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Purpose: Fertility issues are of great concern for young women undergoing treatment for breast cancer (BC). Fertility preservation (FP) protocols using controlled ovarian stimulation (COS) with letrozole have been widely used with overall good results. However, letrozole cannot be used in every country in this context. This study aimed to assess the efficacy of tamoxifen for COS in women with early BC undergoing FP., Methods: This multicentric prospective study included patients aged 18-40, diagnosed with stage I, II and III invasive BC, undergoing tamoxifen-COS before adjuvant or neoadjuvant chemotherapy (NAC). The primary endpoint was the efficacy of tamoxifen-COS protocol evaluated by the number of oocytes collected and vitrified. Secondary endpoints included the time interval before chemotherapy, breast cancer (BC) recurrence rates, and reproductive outcomes., Results: Ninety-five patients were included between 2014 and 2017, aged 31.5 ± 4 years on average. 37.9 % received NAC and 62.1 % received adjuvant chemotherapy. FP procedure was successful in 89.5 % of the cycles. The mean number of collected and vitrified oocytes was 12.8 ± 7.9 and 9.8 ± 6.2, respectively. The mean duration of COS was 10.4 ± 1.9 days. Median time before chemotherapy initiation was 3.6 weeks (IQR 3.1; 4.1) for women receiving NAC. Five-year relapse-free and overall survival rates were in-line with those expected in this population. Twenty-one women had spontaneous full-term pregnancies, while 5 underwent IVF cycles with frozen-thawed oocytes, without pregnancy., Conclusion: Tamoxifen-COS protocols appear to be feasible before adjuvant or NAC treatment in young BC patients and efficient in terms of oocyte yield., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:None of the authors have any conflicts of interest related to this study. Florence Leperlier reports honoraria for lectures and presentations from Ferring Pharmaceuticals, Gedeon Richter, and IBSA, unrelated to this work. Pierre-Emmanuel Bouet reports travel and meeting support from Merck, Gedeon-Richter, Theramex, Ferring, Organon and IBSA. P-E.B. have undertaken consultancy work for Merck and Gedeon-Richter and have received research grants from Theramex, Ferring, MSD, and Genevrier, not related to the present work. Thomas Freour has undertaken consultancy work for Vitrolife France and Gedeon-Richter. T.F. reports travel and meeting support from Gedeon-Richter, Theramex, Ferring and IBSA. T.F. reports honoraria for lectures and presentations from Ferring Pharmaceuticals, Theramex, Gedeon Richter and Merck Serono, unrelated to this work. Marie Robert reports travel fees and congress fees from AstraZeneca, Gilead and Creafirst, and has undertaken consultancy work for AstraZeneca and Lilly. Mario Campone is on the advisory board of AstraZeneca, Novartis, Sanofi, Lilly, Pfizer, Seagen, Gilead and Daiichi-Sankyo. M.C. has undertaken consultancy work for AstraZeneca, Novartis, Daiichi-Sankyo, PET-Therapy, Menarini and DIACCURATE, and he is a speaker for Novartis, Lilly and Amgen. He reports travel support from Pfizer, Novartis, Roche, AstraZeneca and Daiichi-Sankyo., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Research Question: Do heavy metals affect the risk of diminished ovarian reserve (DOR) in women of reproductive age?, Design: A total of 139 cases and 153 controls were included between 2016 and 2020. The participants were aged between 18 and 40 years and attended consultations for couple infertility in one of four fertility centres in western France. Cases of DOR were defined as women with an antral follicle count less than 7, anti-Müllerian hormone levels 1.1 ng/ml or less, or both. Controls were frequency matched on age groups and centres, and were women with normal ovarian reserve evaluations, no malformations and menstrual cycles between 26 and 35 days. Heavy metals (lead, mercury, cadmium and chromium) were measured in whole blood at inclusion. Single-exposure associations were examined with multivariable logistic regressions adjusted on potential confounders. Mixture effects were investigated with quantile g-computation and Bayesian kernel machine regression (BKMR)., Results: Chromium as a continuous exposure was significantly associated with DOR in unadjusted models (OR 2.07, 95% CI 1.04 to 4.13) but the association was no longer significant when confounders were controlled for (adjusted OR 2.75, 95% CI 0.88 to 8.60). Similarly, a statistically significant association was observed for the unadjusted second tercile of cadmium exposure (OR 1.87, 95% CI 1.06 to 3.30); however, this association was no longer statistically significant after adjustment. None of the other associations tested were statistically significant. Quantile g-computation and BKMR both yielded no significant change of risk of DOR for the mixture of metals, with no evidence of interaction., Conclusions: Weak signals that some heavy metals could be associated with DOR were detected. These findings should be replicated in other studies., (Copyright © 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)