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Preoperative controlled ovarian stimulation for fertility preservation in women with ER+ breast cancer does not increase the risk of disease progression or death, despite causing a modest delay in initiating neoadjuvant systemic therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 6, 2026Annals of Surgical Oncology0 citationsOpen Access

Oncologic Safety of Preoperative Controlled Ovarian Stimulation for Fertility Preservation Among Women with Estrogen Receptor Positive Breast Cancer

JCJennifer H. ChenThe University of Texas MD Anderson Cancer Center IPIrene Peregrín-ÁlvarezBaylor College of Medicine CWCarla L. WarnekeThe University of Texas MD Anderson Cancer Center

Key Points

This study aims to evaluate the oncologic safety of preoperative controlled ovarian stimulation (COS) in women with ER+ breast cancer.
Single-institution retrospective cohort study of women with ER+ breast cancer receiving COS from 2014-2024.
Primary outcome was progression-free survival (PFS); compared outcomes of preoperative COS to postoperative COS and matched controls.
Used propensity score matching based on age, HER2 status, and clinical stage.
5-year PFS for preoperative COS (94.1%, 95% CI 65.0–99.2%) was similar to postoperative COS (93.3%, 95% CI 61.3–99.0%), p = 0.73.
Patients with neoadjuvant systemic therapy and preoperative COS had a longer delay to NST initiation (48 days vs. 29.5 days, p < 0.0001).
Disease-free survival was comparable between cohorts: preoperative COS (94.1%, 95% CI 65.0–99.2%) vs. no COS (93.3%, 95% CI 75.9–98.3%), p = 0.15.

Abstract

Abstract Background The oncologic safety of preoperative controlled ovarian stimulation (COS) for fertility preservation in women with an in situ estrogen receptor positive (ER+) breast cancer is unclear. The purpose of this study was to compare oncologic outcomes of women with ER+ breast cancer undergoing preoperative COS versus (1) postoperative COS or (2) matched controls not undergoing COS. Patients and Methods This was a single-institution retrospective cohort study of women with ER+ breast cancer receiving oncofertility counseling who pursued COS from 2014–2024. The primary outcome was progression-free survival (PFS). A subcohort of patients who received neoadjuvant systemic therapy was compared with a matched cohort of similar patients with ER+ breast cancer who did not undergo COS. Propensity score matching criteria were age, HER2 receptor status, and clinical stage. Results Among 51 women with ER+ breast cancer undergoing COS, the median follow-up was 5.5 years. 5-year PFS was similar for preoperative COS ( n = 32) versus postoperative COS ( n = 19): 94.1% (95% CI 65.0–99.2%) versus 93.3% (95% CI 61.3–99.0%), p = 0.73. Patients undergoing neoadjuvant systemic therapy (NST) and preoperative COS ( n = 30) experienced a significantly longer time from diagnosis to NST initiation than propensity-score matches who did not undergo COS (48 versus 29.5 days, p < 0.0001), but disease-free survival was similar: 94.1% (95% CI 65.0–99.2%) versus 93.3% (95% CI 75.9–98.3%), p = 0.15. Conclusions In this study of women with ER+ breast cancers, preoperative COS was not associated with increased risks of disease progression or death. While COS was associated with a modest delay in NST initiation, PFS was similar to propensity-score matched patients who did not undergo COS. Results support the oncologic safety of COS in the setting of an in situ ER+ tumor and provide much-needed evidence for young women with breast cancer receiving gonadotoxic NST who desire future childbearing during survivorship.

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