Embryo transfer following in vitro maturation and cryopreservation of oocytes recovered from antral follicles during conservative surgery for ovarian cancer

Excerpt

Therapeutic advances have significantly improved the prognosis of cancer patients [1]. This has generated new expectations especially for women of adolescent and reproductive age for whom an increased hope of recovery from disease implies a prospect of parenthood [2]. Unfortunately, radio- and chemotherapies have major effects on ovarian function, often leading to premature ovarian failure. Over the last several years, different strategies have been developed to preserve female germ cells and, with them, reproductive function. Before a cancer treatment is started, parts of ovarian cortex can be explanted, cryopreserved and re-implanted orthotopically after clinical remission. With this approach, ovarian and reproductive function can be restored, at least transiently, as demonstrated by the birth of naturally conceived children [3]. Alternatively, following controlled ovarian stimulation, mature oocytes can be retrieved, cryopreserved and used at later stages to achieve a pregnancy with embryos generated in vitro [4]. Retrieval and storage of immature or in vitro matured oocytes may offer an additional opportunity for female germ cell preservation in cancer patients [5]. In fact, germinal vesicle (GV)-stage oocytes can be collected from antral follicles in the absence of gonadotropin administration and cryopreserved before or after in vitro maturation (IVM). Therefore, IVM may be preferable in cases in which tumour estrogen-sensitivity and/or urgency to start therapy conflict with the implementation of a controlled ovarian stimulation treatment. In this report, we describe the recovery of immature oocytes from antral follicles during a laparotomic conservative surgery for ovarian cancer. These oocytes were matured in vitro, cryopreserved by vitrification at the mature stage and subsequently warmed to pursue a pregnancy in an IVF cycle. This experience offers the proof of principle that opportunistic retrieval of immature oocytes during surgery is a realistic possibility to preserve female reproductive potential. …