Successful in vitro maturation for urgent fertility preservation despite hormonal contraception by continuous progestin application

Abstract

We report a unique case of a rare utilization of IVM. This case shows the successful retrieval of immature oocytes followed by in vitro maturation (IVM) for fertility preservation in a patient undergoing chronic progestin contraception. A 24-year-old patient with anaplastic astrocytoma requiring chemotherapy with temozolomide for 12 cycles as soon as possible with wish for fertility preservation while using a long acting etonogestrel birth control implant presented in our unit for fertility preservation in May 2017. The currently used implant should be preserved for further contraception. As the ovaries presented with a high, pco-like, antral follicle count, IVM was offered; the patient agreed. A transvaginal follicular puncture in general anesthesia without any hormonal intervention and IVM of gained oocytes was performed. As the patient actually had no spouse, she decided to freeze unfertilized metaphase II stage oocytes (MII). Thirteen oocytes were obtained, eight of them could be matured and cryopreserved. IVM could be a possibility for fertility preservation in patients with polycystic ovaries when no time is available for stimulation for conventional in vitro fertilization. Even use of continuous progestin application for contraception is no obstacle.

我们报告一个罕见的应用IVM的独特病例。这个病例报告了一个连续应用孕激素避孕的患者成功地取出未成熟卵母细胞然后进行体外成熟（IVM）以保存生育能力。一位24岁的患有间变性星形细胞瘤并且需要尽快使用替莫唑化疗12周期的患者, 她希望保留生育能力, 同时使用我院于2017年5月提出的长效依托孕烯节育植入物保留生育能力。为了避孕她目前使用的植入物应予以保留。由于患者的卵巢呈现类似多囊卵巢, 窦状卵泡样改变, 故建议使用IVM技术, 并且患者同意使用。在无妊娠激素干预的情况下采用全身麻醉后经阴道卵泡穿刺, 后将取得的卵母细胞进行体外成熟。由于这位患者未婚, 她决定将未受精的分裂中期的II期卵母细胞（MII）进行冷冻。一共获得13个卵母细胞, 其中8个卵母细胞可以成熟并冷冻保存。当传统的体外受精没有时间进行时, IVM可能成为多囊卵巢患者保留生育能力的一种可能性。即使连续用孕激素避孕也没有影响。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Fertility preservation
• in vitro maturation
• contraception
• progestin

Disclosure statement

No potential conflict of interest was reported by the authors.