Breast cancer, subclavian port catheter and controlled ovarian stimulation (COS): a case report highlighting a challenging combination for fertility protection

Aims This report points to an elevated risk of thromboembolism in a breast cancer patient, who, in preparation of neoadjuvant chemotherapy, received a port catheter. For fertility protection, COS and oocyte retrieval was planned. This combination of prothrombotic risk factors ought to be considered for LMWH-prophylaxis.

Material, methods We report on a 39-year-old nulliparous woman with HR+/HER2- early breast cancer (cT1c, cN0, G3, Ki67 60%, cM0). BMI was normal, no personal or family-related risk factors were known. Ovarian reserve was poor (AFC 5, AMH 0.63ng/ml). In preparation for neoadjuvant chemotherapy, a port catheter was implanted in the left subclavian vein; the procedure was uneventful. For fertility protection, she was started on COS using an antagonist protocol (rec-FSH, HMG, Ganirelix) in combination with letrozole given her HR-positive cancer. Ten days later she presented with pain and heaviness of her left arm; estradiol-level was 347pg/ml at this time.

Results Doppler-sonography revealed a thrombosis of the port catheter; consequently, anticoagulation with LMWH was started in a therapeutic dosage. Despite this event, ovulation was induced with a GnRH-trigger and ultrasound-guided oocyte retrieval was performed. A total of three metaphase-II-oocytes was vitrified. On the following day the first cycle of neoadjuvant chemotherapy was administered complication-free using the port catheter. Therapeutic anticoagulation was continued for three months.

Summary This case highlights the relevance of a combination of several prothrombotic effects: cancerous disease, venous access device and supraphysiologic estradiol concentrations caused by COS. In such cases, adequate prophylactic measures should be considered even without further risk factors.

Publication History

Article published online:
21 June 2022