictions, many cancer patients who wish to preserve their fertility through oocyte and embryo freezing choose for random start ovarian stimulation procedures rather than the more traditional method of initiating stimulation at the onset of the next menstrual cycle (EFP). There is a lack of evidence comparing the clinical IVF characteristics of cancer patients with the molecular steroidogenic aspects of these cycles. In our investigation, we sought to answer this issue in order to better comprehend the degree to which random start cycles resemble regular start cycles. A randomized, controlled trial of IVF for fertility preservation in 62 cancer patients scheduled to have treatment between 2017 and 2022. About 62 individuals were enrolled in the trial, all of whom had been diagnosed with cancer before undergoing cancer treatment/surgery and who had had ovarian stimulation for oocyte (n=41) and embryo (n=21) cryopreservation utilizing a GnRH antagonist regimen and human menopausal gonadotropins. The aromatase inhibitor letrozole was used with gonadotropin stimulation for individuals with breast cancer and endometrial cancer. 

In 22 cases, ovarian stimulation was started at EFP as a control, in 20 patients it was started at LFP, and in the other 20 patients it was started at mid-LP. In the course of the oocyte retrieval process, luteinized granulosa cells (GCs) were isolated from follicular aspirates and employed in the tests independently for each patient. Immunoblotting and reverse transcription polymerase chain reaction were used to examine the levels of expression of enzymes involved in sex steroid biosynthesis (StAR, 3-HSD, Aromatase), cholesterol synthesis (3-hydroxy-3-methylglutaryl Co-A reductase [HMG-Co-A reductase]), utilization (hormone sensitive lipase [HSL]), and storage (Acetyl-Coenzyme A ace The expression patterns of the steroidogenic enzymes and their connection to mitochondria were studied using laser confocal immunofluorescence imaging. The groups were compared based on their ability to produce E2 and P4 in vitro.

Patients undertaking conventional start and random start IVF cycles had comparable demographic and IVF features at baseline. In LFP and LP start cycles, gonadotropin stimulation lasted substantially longer than in regular start cycles. There was no significant difference between the conventional and random start cycles in terms of ovarian response to gonadotropin stimulation, mature and total oocyte yield, fertilization, or Day 5 blastulation rates of the embryos. In terms of viability index and gross light microscopic morphologic aspects, researchers found no significant changes between the luteal GCs of these random start cycles. The expression profiles of gonadotropin receptors, enzymes involved in sex steroid biosynthesis and cholesterol synthesis/utilization, and the steroidogenic activity of the luteal GCs of the random start cycles are nearly identical to those of the conventional start cycles, as revealed by more in-depth analysis of the molecular luteal characteristics of the cells using RT-PCR, immunoblotting methods. Using confocal microscopy, we found that the signal expression profiles of the steroidogenic enzymes and their co-localization inside mitochondria followed similar patterns.