Fertility preservation immediately after therapeutic abortion results in multiple normal follicular growth with the absence of mature oocytes due to early luteinization: a case report and literature review

Abstract

Cancer therapy has priority over fertility preservation. The time available for fertility preservation in patients with cancer is often very limited and depends on the condition of the underlying disease. This case report presents the results of two rounds of controlled ovarian stimulations (COSs) performed after an induced abortion. The patient had mixed phenotype acute leukemia diagnosed during early pregnancy and underwent a surgical abortion, followed by ovarian stimulation using urinary follicle-stimulating hormone (uFSH) and gonadotropin-releasing hormone (GnRH) agonists. Oocyte retrieval was subsequently performed for oocyte cryopreservation. Despite good hormonal and ultrasonic follicular growth, no oocytes were obtained. During a second COS performed at a low human chorionic gonadotropin (hCG) level (less than 100 IU/L), several mature oocytes were obtained, suggesting that higher hCG levels during COS induce the absence of mature oocytes during normal follicular growth. It is recommended to start COS post-abortion after confirming a low hCG level while considering the timing of cancer treatment.

治疗性流产后立即生育力保护能力可导致多个正常卵泡生长, 但由于早期黄体化而缺乏成熟卵母细胞:一个病例报告和文献复习 摘要

癌症治疗优先于生育力保护。通常, 癌症患者保留生育力的时间很有限, 这取决于潜在疾病的状况。本病例报告介绍了人工流产后进行的两轮控制的超促排卵( COS )的结果。患者在早孕期诊断为混合型急性白血病, 行手术流产, 随后用尿促卵泡激素( uFSH )和促性腺激素释放激素( GnRH )激动剂刺激卵巢。随后进行取卵术, 卵母细胞冷冻保存。尽管激素和超声表明卵泡生长良好, 但没有获得卵母细胞。在低人绒毛膜促性腺激素( hCG )水平( < 100 IU / L )进行的第2次COS中, 获得了数个成熟卵母细胞, 提示COS期间较高的hCG水平诱导了正常卵泡生长过程中成熟卵母细胞的缺失。

随后进行卵母细胞取出, 取出卵母细胞冷冻保存。尽管有良好的激素和超声下卵泡生长, 没有获得卵母细胞。在低于100iu/l 的第二次 COS 中, 获得了几个成熟卵母细胞, 提示 COS 中较高的 hCG 水平导致了正常卵泡生长过程中成熟卵母细胞的缺失。建议流产后在确认较低hCG水平后开始COS, 同时考虑癌症治疗时机。

Keywords:

• Acute leukemia
• fertility preservation
• cryopreservation
• post-abortion ovarian stimulation
• premature luteinization
• hCG level

Disclosure statement

The authors report no conflicts of interest.