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

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.

Resumo

Relatamos um caso de obtenção ex vivo de óvulos, guiada por ultrassonografia, para preservação da fertilidade em uma mulher com tumor ovariano borderline bilateral, para quem a recuperação transvaginal convencional foi considerada insegura, devido ao aumento do risco de disseminação de células malignas. Foi realizada estimulação ovariana com gonadotrofinas. A cirurgia foi agendada de acordo com a resposta ovariana à estimulação gonadotrófica exógena; após ooforectomia por laparoscopia, ∼ 37 horas após a maturação folicular, procedeu-se à recuperação extracorpórea de oócitos. Um total de 20 folículos ovarianos foi aspirado e 16 complexos cumulus foram obtidos, resultando na vitrificação de 12 oócitos maduros e de 3 oócitos imaturos amadurecidos in vitro. Nosso resultado enfatiza a viabilidade da recuperação ex vivo de oócitos maduros após estimulação ovariana controlada para mulheres com alto risco de disseminação maligna pela captação oocitária realizada convencionalmente pela via transvaginal.

Keywords

cryopreservation - ex vivo oocyte retrieval - fertility preservation - ovarian cancer - borderline ovarian tumor - vitrification

Palavras-chave

criopreservação - recuperação extracorpórea de oócitos - preservação de fertilidade - câncer do ovário - tumor borderline de ovário - vitrificação

