The issue of fertility preservation (FP) in young cancer patients has become an important issue. Although many techniques have been developed, vitrification of fertilized or unfertilized eggs recovered after controlled ovarian stimulation, prior to cancer treatment, is now the most established and effective method of maintaining female fertility.
When ovarian stimulation is not possible or contraindicated, cryopreservation of the ovaries or vitrification of eggs / embryos after in vitro maturation (IVM) of eggs recovered from small follicles may be alternatives. The place of IVF in the strategy of women FPs has recently been discussed.
We herein report the case of a 29-year-old nulligravida woman diagnosed with left grade III invasive ductal carcinoma. The tumor was positive for both estrogen receptors and progesterone and negative for Her2 overexpression. After left tumorectomy with sentinel node biopsy (1N+/4), adjuvant chemotherapy was scheduled 3 weeks later.
17 small follicles were detected by vaginal ultrasound on the 16th day of the cycle before counseling to maintain fertility. Due to the contraindication of ovarian stimulation for oncological purposes, the patient was offered oocyte vitrification after maturation of eggs (IVM) in the laboratory in combination with ovarian cryopreservation.
Seven immature oocytes were retrieved and were matured and vitrified in the laboratory. Five years later, the patient experienced infertility. The pregnancy was approved by the oncology team, but the patient was advised to avoid ovarian stimulation.
Therefore, the multidisciplinary decision was the re-utilization of cryopreserved oocytes as a first choice. The six oocytes were thawed and all survived the procedure, allowing fertilization with Intracytoplasmic Sperm Injection (ICSI) technique. Five embryos were created and one of them was transferred to the uterus. The patient became pregnant and gave birth to a healthy baby boy.
This is the first live birth achieved using vitrification and in vitro egg maturation (IVM) to maintain fertility (FP) in a woman with cancer. This approach was based on the inability to perform ovarian stimulation based on the patient’s oncological history. Therefore, IVM should be considered as a viable and effective choice in the strategy for women to maintain fertility.
The article was published in Analls of Oncology.
Do you think that this technique could be used by any woman who does not want to use hormones for in vitro fertilization?
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