Random-start controlled ovarian stimulation for emergency fertility preservation in a patient with myelodysplastic syndrome: a case report

Abstract

This study reports a case of a gonadotropin-releasing hormone agonist trigger in a young female with myelodysplastic syndrome (MDS) who underwent fertility preservation using random-start controlled ovarian stimulation. This method involves the stimulation of the ovary regardless of a patient's menstrual-cycle phase. A review of the related literature is also provided. A 17-year-old patient was diagnosed with MDS and required initiation of peripheral blood stem cell transplantation within a maximum of 3 weeks and was in the luteal phase of the menstrual cycle when the possibility of attempting preservation of fertility was presented to her. She opted for a random-start controlled ovarian stimulation with gonadotropins. With successful hemorrhagic prophylaxis, 17 oocytes were retrieved including 10 mature and 7 immature oocytes. Of the immature oocytes, 3 were successfully matured in vitro and a vitrification protocol was used to freeze the 13 mature oocytes.

Random start ovarian stimulation

“…In the first patient, we managed to retrieve six mature oocytes, similar to a study done by Courbiere et al [ 10 11 ] This optimal response further supports the effectiveness of the random-start protocol, wherein oocytes can be obtained efficiently irrespective of the phase of the menstrual cycle, in an urgent situation. In a cohort study done in 2013, the leading indication for emergency IVF was haematological cancer (42%).…”

Ovarian follicular waves during the menstrual cycle: physiologic insights into novel approaches for ovarian stimulation

“…Three cases have been documented in which immature oocytes were retrieved on random days of the luteal phase prior to chemotherapy; oocytes underwent subsequent successful in vitro maturation and cryopreservation (120). More recently, 17 oocytes were obtained from a 17-year-old woman undergoing urgent LPS before a blood stem cell transplantation; ten mature oocytes were cryopreserved, and the remaining seven underwent in vitro maturation and were subsequently frozen (121).…”

Ovarian stimulation and oocyte cryopreservation in females and transgender males aged 18 years or less: a systematic review

“…Another notably young patient ≤ 12 years-old (their exact age was not specified) was a transgender male who had 9 mature oocytes cryopreserved over 2 cycles ( 29 ). A further 31 patients aged 13-15 years old ( 10 , 19 , 26 – 29 , 31 , 32 , 35 , 36 , 38 – 40 ) cryopreserved a median of 9.5 oocytes (range 0-22) and 31 patients aged 16-18 years old ( 19 , 23 – 25 , 27 – 29 , 33 , 34 , 37 , 39 ) cryopreserved a median of 14 oocytes (range 0-35).…”

“…Some form of ovarian reserve testing was performed prior to commencing ovarian stimulation in 19 studies, and these values were analysed where possible ( Table 1 ), however, reporting of these results was incomplete. Out of 468 participants, anti-mullerian hormone (AMH, ng/mL) was described in 52 participants ( 10 , 19 , 25 – 29 , 31 , 34 – 36 , 38 – 40 , 43 ), follicular stimulating hormone (FSH, mIU/mL) in 33 participants ( 10 , 19 , 24 – 26 , 29 – 33 , 38 – 40 ) and antral follicle count (AFC) in 25 participants ( 10 , 19 , 25 , 26 , 31 – 36 , 40 ). Median AMH was 2.9ng/mL (range 0.003-12.9), median FSH was 4.5mIU/L (range <0.1-20.5) and median AFC was 16 (range 5-35).…”