Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

Carvalho, Bruno Ramalho de; Cintra, Geórgia Fontes; Franceschi, Taise Moura; Cabral, Íris de Oliveira; Resende, Leandro Santos de Araújo; Gumz, Brenda Pires; Pinto, Thiago David Alves

doi:10.1055/s-0040-1718436

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Case Report • Rev. Bras. Ginecol. Obstet. 43 (03) • Mar 2021 • https://doi.org/10.1055/s-0040-1718436 copy

Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

Recuperação ex vivo de oócitos maduros para preservação da fertilidade em paciente com tumor ovariano borderline bilateral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ~ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained.We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

Keywords:
cryopreservation; ex vivo oocyte retrieval; fertility preservation; ovarian cancer; borderline ovarian tumor; vitrification

Reference	Age	Marital status; parity; brief medical history	COS	Surgery type	Pathology	US guidance (yes/no)	Total mature oocytes yielded
Fatemi et al (2011) ¹²12 Fatemi HM, Kyrou D, Al-AzemiM, Stoop D, de Sutter P, Bourgain C, Devroey P. Ex-vivo oocyte retrieval for fertility preservation. Fertil Steril. 2011;95(05):1787.e15-1787.e17. Doi: 10.1016/j.fertnstert.2010.11.023 https://doi.org/10.1016/j.fertnstert.201...	27	Not mentioned; nulliparous; previous infertility reported; previous laparoscopic left salpingo-oophorectomy, papillary serous adenocarcinoma; ovarian reserve not mentioned	rFSH 200 IU/day; ganirelix acetate, 0,25 mg/day, from day 6; maturation trigger with urinary hCG 10,000 IU	Laparotomy	Papillary serous adenocarcinoma (recurrence)	No	13^†
Bocca et al (2011) ¹³13 Bocca S, Dedmond D, Jones E, Stadtmauer L, Oehninger S. Successful extracorporeal mature oocyte harvesting after laparoscopic oophorectomy following controlled ovarian hyperstimulation for the purpose of fertility preservation in a patient with borderline ovarian tumor. J Assist Reprod Genet. 2011;28(09):771-772. Doi: 10.1007/s10815-011-9596-7 https://doi.org/10.1007/s10815-011-9596-...	25	Single; nulliparous; previous laparoscopic left salpingo-oophorectomy, serous borderline ovarian tumor; AFC ∼ 10	rFSH 200 IU/day; ganirelix acetate, 0,25 mg/day, from day 7 to day 10; maturation trigger with rhCG 250 µg on day 10	Laparoscopy, ∼ 34–35 hours after maturation trigger^‡	Serous borderline tumor	No	14
Pereira et al (2017) ¹⁴14 Pereira N, Hubschmann AG, Lekovich JP, Schattman GL, Rosenwaks Z. Ex vivo retrieval and cryopreservation of oocytes from oophorectomized specimens for fertility preservation in a BRCA1 mutation carrier with ovarian cancer. Fertil Steril. 2017;108(02): 357-360. Doi: 10.1016/j.fertnstert.2017.05.025 https://doi.org/10.1016/j.fertnstert.201...	37	Single; nulliparous; AFC ∼ 14	rFSH 300 IU/day + hpHMG 150 IU/day + letrozol 5 mg/day; rFSH reduced to 150 IU/day from day 8 to day 11; ganirelix acetate, 0,25 mg/day; maturation trigger with rhCG 250 µg on day 12	Laparotomy, ∼ 34 hours after maturation trigger	Not mentioned	No	7
de la Blanca et al (2018) ¹⁵15 de la Blanca EP, Fernandez-Perez MF, Martin-Diaz EDM, Lozano M, Garcia-Sanchez M, Monedero C. Ultrasound-guided ex-vivo retrieval of mature oocytes for fertility preservation during laparoscopic oophorectomy: a case report. J Reprod Infertil. 2018;19(03):174-181	31	Single; nulliparous; previous laparoscopic left salpingo-oophorectomy, mature teratoma; AFC unfeasible, AMH 1.1 ng/mL	Chorifollitropin α 150 µg, rFSH 200 IU/day from day 8 to day 9; ganirelix acetate, 0,25 mg/day, from day 6 to day 10; maturation trigger with rhCG 250 µg on day 10	Laparoscopy, ∼ 35 hours after maturation trigger	Struma ovarii	Yes	5

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[1] Address for correspondence Bruno Ramalho de Carvalho, SGAS 614, Conjunto C, Sala 177, Edifício VITRIUM - Centro Médico Inteligente, Asa Sul, Brasília, Distrito Federal, 70200-740, Brazil (e-mail: ramalho.b@gmail.com).