Publikationsverlauf

Eingereicht: 10. Juni 2020

Angenommen: 03. August 2020

Artikel online veröffentlicht:
19. Januar 2021

• References

• 1 Yoshida A, Tavares BVG, Sarian LO, Andrade LALA, Derchain SF. Clinical features and management of women with borderline ovarian tumors in a single center in Brazil. Rev Bras Ginecol Obstet 2019; 41 (03) 176-182 DOI: 10.1055/s-0039-1683415.
• 2 Schuurman MS, Timmermans M, van Gorp T, Van de Vijver KK, Kruitwagen RFPM, Lemmens VEPP, van der Aa MA. Trends in incidence, treatment and survival of borderline ovarian tumors in the Netherlands: a nationwide analysis. Acta Oncol 2019; 58 (07) 983-989 DOI: 10.1080/0284186X.2019.1619935.
• 3 Plett H, Harter P, Ataseven B, Heitz F, Prader S, Schneider S. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol 2020; 157 (02) 411-417 DOI: 10.1016/j.ygyno.2020.02.007.
• 4 Candotti G, Peiretti M, Mangili G, Bergamini A, Candiani M, Cioffi R. et al. What women want: Fertility sparing surgery in Borderline ovarian tumours patients and pregnancy outcome. Eur J Surg Oncol 2020; 46 (05) 888-892 DOI: 10.1016/j.ejso.2019.11.001.
• 5 Revel A, Safran A, Benshushan A, Shushan A, Laufer N, Simon A. In vitro maturation and fertilization of oocytes from an intact ovary of a surgically treated patient with endometrial carcinoma: case report. Hum Reprod 2004; 19 (07) 1608-1611 DOI: 10.1093/humrep/deh241.
• 6 Huang JY, Buckett WM, Gilbert L, Tan SL, Chian RC. Retrieval of immature oocytes followed by in vitro maturation and vitrification: a case report on a new strategy of fertility preservation in women with borderline ovarian malignancy. Gynecol Oncol 2007; 105 (02) 542-544 DOI: 10.1016/j.ygyno.2007.01.036.
• 7 Fadini R, Dal Canto M, Mignini Renzini M, Milani R, Fruscio R, Cantù MG. et al. Embryo transfer following in vitro maturation and cryopreservation of oocytes recovered from antral follicles during conservative surgery for ovarian cancer. J Assist Reprod Genet 2012; 29 (08) 779-781 DOI: 10.1007/s10815-012-9768-0.
• 8 Prasath EB, Chan ML, Wong WH, Lim CJW, Tharmalingam MD, Hendricks M. et al. First pregnancy and live birth resulting from cryopreserved embryos obtained from in vitro matured oocytes after oophorectomy in an ovarian cancer patient. Hum Reprod 2014; 29 (02) 276-278 DOI: 10.1093/humrep/det420.
• 9 Segers I, Mateizel I, Van Moer E, Smitz J, Tournaye H, Verheyen G, De Vos M. In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising “ex vivo” method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe. J Assist Reprod Genet 2015; 32 (08) 1221-1231 DOI: 10.1007/s10815-015-0528-9.
• 10 Park CW, Lee SH, Yang KM, Lee IH, Lim KT, Lee KH, Kim TJ. Cryopreservation of in vitro matured oocytes after ex vivo oocyte retrieval from gynecologic cancer patients undergoing radical surgery. Clin Exp Reprod Med 2016; 43 (02) 119-125 DOI: 10.5653/cerm.2016.43.2.119.
• 11 Lu C, Zhang Y, Zheng X, Song X, Yang R, Yan J. et al. Current perspectives on in vitro maturation and its effects on oocyte genetic and epigenetic profiles. Sci China Life Sci 2018; 61 (06) 633-643 DOI: 10.1007/s11427-017-9280-4.
• 12 Fatemi HM, Kyrou D, Al-Azemi M, 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.
• 13 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.
• 14 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.
• 15 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
• 16 Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000; 16 (05) 500-505 DOI: 10.1046/j.1469-0705.2000.00287.x.
• 17 Kuwayama M. Highly efficient vitrification for cryopreservation of human oocytes and embryos: the Cryotop method. Theriogenology 2007; 67 (01) 73-80 DOI: 10.1016/j.theriogenology.2006.09.014.
• 18 Mandelbaum RS, Blake EA, Machida H, Grubbs BH, Roman LD, Matsuo K. Utero-ovarian preservation and overall survival of young women with early-stage borderline ovarian tumors. Arch Gynecol Obstet 2019; 299 (06) 1651-1658 DOI: 10.1007/s00404-019-05121-z.
• 19 Bourdel N, Huchon C, Cendos AW, Azaïs H, Bendifallah S, Bolze PA. et al. Tumeurs frontières de l'ovaire. Recommandations pour la pratique clinique du CNGOF – Texte court. Gynécol Obstét Fertil Sénol 2020; 48 (03) 223-235 DOI: 10.1016/j.gofs.2020.01.022.
• 20 Rousset-Jablonski C, Selle F, Adda-Herzog E, Planchamp F, Selleret L, Pomel C. et al. Fertility preservation, contraception and menopause hormone therapy in women treated for rare ovarian tumours: guidelines from the French national network dedicated to rare gynaecological cancers. Eur J Cancer 2019; 116: 35-44 DOI: 10.1016/j.ejca.2019.04.018.
• 21 Liu D, Cai J, Gao A, Wang Z, Cai L. Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival. BMC Cancer 2020; 20 (01) 320 DOI: 10.1186/s12885-020-06828-y.
• 22 Mikuš M, Benco N, Matak L, Planicić P, Ćoric M, Lovrić H. et al. Fertility-sparing surgery for patients with malignant ovarian germ cell tumors: 10 years of clinical experience from a tertiary referral center. Arch Gynecol Obstet 2020; 301 (05) 1227-1233 DOI: 10.1007/s00404-020-05522-5.
• 23 Chevrot A, Pouget N, Bats AS, Huchon C, Guyon F, Chopin N. et al. Fertility and prognosis of borderline ovarian tumor after conservative management: Results of the multicentric OPTIBOT study by the GINECO & TMRG group. Gynecol Oncol 2020; 157 (01) 29-35 DOI: 10.1016/j.ygyno.2019.12.046.
• 24 Wright JD, Shah M, Mathew L, Burke WM, Culhane J, Goldman N. et al. Fertility preservation in young women with epithelial ovarian cancer. Cancer 2009; 115 (18) 4118-4126 DOI: 10.1002/cncr.24461.
• 25 Rashedi AS, de Roo SF, Ataman LM, Edmonds ME, Silva AA, Scarella A. et al. Survey of fertility preservation options available to patients with cancer around the globe. J Glob Oncol 2018; 4: 1-16 DOI: 10.1200/JGO.2016.008144.
• 26 Oktay K, Harvey BE, Loren AW. Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline update summary. J Oncol Pract 2018; 14 (06) 381-385 DOI: 10.1200/JOP.18.00160.
• 27 Practice Committee of the American Society for Reproductive Medicine. Electronic address: [e-mail]. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril 2019; 112 (06) 1022-1033 DOI: 10.1016/j.fertnstert.2019.09.013.
• 28 Carvalho BR, Kliemchen J, Woodruff TK. Ethical, moral and other aspects related to fertility preservation in cancer patients. JBRA Assist Reprod 2017; 21 (01) 45-48 DOI: 10.5935/1518-0557.20170011.
• 29 Cobo A, Garcia-Velasco JA, Domingo J, Remohí J, Pellicer A. Is vitrification of oocytes useful for fertility preservation for age-related fertility decline and in cancer patients?. Fertil Steril 2013; 99 (06) 1485-1495 DOI: 10.1016/j.fertnstert.2013.02.050.
• 30 Feichtinger M, Rodriguez-Wallberg KA. Fertility preservation in women with cervical, endometrial or ovarian cancers. Gynecol Oncol Res Pract 2016; 3: 8 DOI: 10.1186/s40661-016-0029-2.
• 31 Perri T, Lifshitz D, Sadetzki S, Oberman B, Meirow D, Ben-Baruch G. et al. Fertility treatments and invasive epithelial ovarian cancer risk in Jewish Israeli BRCA1 or BRCA2 mutation carriers. Fertil Steril 2015; 103 (05) 1305-1312 DOI: 10.1016/j.fertnstert.2015.02.011.
• 32 Li S, Lin H, Xie Y, Jiao X, Qiu Q, Zhang Q. Live births after in vitro fertilization with fertility-sparing surgery for borderline ovarian tumors: a case series and literature review. Gynecol Obstet Invest 2019; 84 (05) 445-454 DOI: 10.1159/000497203.